Objectives. To determine incidentally found prostate cancer frequency and impact on overall survival after RCP. Patients and Methods. The records of 81 men who underwent cystoprostatectomy from January 2000 to December 2009 were reviewed. The vital status of the study group was assessed as on September 1, 2009, by passive followup, using data from the population registry. Results. The 81 men underwent RCP. The incidental prostate cancer was found in the specimens of 27 (33.3%) patients. 13 (48.1%) of 27 prostate cancer cases were clinically significant. For 3 patients (11.1%) an extraprostatic extension was found. For 2 patients (7.4%)—positive margins, for 1 patient (3.7%)—Gleason sum 8, and for the rest 7 patients bigger than 0.5 cm3 volume tumor, and Gleason sum 7 was found. The mean follow-up time was 39.2 ± 33.8 months (varies from 0.8 to 131.2 months). The patients with bladder cancer and incidentally found prostate cancer lived shorter (28.1 ± 27.5 and 45.5 ± 35.40 months). Higher overall survival (P = 0.03) was found in the patient group with bladder cancer without incidentally diagnosed prostate cancer. Conclusion. There are indications that in this small study prostate cancer has influenced on patients' survival with bladder cancer after radical cystoprostatectomy.

Background and Objectives: To determine the value of diuretic ultrasonography for the diagnosis of obstructive hydronephrosis. Materials and Methods: Diuretic enhanced ultrasonography was used routinely as a part of examination of patients with hydronephrosis in our Department. There were 72 patients (42 males, 30 females; aged 2 months to 17 years; median age 7.07 years) with a sonoscopic diagnosis of hydronephrosis included from January 2006 until October 2011. The anteroposterior diameter (AD) of renal pelvis was measured sonoscopically before and at sixty minutes after furosemide injection. A weight-adjusted dose of 1 mg/kg of furosemide was administered intravenously. Results: Patients were operated on if pyeloureteral obstruction was suspected because of low or deteriorating differential renal function, increasing hydronephrosis or symptoms thereof. Hydronephrosis was unilateral in 61 (84.7%) and bilateral in 11 (15.3%) patients. The median AD of pelvis before furosemide injection was 22 mm in operated and 17 mm in non-operated patients (p = 0.005). Sixty minutes after furosemide injection, the AD of pelvis in operated patients was 35.5 mm and 25.8 mm in non-operated—25.8 mm (p < 0.001). Logistic regression model demonstrated that significant factors for surgery were: AD 60 min after furosemide infection and ultrasonographic parenchymal sclerosis. Conclusion: Ultrasound measurement of the AD of renal pelvis 1 h after the injection of furosemide used as an additional investigation can help in predicting obstructive hydronephrosis.

Testicular Sertoli cell tumors are extremely rare. Generally, they are benign neoplasms, which belong to a group called sex cord–stromal tumors. In this article, we present a case report of a Sertoli cell tumor, which was accidentally discovered during a urological consultation of a 42-year-old male. An ultrasound showed a 2.1 × 2.2 cm hypoechogenic, hypervascular tumor in the middle third of the left testicle. Serum tumor markers (α-fetoprotein, alkaline phosphatase, β-human chorionic gonadotropin, and lactic dehydrogenase) were all within the normal range. Rapid microscopic evaluation of fresh frozen sections during the operation was inconclusive, which led to a decision not to perform a radical orchiectomy immediately. On formalin-fixed paraffin-embedded (FFPE) sections, the tumor histology showed atypical patterns, and immunohistochemical analysis was performed in order to determine the type of neoplasm and differentiate it from other types of testicular tumors, so as to assign the further course of treatment. Radical inguinal orchiectomy was performed. The final pathology report showed a tumor with no predictive signs of aggressive behavior, which most closely resembled a Sertoli cell tumor.

We present a case of a 59-year-old male who was admitted to the emergency department with urinary retention, with a history of lower urinary tract symptoms, with the value of serum prostate specific antigen level of 100 ng/mL and an estimated prostate size of 800 mL, according to magnetic resonance imaging. A prostate biopsy showed benign prostatic hyperplasia. Transvesical prostatectomy was performed, following additional procedure of transurethral resection of the prostate. To the best of our knowledge, this is the fourth highest prostate volume reported in medical literature. In this paper, we examine the factors that may have influenced the development of giant prostate hyperplasia.

