Urologicka Klinika

Prague, Czech Republic

Urologicka Klinika

Prague, Czech Republic
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Surgery is a method of choice for the management of localized and locally-advanced renal tumors. In cT1a (up to 4 cm) tumors nephron-sparing approach (= partial nephrectomy) is current recommended standard, provided it is technically feasible and there are no contraindications. The amount of nephron-sparing surgeries increases over time also owing to new technologies such as 3D imaging during surgery, robot-assisted surgery, better hemostatic instruments and greater experience, which all lead to shorter or no warm ischemia during nephron-sparing surgery. However, there is no long-term functional benefit in elderly patients over 75 years of age. Nevertheless, if preservation of functional parenchyma is needed, thermal ablation methods (radiofrequency ablation or cryoablation) or active surveillance are possible. In management of locally advanced renal tumors R0 surgery is intended as adjuvant systemic treatment in not yet the standard. For selected patients with distant metastases surgery, metastasectomy, is possible. However, only complete metastasectomy of all lesions brings better overall survival.

Tilandyova P.,Ustav Patologickej Anatomie | Kajo K.,Ustav Patologickej Anatomie | Kliment J.,Urologicka Klinika | Plank L.,Ustav Patologickej Anatomie | Lasabova Z.,Ustav Molekulovej Biologie
Klinicka Onkologie | Year: 2010

Prostate cancer is one of the most common malignant diseases in men above the age of 50. A genetic predisposition and/or acquired genetic and epigenetic changes together with life-style contribute to the development of the disease. The most studied epigenetic modification in prostate cancer is the methylation of the cytosine located within the dinucleotide CpG of promoter regions of different genes by methylation specific PCR. The evidence of gene silencing by DNA methylation in genes like GSTP1, APC or RASF1 is a common and relatively specific event in prostate cancer. DNA methylation testing can be performed on tissue samples or urine, ejaculate or serum. Translational research is searching for new biomarkers for early detection and prognosis of prostate cancer, but because of large methodological differences in applied techniques and patient cohorts, the investigations have yielded promising, but also some controversial results. More prospective randomized trials and standardized methods are needed to assess the true value of methylation for the diagnosis and prognosis of prostate cancer.

The ideal treatment of ED considering the patient's welfare should be easy to administer, non-invasive, painless and highly effective, with minimal side effects. Modern, oral first-line erectile dysfunction therapy using phosphodiesterase 5 inhibitors is safe, effective and well tolerated. Intracavernosal therapy as the second-line therapy is safe and effective in diabetic patients, in men with cardiovascular disease and in men who have undergone radical prostatectomy. A new method of erectile dysfunction therapy is low- intensity extracorporeal shock wave therapy which produces neovascularization. Lifestyle changes (intensive exercise and decrease in Body Mass Index) can improve erectile function. © 2014, Ambit Media a.s. All rights reserved.

Erectile dysfunction is defined as an inability to achieve and maintain an erection sufficient for satisfactory sexual intercourse. Erectile dysfunction incidence is common worldwide. Erectile dysfunction may be the first clinical manifestation of endothelial dysfunction. Erectile dysfunction shares risk factors with cardiovascular disease and is a predictor of a serious cardiovascular event in men who are 30-60 years of age and in diabetic patients over a period of two to five years. © 2014, Ambit Media a.s. All rights reserved.

Medical examination of children with incontinence is primarily carried out by a paediatrician. Basic examination enables differentiation between functional voiding disorder and more serious forms of incontinence. In the case of functional voiding disorder, treatment is initiated by the paediatrician. When basic treatment fails, or in the case of suspected organic anomaly the paediatrician should refer the child to a specialized clinic for advanced examination.

Hradil D.,Urologicka klinika | Kral M.,Urologicka klinika
Onkologie (Czech Republic) | Year: 2014

Prostate cancer (PC) is the most common solid neoplasm in Europe and USA with the third highest mortality. Introduction of PSA - based sreeening multiplied incidence with stagnant level of mortality. These results can be explained by shift to lower stage at the time of diagnosis and also by improved therapeutic options.

Treatment of hydronephrosis should be minimally invasive, with the aim to relieve the patient's symptoms and to save or improve renal function. Laparoscopic pyeloplasty is a surgical method depends on the skill and experience of the surgical team. With significant improvements in recent years more and more indications for laparoscopic method, which is already regarded as standard.

