Uros Babic

Introduction: Penile fracture is a rare urologic emergency that may occur when the erect penis is injured, most often during sexual intercourse. In 10%-21% of cases, it is associated with urethral injury. The diagnosis is most often made by clinical examination, but additional diagnostic methods are useful in evaluating the site of rupture of the corpora cavernosa and detecting urethral injury. This medical emergency requires urgent surgical management as delays are associated with worse outcomes. Case report: A 43-year-old man reported to the Emergency Center of the University Clinical Center of Serbia due to an injury to the erect penis during sexual intercourse. The anamnestic data were that he had felt pain and heard a "popping" sound, upon which sudden detumescence of the penis occurred and penile hematoma appeared, as well as blood during urination. Suspicion of a penile fracture was established on clinical examination. An ultrasound examination showed a rupture of the tunica albuginea of the right cavernous body, and retrograde urethrocystography revealed a rupture of the penile urethra. The patient underwent surgery that same evening. The surgical approach was a median penoscrotal incision, followed by suturing of the right cavernous body and penile urethra through a gently placed urinary catheter. Postoperative recovery was uneventful. During follow-up examinations, the patient reported normal erections, regular urination and satisfaction with the appearance of his penis. Conclusion: Penile fracture is a rare urologic emergency, which is relatively rarely associated with urethral injury. The presentation of our case indicates the importance of initial ultrasound and radiographic diagnostics. In the case where the site of injury is present preoperatively, a ventral penoscrotal incision may be a suitable surgical approach. Timely recognition and surgical treatment of penile fracture associated with urethral injury gives excellent functional results.

Concurrent global increase of prevalence of obesity and male fertility implies link between overweight and obesity with male subfertility. This hypothesis is supported by numerous population-based epidemiological studies. Increase in body mass index (BMI) is associated with poor sperm quality in fertile, and more noticeable in infertile men. Nevertheless, some studies disprove damaging effect of BMI on semen quality. To examine the influence of men’s BMI in infertile couples undergoing in vitro fertilization (IVF) on semen analysis parameters and IVF outcomes. Study encompassed all couples who underwent IVF at Gynecology and Obstetrics Clinic Narodni Front in Belgrade during 2018 and 2019. Exclusion criteria were azoospermia, conditions and diseases that could affect the semen analysis parameters (diabetes, malignant diseases treated with radiation and/or chemotherapy, trauma or surgery of the genital organs, mumps or undescended testicles in childhood). Evaluated semen analysis parameters included semen ejaculate volume, sperm pH, sperm count, sperm motility, and sperm morphology. IVF outcomes comprised total number of embryos, number and percentage of obtained good-quality embryos and clinical pregnancy rates. Based on BMI value, participants were divided into a group of underweight (Group 1), normally weight (Group 2), overweight (Group 3), and obese men (Group 4). After applying inclusion and exclusion criteria, 411 men (couples) were included in the analysis. The largest number of men were overweight, while the smallest belonged to the group of underweight participants. There are no significant differences in the semen analysis parameters between study groups. Correlation analysis shown weak and insignificant correlation between BMI and semen analysis parameters. The number and proportion of good quality embryos is significantly lower in overweight and obese study groups compared to normal weight and underweight groups (2.89, 2.91, 2.42, and 2.36, respectively, P = .041). The differences in other IVF outcomes: total number of embryos (3.61, 3.74, 3.21, and 3.37, respectively) and clinical pregnancy rates (41.26%, 43.09%, 42.78%, and 39.95%, respectively) between study groups were not significant (P > .05). BMI does not significantly affect semen analysis parameters, but a higher BMI is associated with a lower number and proportion of good quality embryos in IVF outcomes.

