Auškalnis, Stasys

Objective Traumatic penile amputation is a rare urological emergency that requires surgical strategy. Published clinical replantation cases (2015-2023) are few, numbering only 46 over 7 years. Reconstruction using local flaps following major traumatic corporal amputation is exceptionally rare and remains largely unquantified in systematic reviews. When replantation is impossible, reconstruction using local tissues must be considered. We present a case of penile amputation management using a two-stage local flap reconstruction to restore both function and aesthetics.

Methods A 33-year-old male with chronic alcohol use, presented disoriented and anemic with severe, delayed genital trauma. Examination showed a deep, contaminated cut-laceration with bilateral testicular loss and a 4-5 cm corporal remnant. Amputated parts were unrecovered. Stage 1 involved meticulous debridement, securing urinary drainage and targeted antibiotic adjustment after multi-pathogen growth. Once inflammation subsided, the reconstructive second stage was performed. Longitudinal incision lines were made along the palpable remnants of the corpora cavernosa. Scar tissue was dissected and the suspensory ligament of the penis was released. The remaining cavernous bodies were then elevated together with the overlying skin flap, resulting in an observed penile lengthening. The ventral tissue defect formed beneath the penis was covered by advancement and elevation of adjacent scrotal tissues and overlying skin to construct a neophallus.

Results In this case, the patient presented with severe contamination, delayed trauma, severely limited definitive treatment options. The unsuitability of replantation and the high complication risk associated with complex microsurgical free flap procedures in this setting required a staged, local reconstruction approach. The use of a scrotal advancement flap was crucial, as it provided well-vascularized and elastic tissue ideally suited for covering the remaining corporal stump. This tailored two-stage management optimized the functional and aesthetic outcome using only native local tissue.

Conclusion Reconstruction after penile amputation is a complex challenge. Our case demonstrates that meticulous debridement and planned local flap reconstruction provide a strong foundation for success, restoring urinary function and achieving an acceptable aesthetic outcome, even when replantation is precluded.

Introduction & Objectives: The aim of this study was to evaluate whether MSKCC pre-radical prostatectomy prostate cancer nomograms are a reliable method for predicting prostate cancer (PCa) recurrence-free survival (RFS) after I-125 seeds brachytherapy. Objectives: a) To calculate 5- and 10-year biochemical recurrence-free survival (RFS) probabilities using MSKCC nomograms in patients treated with I-125 brachytherapy. b) To compare nomogram-predicted and actual recurrence free PCa outcomes. c) To evaluate the impact of tumor extension parameters (extracapsular extension (ECE) seminal vesicle invasion (SVI), lymph node invasion (LNI)) on PCa recurrence risk. Materials & Methods: Patients diagnosed with PCa and treated with LDR brachytherapy between the years 2007 and 2024 in the Hospital of Lithuanian University of Health Sciences, Kaunas Clinics, were included into this retrospective study. Medical records of 645 patients were analyzed, collecting demographic and clinical data including age, prostate-specific antigen (PSA) levels, biopsy results, Gleason score, and biochemical recurrence. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 30.0. Results: The mean patient age was 63±7 years (range 39–88). During a mean follow-up of 10±5.4 years, 34 patients developed recurrence and 19 died from PCa. In our study PCa recurrence-free survival was 96% at 5 years and 94% at 10 years. MSKCC nomogram calculated predictions were 86±11% for 5 years and 77±14% for 10-years PCa recurrence-free survival; predicted probabilities were related to actual outcomes (p<0.001) but underestimated real results of our study. Calculated ECE probability was higher in patients with PCa recurrence group compared to PCa recurrence-free patients (49±20% vs 33±16%, p<0.001). In univariate analysis, ECE, SVI, and LNI were significant predictors of PCa recurrence (p<0.001), but in multivariate analysis only ECE remained significant: each 1% increase was associated with a 5% higher recurrence risk (HR 1.05, p<0.001). Patient age was not a significant predictor. Conclusions: Observed 5- and 10-year PCa recurrence-free survival rates after LDR brachytherapy were 96% and 94%, respectively. MSKCC nomogram predicted the probability of PCa progression-free survival after I-125 seeds brachytherapy but their prognosis was worse than our study data. Among tumor extension parameters, ECE probability was an independent predictor of PCa recurrence, whereas seminal vesicle invasion and lymph node invasion were not significant in multivariate analysis. These findings suggest that more precise prediction models are needed for patients treated with LDR brachytherapy.