Background and objectives: Microwave thermal ablation (MWT) is one of the treatment options for kidney cancer. However, for patients over 70 years old the safety and oncological efficacy of this treatment is still controversial. The goal of this study was to compare MWT with open partial nephrectomy (OPN) and to find out whether MWT is preferable in maintaining patient renal function and reducing the risk of postoperative complications. Materials and Methods: Depending on the treatment choice, all patients were divided into two groups: an MWT group and an open kidney resection (OPN) group. Data have been retrospectively collected for 7 years, starting with January 2012 up to January 2019. A total number of 33 patients with exophytic, single small renal masses were treated with either OPN (n = 18) or MWT (n = 15). All patients had histologically proven T1 kidney cancer. MWT was performed for patients who refused to have OPN or in those cases where the collecting system, renal calyx, and great vessels were free from tumor margins of more than 1 cm. Results: In the MWT group a median (IQR) patients’ age was 75 years (71–79) years, in the OPN group—71.5 (70–75) years, p = 0.005. A median (IQR) Charleston comorbidity index in the MWT group was 7.5 (5–10) and in the same way in the OPN group it was 5.22 (5–6), p = 0.005. A median (IQR) estimated glomerular filtration rate (eGFR) before surgery was higher in the MWT group 59.9 (49.5–73.8) mL/min/1.73 m2 vs. 46.2 (42.7–65.8) mL/min/1.73 m2 in the OPN group, p = 0.12. Three days following the surgery a median (IQR) eGFR was 56.45 (46.6–71.9) in MWT group mL/min/1.73 m2 vs. 43.45 (38.3–65) mL/min/1.73 m2) in the OPN group, p = 0.30. A median (IQR) of primary hemoglobin level was lower in the MWT group compared with the OPN group (134.5 (124–140) g/L vs. 125 (108–138) g/L), p = 0.41. However, after the surgery a median (IQR) lower hemoglobin level was detected in the OPN group (123.5 (111–134) g/L vs. 126 (112–135)), p = 0.53. The median (IQR) duration of the procedure in MWT group was shorter compared with the OPN group (26 (25–30) min vs. 67.5 (55–90) min), p < 0.0001. A median (IQR) hospitalization time was shorter in MWT group (3 (2–3) days vs. 89 (7–11.5) days), p < 0.0001. Pain by the visual analogue scale (VAS) scale the first day after surgery was significantly lower—median (IQR) in the MWT group was 2 (1–3) vs. 4 (3–6)), p = 0.008. Treatment failure rate was numerically higher in MWT (1/15 vs. 0/18, p = 0.56). Conclusions: Pain level on the next day after surgery, mean number of hospitalization and operation time were significantly lower in the MWT group than in the OPN group. The blood loss estimated glomerular filtration rate and oncologic data between the two groups was not statistically significant.