At the time when mass COVID-19 vaccination began, providing appropriate vaccination advice to uro-oncology patients became a challenge. This was a single-center cross-sectional observational study aimed to investigate the rate of COVID-19 vaccination among uro-oncology patients receiving systemic therapy for metastatic renal cell carcinoma and metastatic castration-resistant prostate cancer. Furthermore, we aimed to assess patients’ attitudes and identify factors influencing their decision to vaccinate against COVID-19. Data on patients’ sociodemographic characteristics, vaccination status, and awareness and attitudes about COVID-19 vaccination were collected from questionnaires completed by the patients. A total of 173 patients were enrolled in this study, and 124 (71.7%) of them completed the COVID-19 vaccination. Significantly higher vaccination rates were found in male patients, and also in older patients, highly educated patients, and those who lived with one household member. Furthermore, we found significantly higher vaccination rates in patients who had consulted with doctors involved in their treatment, particularly with urologists. A significant association was observed between COVID-19 vaccination and doctor’s advice, family member influence, and personal beliefs toward the vaccination. Our study showed multiple associations of patients’ sociodemographic characteristics with vaccination rates. Furthermore, consultation with doctors who are particularly involved in oncology treatment and advice received from them were associated with significantly higher vaccination rates among uro-oncology patients.

Inflammatory myofibroblastic tumour (IMT) is a rare tumour with an intermediate biological behaviour. It usually occurs in children and adolescents, primarily in the abdomen or lungs. Histopathologically, IMT consists of spindle cells, i.e., myofibroblasts, and a variable inflammatory component. Localization in the urinary bladder is rare. We are presenting a rare case of IMT in the bladder in a middle-aged man treated by partial cystectomy. A 62-year-old man consulted a urologist because of haematuria and dysuric disturbances. A tumorous mass was detected by an ultrasound in the urinary bladder. CT urography described the tumorous mass at the dome of the urinary bladder measuring 2 × 5 cm. A smooth tumorous mass was cystoscopically observed at the dome of the urinary bladder. Transurethral resection of the bladder tumour was performed. Histopathological analysis of the specimen identified spindle cells with a mixed inflammatory infiltrate; immunohistochemical findings showed positivity for anaplastic lymphoma kinase (ALK), smooth muscle actin (SMA) and vimentin. A histopathological diagnosis of IMT was established. It was decided that the patient would undergo a partial cystectomy. A complete excision of the tumour from the dome of the urinary bladder with surrounding healthy tissue was performed. Histopathological and immunohistochemical findings of the sample confirmed the diagnosis of IMT, without the presence of the tumour at the surgical margins. The postoperative course went smoothly. IMT is a rare tumour in adults, especially localised in the urinary bladder. IMT of the urinary bladder is difficult to distinguish from urinary bladder malignancy both clinically and radiologically, as well as histopathologically. If the location and size of the tumour allow it, bladder-preserving surgeries such as partial cystectomy represent a reasonable modality of operative treatment.

Introduction: In general, cysts of the median raphe of the penis are asymptomatic. Objective: To present a rare case of parameatal cyst of the penis, which caused loss of self-confidence, impaired sexual satisfaction and disturbance of the urinary stream. Main outcome measures were effect of negative penis image on man and consequent impact on satisfaction with sexual intercourse and personal distress. Methods: A 34-year-old married man sought consultation for a painless cystic mass with abnormal shape of glans penis. The man reported significant emotional distress associated with the image of his penis. He was not satisfied with his sexual life. Psychological analysis of the patient was carried out by a sex psychotherapist. Before and six months after surgical excision, change in patient’s emotional well-being was assessed with Self-Esteem and Relationship (SEAR) questionnaire. The International Index of Erectile Function (IIEF) was used to assess change and end point sexual satisfaction. Results: Parameatal cyst of the penis affected the patient emotionally and clearly impacted his selfesteem. Histopathological examination revealed a solitary cystic cavity. The cystic wall was consisted of stratified columnar epithelium and partly had decapitation secretion. Surgical excision was effective. No postoperative irregularity of urinary stream was noticed. The patient reported significant improvements in sexual function that was associated with positive changes in emotional well-being and sexual relationship. Conclusions: This case report supports histogenetic relationship of median raphe cyst of the penis with the urothelium. It was unusual for the sudden growth in absence of inflammatory signs or trauma. It presents the relationship between body and mind. The findings from this case suggest that there is substantial psychosocial burden associated with negative effects of penis image on confidence, self-esteem and sexual satisfaction. The perception of satisfaction with sex act was directly associated with the sense of negative penis image. Keywords: Median Raphe (Parameatal) Cyst of the Penis; Negative Image of the Penis; Self-Esteem; Satisfaction with Sexual Intercourse; Self-Confidence; Voiding Dysfunction.