Martan A.,Gynekologicko Porodnicka Klinika | Masata J.,Gynekologicko Porodnicka Klinika | Svabik K.,Gynekologicko Porodnicka Klinika | El-Haddad R.,Gynekologicko Porodnicka Klinika | And 2 more authors.
Ceska Gynekologie | Year: 2015

Objective: The objective of this study was to evaluate the cure effect of a transurethral injection of Bulkamid® for recurrent female stress and mixed urinary incontinence in women who had undergone failed tape surgery. Our hypothesis was that cure effect of Bulkamid® is positive in patients when previous tape anti-incontinence surgery has been unsuccessful. Design: Retrospective clinical study. Settings: Department of Obstetrics and Gynecology, 1st Medical Faculty, Charles University and General Faculty Hospital in Prague Materials and methods: This retrospective study featured 34 patients with recurrent urinary incontinence (SUI: 28, mixed: 6 - predominant symptom was SUI) after unsuccessful tape anti-incontinence surgery. 25 of the patients had undergone anti-incontinence surgery more than once. The cure effect of a transure-thral injection of Bulkamid® was evaluated an average of 29 months after the surgery; the minimum period after surgery was 6 months. Subjective assessment of the leakage of urine was based on the International Consultation on Incontinence Questionnaire - Short form (ICIQ-UI SF) filled in before and after surgery. An improvement in urinary incontinence was defined as a drop in the score of more than 50%. Objective assessment of leakage of urine was assessed by cough test. The cure effect was evaluated by VAS (Visual Analogue Scale) score and by using the five-point Likert score. Ethical committee approval was obtained, and all subjects gave written informed consent to participate in the study. Results: The mean age of patients was 71.03 years, mean body mass index (BMI) 29.12 and mean parity 1.91. The cough test showed that 4/34 (11.8%) of patients had negative results for this test after the operation. The ICIQ-UI SF questionnaire showed that 14/34 (41.2%) of our patients were dry or improved after surgery. The mean VAS score was 62.4 after the operation. The Likert score was 4 or 5 (cured or improved) after the operation for 88.2% of patients. Conclusions: Our hypothesis that the cure effect of Bulkamid® operation would be positive in patients who have undergone previous unsuccessful tape anti-incontinence surgery was partially confirmed. The Likert and VAS scores indicate that the effect of Bulkamid® surgery is good; however, an evaluation of the cure effect of this procedure based on the ICIQ-UI SF score is less positive. This kind of operation, which is minimally invasive, is less arduous for patients, and it is also suitable for patients who have refused further surgical treatment.

Incidence of prostate cancer increases worldwide. Despite progress in techniques such as active surveillance and improvement in non-surgical methods, the radical prostatectomy remains an important form of prostate cancer management alone or as apart of multimodal therapy in patients with high risk prostate cancer. During years of its use, there was a significant change in the understanding of prostate neuroanatomy, which improved its safety, decreased perioperative morbidity and improved functional results. The article refers mainly to oncological results. Despite we cannot completely devide them from the functional ones, because quality of life following radical prostatectomy is an important aspect, which is unseparable part of discussion with patients with diagnosed prostate cancer. Regardless the availability of open and minimally invasive radical prostatectomy we should not forget that an experience surgeon taking into consideration individal cancer factors and patient's preferences remains the most important variable in order to achieve optimal results.

Kriz J.,Spinalni Jednotka | Rejchrt M.,Urologicka Klinika
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2014

Autonomic dysreflexia is a serious complication found in more than half of patients with spinal cord injury above the T6 level. In case of an autonomic system disorder, a trigger below the level of injury causes severe vasoconstriction with paroxysmal hypertension. Presenting symptoms include bradycardia, pounding headache, sweating and flushing above the level of lesion, and anxiety. However, AD can sometimes occur without symptoms. The causes of AD include bladder and bowel distension, urological surgeries as well as burning, pressure sores and fractures. Uncontrolled hypertension can lead to hemorrhagic stroke, retinal hemorrhage, respiratory or cardiac problems and even death. Management involves placing the patient in an upright position to take advantage of orthostatic reduction in blood pressure. As the first line of treatment, the cause of irritation has to immediately be eliminated; this usually leads to blood pressure stabilization. If hypertension continues, rapid onset antihypertensive drugs should be used.

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