Introduction & Objectives: Prostate cancer (PCa) is the leading oncologic disease and cause of cancer-related death among men, with 1.4 million new cases and over 400,000 deaths worldwide in 2022 [1]. In Lithuania, PCa accounts for 27% of all male malignancies [2]. Standard systemic prostate biopsy has notable limitations, resulting in reduced detection of clinically significant prostate cancer (csPCa) [3]. Microultrasound (microUS) is an emerging high-resolution imaging modality that enables targeted prostate biopsy with superior tissue visualization compared to conventional ultrasound [4]. This study prospectively evaluates the diagnostic accuracy of microUS-guided biopsy for csPCa detection. Materials & Methods: We conducted a prospective study on 308 patients who underwent systematic and lesion-targeted (S+T) biopsy using the ExactVu microUS system (29Hz frequency). Clinical indications for the biopsy were abnormal DRE, PSA, and lesions in mpMRI. Tissue samples were sent for pathologic examination to determine the Gleason score of the tumor. All data were accumulated, analysed, and compared using the IBM SPSS Statistics package version 30.0. Results: Among the sample of 308 men (aged 41-90; median PSA: 8,47 ng/ml), 272 (88,3% ) of them were confirmed positive for PCa, while 64,6% of them were csPCa. For PCa alone, systemic and targeted biopsies diagnostic rate were 81,5% and 80,8%, while combining them together yielded a rate of 88,3%. Meanwhile, for csPCa systemic, targeted and combined biopsy methods showed diagnostic rates of 65,7%, 73,1% and 73,2% respectably. Lesion targeted PB alone had the sensitivity and specificity of 90,8% and 63,2% for cancer, while PPV and NPV was 91,6% and 61,0%. Compared to combined diagnostics of S+T biopsy, we observed a sensitivity and specificity of 99,6% and 62,3%, with PPV and NPV being 92,3% and 97,3%. When taking into consideration the csPCa lesion, targeted PB performed with 76,3% sensitivity and 61,9% specificity (PPV=95,6%; NPV=19,4%). Comparing with S+T biopsy, we observed a sensitivity of 75,7% and specificity of 86,0% for csPCa (PPV=96,0%; NPV=44,6%). Conclusions: S+T PB guided by microUS has shown the best overall accuracy and performance in general PCa and csPCa diagnostics. The addition of systematic biopsy proves to enhance the specificity and sensitivity of diagnostics in the general PCa group and improves specificity and NPV in the csPCa group, proving to be a useful triage test over risk-stratified PB decision

Background: An inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumor, sometimes with urinary bladder involvement (though this is extremely uncommon). Due to its rarity, the exact etiology and optimal treatment strategy remain unclear. Methods: A review of the existing literature on IMT of the urinary bladder was performed. Results: We report a case of a 32-year-old female presenting with frequent urination, hematuria with clots, and lower abdominal pain for one month. Initially misdiagnosed as acute cystitis, the symptoms persisted despite antibiotic therapy. Laboratory findings revealed severe anemia, and imaging studies identified a large bladder mass. Transurethral resection of the bladder tumor (TURB) was performed, and a 96 g mass was removed. Histopathological examination confirmed IMT of the urinary bladder (IMTUB) with positive immunohistochemical staining for ALK, vimentin, and actin. Follow-up at 30 months showed no recurrence, with annual cystoscopy and CT scans confirming remission. Conclusions: IMTUB should be considered in young patients presenting with hematuria and lower urinary tract symptoms. Early diagnosis through cystoscopy, imaging, and histopathological confirmation is essential for appropriate management. TURB remains the gold standard for treatment, with ALK inhibitors providing additional therapeutic options in select cases. Long-term follow-up is necessary due to the unknown malignant potential of IMTUB.

Nutukimas - viena aktualiausių dabartinės visuomenės problemų, neigiamai veikianti daugelį organizmo sistemų ir trikdanti sergančiojo šia liga gyvenimo kokybę, darbingumą bei trumpinanti gyvenimą. Tai - metaboliškai aktyvi ir recidyvuojanti liga, kurios metu kūno masė didėja riebalinio audinio sąskaita. Nutukimą kaip ligą Amerikos medicinos asociacija oficialiai pripažino 2013 metais. Nutukimas pastaruoju metu yra labiausiai aptarinėjama tema tiek medicinos, tiek plačiojoje visuomenėje. Kalbant apie nutukimą, dažnai ši būklė siejama su asmeniniu kaltės priskyrimu: „reikia tik noro“, „reikia suimti save į rankas“ ir t. t. Įvairiais istoriniais laikotarpiais požiūris į žmogaus kūno formas keitėsi nuo Rubenso tipo moterų iki anoreksinių mados manekenių formų. Menamų kūno formų standartų neatitinkantis žmogus gali būti pavadintas putliu, stambiu, apkūniu, didelio dydžio ar net storuliu ar apsileidusiu. Medicinos bendruomenėje vyrauja terminai: antsvoris, hipotalaminis, pilvinis, centrinio tipo, kušingoidinis, morbidinis nutukimas ir kt. Nutukimas turi kompleksines pasekmes - skatina lėtines ligas, galinčias sutrumpinti žmogaus amžių 10-15 metų. Per pastaruosius 5 dešimtmečius nutukimo paplitimas pasaulyje padidėjo daugiau nei 3 kartus, ir dabar tai įvardijama kaip nutukimo pandemija. Klinikinėje praktikoje nustatomos įvairiausios nutukimo priežastys - nuo genetinių (Prader-Willi sindromas, Aistrom sindromas, LEPR (leptino receptoriaus) ar LEP (leptino) geno mutacijos ir kt.), endokrininių (hipotirozė, hiperkorticizmas, hipogonadizmas ir kt.) iki valgymo priklausomybių. Skirtingos yra ir nutukusių kūno formos bei kūno kompozicija. Todėl kūno masės indeksas (KMI) klinikiniu požiūriu jau nebetenka prasmės. KMI tikslinga naudoti populiaciniams, palyginamiesiems tyrimams. Statistiniais duomenimis (HIS Lietuva, Eurostat, 2019-2022 m.), pagal KMI nutukusių suaugusių Lietuvoje buvo 21-23 proc. Skaičiuojama, kad apie 60 proc. suaugusiųjų Lietuvoje turi antsvorio ar yra nutukę. Tai - tik statistika, neatspindinti konkrečios individo būklės. 2025 m. pasaulio 58 ekspertų grupė, atstovaujanti įvairioms medicinos specialybėms ir šalims, išanalizavo turimus įrodymus ir, pritarus 75 medikų ir pacientų organizacijoms, rekomendavo klasifikaciją, kurioje išskiriamas ikiklinikinis ir klinikinis nutukimas. Pagal epidemiologinius ir klinikinius duomenis, nutukimas susijęs su daugiau nei 200 skirtingų ligų ir sveikatos sutrikimų. [...]