The COVID-19 pandemic affected the functioning of health care systems, including emergency services worldwide. The aim of this study was to examine the impact of the pandemic and lockdown on the care of urgent urological patients in daily practice. Methods. Data were retrospectively collected from patients urgently hospitalized at Emergency Department of Clinic of Urology, University Clinical Center of Serbia, during the first three months of lockdown between Mar 15, 2020 and Jun 15, 2020, and compared to the same period in 2019. The collected data included demographic and clinical characteristics, as well as treatment characteristics and treatment outcomes. Results. This study included 80 patients who were hospitalized during the lockdown in 2020 and 68 patients who were hospitalized in the same period in 2019. There was no difference in total number of hospitalized patients, age and gender comparing these two periods. Among patients with urinary tract infection, the number of patients with urosepsis was significantly higher in 2020 (p = 0.028). The median time from symptoms onset to hospitalization was significantly longer in patients who were hospitalized in 2020 (p=0.049). No difference was found in duration of hospitalization and characteristics of treatment between two periods. The number of deaths was significantly higher in 2020 (p = 0.034). Conclusion. During lockdown in Serbia, patients applied to the emergency urology service significantly later. Furthermore, a higher number of patients with urosepsis and a higher number of deaths among hospitalized patients were found during lockdown compared to the previous year.

Introduction / Goal: Benign prostatic hyperplasia (BPH) is the most common benign neoplasm that occures in male population with an incidence of 45 to 90% between 50 and 80 years of age. BPH can cause an increase in output resistance, or an increase in resistance to urine flow, with its static and dynamic components. In clinical practice, the most common pharmacological treatment of lower urinary tract symptoms (LUTS) in patients with BPH is based on monotherapy with alpha-blockers, 5-alpha-reductase inhibitors or combination therapy. The aim of this review is to determine the main therapeutic and side effects of the most common pharmacological therapy and the recommended approaches of the European Association of Urology (EAU) and the American Urological Association (AUA) in the diagnosis of benign prostate obstruction (BPO). Method: Selective literature search with additional examination of EAU and AUA guidelines and meta-analysis. Results: The treatment of patients with BPH is complex. The factors on the basis of which treatment decisions are made are based on the patient's subjective perception of symptoms and quality of life due to LUTS and in relation to the presence of subvesical obstruction. Urodynamic pressureflow studies are the basis for the definition of BPO due to BPH or other etiology. Non-invasive uroflowmetry, determination of residual urine after urination (PVR) and non-invasive ultrasound tests are of great use in the diagnosis of BPO. Treatment with alpha1 receptor inhibitors (alpha-blockers), or 5-alpha-reductase inhibitors may be considered in patients with predominantly urinary dysfunction. Conclusion: Standard pharmacological medical treatment for BPH / LUTS is still based on alphablockers, 5-alpha-reductase inhibitors or a combination thereof. In the future, BPH / LUTS treatment is expected to become individualized, according to the type of symptoms, the presence of sexual dysfunction and the risk of BPH progression.