Introduction. Prostate cancer is the most common malignant neoplasia among men in Lithuania, though it presents a low mortality rate. In 2007 more than 3 500 Lithuanians were diagnosed with prostate cancer. Many patients were treated with radiotherapy. Unfortunately, after several years the number of cases of prostate cancer recurrence after radiotherapy started to grow. This new problem requires the following difficult decision to make: which treatment method to choose? Radical prostatectomy, high-dose radiotherapy, cryotherapy, high-intensityfocused ultrasound, active surveillance or hormone therapy – all are viable salvage methods. In 2012 we performed the first cryotherapy procedures. Now we want to present our first clinical experience in prostate cancer salvage cryotherapy. Materials and methods. Five patients diagnosed with prostate cancer were selected for prostate cryotherapy. Four patients were treated only with radiotherapy, one patient was treated with radiotherapy plus neoadjuvant hormonal treatment. Prostate cancer recurrences were diagnosed by multiparametric MRI and ultrasound guided transrectal or transperineal biopsies. MRI findings were validated with the Magnetic Resonance Prostate Imaging Reporting and Data System (PI-RADS). CT, MRI, ultrasound scanning, and bone scintigraphy were performed for patients before treatment. No pathological bone changes were detected. All patients received 2-cycle cryotherapy with real-time ultrasound guidance and temperature change tracking. Results. The described treatment scheme for these patients enables to deliver two freezing-thawing cycles with 10–12 probes and a urethra-warming catheter. All procedures were completed succesfully without any intraoperative complications. Urinal obstruction was observed after 1 week for 1 of 5 patients. He had to stay with epicystostomy and overwent prostate transurethral resection. After these procedures the patient could urinate normally. One patient had biochemical progression due to metastasis in parailiacal lymph nodes, and he got external beam therapy to lymph-node projection. After 6 months there was no cancer progresion signs on MRI and PSA was 1.77 ng/ml. No patients suffered from urinary incontinence. Conclusions. Our initial experience shows that cryotherapy can be a viable alternative for patients with disease progression after radiotherapy. Currently the biggest advantages of cryotherapy are as follows: possibility to treat patients not suitable for salvage prostatectomy, short hospitalization, low complication risk and lower overall cost than other methods. Short term data seems to be promising but longer follow-up is necessary to verify oncological and functional results.

Nephrocutaneous fistula is a very rare complication of renal surgery. It may be associated with renal tumors, nonfunctional kidneys, staghorn calculi, renal trauma or chronic urinary tract infections. Because of widely used imaging

Reikšminiai žodžiai: perkutaninė nefrolitotripsija, komplikacijos, inkstų akmenligė. Darbo tikslas. Apžvelgti Vilniaus miesto klinikinėje ligoninėje (VMKL) atliktų perkutaninių nefrolitotomijų rezultatus, atlikti jų analizę, palyginti su kitomis panašiomis pasaulio klinikinėmis studijomis ir suformuluoti rekomendacijas rezultatams gerinti. Tyrimo medžiaga ir metodai. Retrospektyviai analizuota visų 2012–2015 m. VMKL atliktų perkutaninių nefrolitotomijų duomenys. Įvertintos dažnos pooperacinės komplikacijos – karščiavimas, kraujavimas, pooperacinė hidronefrozė, kuriai reikalingas šlapimtakio stentavimas, bei kitos retos komplikacijos – žarnyno nepraeinamumas, pneumonija, pleuros pažeidimas, plaučių arterijos embolizacija, A-V fistulės susiformavimas ir sepsis. Rezultatai palyginti su naujausiomis PNL klinikinėmis studijomis, publikuotomis „PubMed“ duomenų bazėje. Rezultatai. 2012–2015 m. VMKL atliktos 137 perkutaninės nefrolitotomijos. 43 pacientams (31,38 proc.) pasireiškė įvairių poopercinių komplikacijų: karščiavimas – 16 (11,7 proc.), kraujavimas – 3 (2,2 proc.), hidronefrozė – 11 (8 proc.), pneumonia – 3 (2,2 proc.), širdies ritmo sutrikimas – 2 atvejai (1,5 proc.), po 1 atvejį (0,7proc.) buvo pleuros pažeidimas, sepsis, A-V fistulė, dinaminis žarnyno nepraeinamumas, tromboflebitas, PATE. Lyginant su literatūroje skelbiamais duomenimis, daugiau nustatyta karščiavimo, hidronefrozės ir pneumonijos atvejų, kitų komplikacijų buvo mažiau. Išvados. Vilniaus miesto klinikinėje ligoninėje sėkmingai taikomas inkstų akmenligės gydymas perkutaninėmis nefrolitotomijomis. Komplikacijų dažnis atitinka pasaulio studijose skelbiamus dažnius, o kai kurių komplikacijų dažnis yra net mažesnis. Mūsų duomenimis, komplikacijų dažnis priklausė nuo priešoperacinio paciento parengimo – infekcijos eradikacijos, nefrostomos, gretutinių ligų kontrolės ir gydytojo įgūdžių.