Background and Objectives: One of the most frequent genetic alterations reported to date in prostate cancer (PC) is aberrant methylation of glutathione transferase P1 (GSTP1). Taking into consideration the involvement of oxidative stress in PC pathogenesis and recent advances in scientific understanding of the role of GSTP1*Ala114Val rs1138272 polymorphism in carcinogenesis, we hypothesized that this single-nucleotide polymorphism (SNP) influences the risk of PC independently of, or in combination with, other GST polymorphisms, including GSTP1*IIe105Val rs1695 or GSTM1 and GSTT1 deletion polymorphisms. Materials and Methods: Genotyping was performed in 237 PC cases and in 236 age-matched controls by multiplex polymerase chain reaction (PCR) for deletion of GST polymorphisms and by quantitative PCR for SNPs. Results: We found that carriers of either GSTP1*Val (rs1138272) or GSTP1*Val (rs1695) variant alleles had a PC risk compared to individuals with both referent alleles (OR = 4.93, 95%CI: 2.89–8.40, p < 0.001 and OR = 1.8, 95%CI: 1.19–2.73, p = 0.006, respectively). Additionally, in a haplotype analysis we found that individuals with GSTP1*C haplotype, represented by both variant alleles (GSTP1*Val rs1695 + GSTP1*Val rs1138272), had a 5.46 times higher risk of PC development compared to individuals with the most frequent haplotype (95%CI = 2.56–11.65, p < 0.001), suggesting a potential role of those variants in PC susceptibility. A regression analysis on the number of risk-associated alleles per individual (GSTM1*active, GSTT1*null, GSTP1*Val rs1695 and GSTP1*Val rs1138272) showed a significant increase in the risk of developing PC, from 3.65-fold in carriers of two risk alleles (95%CI = 1.55–8.61, p = 0.003) to an approximately 12-fold increase in carriers of all four risk alleles (95%CI = 3.05–44.93, p < 0.001). Conclusion: Prostate cancer may be influenced by multiple glutathione transferase (GST) polymorphic genes, especially GSTP1, highlighting the role of gene–gene interactions in human susceptibility to this cancer.

The study identifies the prevalence of violence victimization and the perpetration among youths, and explores the determinants and predictors using a socio-ecological model. The data of 36 variables from a representative sample of 1722 persons, ages 15–24 years, from the National Health Survey of Serbia in 2013, were analyzed by a multivariate logistic regression modeling. The study shows that 13.4% of youths experienced multi-victimization, while 10.4% were perpetrators of violence. Up to one-third of the victims were violence perpetrators. A small percentage of victims seek family and community support. Predictors of violence among youths were: male sex, households with fewer members, urban settlements, violence perpetration, self-assessed health as poor, lack of close friends and perception that it was difficult to obtain the assistance needed. Predictors of youth violence highlighted the need to improve health education, social support and community regulations, as well as strengthen the promotion of gender equality and a healthy environment.

Background/Aim. Benign prostatic hyperplasia (BPH) is a pathological process, which is one of the most common causes of so-called lower urinary tract symptoms (LUTS). LUTS affect many aspects of daily activities and almost all domains of health-related quality of life (HRQoL). The objective of this study was to evaluate the effects of operative treatment of BPH using standard clinical diagnostic procedures and effects on LUTS using the symptom-score validated to Serbian language as well as implications on HRQoL. Methods. Seventy-four patients underwent surgical treatment for BPH. The study protocol included objective and subjective parameters of the following sets of variables measured before and after the surgery: voiding and incontinence symptoms were measured using the International Continence Society male Short Form (ICS male SF) questionnaire, HRQoL was measured using the SF-36 questionnaire along with standard clinical measurement of residual urine and urine flow. Results. After the surgery, all patients had decrease of voiding scores (13.5 ? 3.3 before and 1.5 ? 1.4 after surgery) and incontinence symptoms (5.7 ? 3.9 before and 0.6 ? 0.8 after surgery) in comparison to period before operative treatment. Significant improvements in all dimensions of HRQoL were noticed, particularly in emotional health. Although mental and physical total scores were significantly better than prior to the surgery, the level of improvement of voiding and incontinence scores were significantly correlated only with the level of improvement of mental score. Conclusion. After BPH surgery, patients are likely to have normal voiding symptoms, barely some involuntary control over urination and overll better HRQoL, particularly in emotional domain.