Background: Bladder leiomyosarcoma is an extremely rare non-urothelial malignancy, accounting for less than 0.1% of all bladder tumors. It presents significant diagnostic and therapeutic challenges due to its aggressive nature and the absence of standardized treatment protocols. Case presentation: We report the case of a 61-year-old woman who presented with hematuria, dysuria, and suprapubic pain. Imaging revealed a large, locally invasive bladder mass, and histopathological examination following transurethral resection confirmed leiomyosarcoma. The patient underwent radical cystectomy with resection of adjacent bowel segments and urinary diversion. Histology showed a high-grade leiomyosarcoma (pT3N0) with extensive necrosis and a high mitotic index. Two months postoperatively, peritoneal dissemination was detected. Systemic chemotherapy with dacarbazine and doxorubicin initially led to the regression of metastases, but disease progression occurred within months, including lung, liver, and bone metastases. Palliative radiotherapy and second-line chemotherapy were initiated. As of now, 16 months have elapsed since surgery. Conclusions: This case underscores the aggressive clinical course of bladder leiomyosarcoma despite multimodal therapy and the urgent need for individualized management strategies. Given its rarity, this case contributes to the limited literature and highlights the importance of vigilant follow-ups and further studies to establish evidence-based treatment protocols.

Rekomendacijose pateiktas įvairių sričių specialistų — šeimos gydytojų, gydytojų urologų, gydytojų akušerių ginekologų bei laboratorinės diagnostikos gydytojų kompleksinis požiūris į visuomenėje įgytų šlapimo takų infekcijų diagnostikos, gydymo ir prevencijos rekomendacijas vyrų ir moterų grupėse esant rizikos veiksniams, galintiems apsunkinti klinikinę ligos eigą. Racionalus ir savalaikis antibiotikoterapijos taikymas įvairių grupių pacientams, optimali diagnostikos ir stebėjimo taktika labai svarbi ambulatorinėje praktikoje siekiant išvengti komplikuotų atvejų ar bereikalingo gydymo ir rezistentiškumo antibiotikams vystymosi. Šios rekomendacijos skirtos Medicinos fakulteto studentams, rezidentams, šeimos gydytojams, gydytojams urologams, gydytojams akušeriams ginekologams. jos parengtos daugiadalykės gydytojų specialistų komandos, todėl apjungia ir unifikuoja skirtingų profilių pacientų šlapimo takų infekcijų diagnostikos ir gydymo mokslu pagrįstas praktines rekomendacijas.

Introduction & Objectives: In 2020 there were over 300 000 new cases of prostate cancer (PCa), while it accounts for nearly 27% of all male neoplastic disorders in Lithuania. Standart systematic prostate biopsy (SPB) method has been proven to have its limitations, which result in diminished diagnostic rate of tumors. Micro-ultrasound (microUS) is an emerging high-resolution imaging technology used for prostate cancer diagnosis, particularly for guiding targeted biopsies. Compared to conventional ultrasound, microUS provides improved visualization of prostate tissue, allowing for better differentiation of suspicious lesions. This study aims to prospectively evaluate the effectiveness and diagnostic accuracy of microUS in guiding prostate biopsies for detecting clinically significant prostate cancer (csPCa). Materials & Methods: We conducted a prospective study on 152 patients who underwent systematic and lesion targeted (S+T) biopsy using ExactVu microUS system (29Hz frequency). Clinical indications for the biopsy were abnormal DRE, PSA and lesions in mpMRI. Tissue samples were sent for pathologic examination to determine the Gleason score of the tumor. All data were accumulated, analysed, and compared using the IBM SPSS Statistics package version 30.0. Results: Among the sample of 152 men (aged 47-86; median PSA: 7,76 ng/ml) 139 (91,4% ) of them were confirmed positive for PCa, while 70,5 % of them were csPCa. For PCa alone systemic and targeted biopsies alone diagnostic rate was 84,9% and 84,2%, while combining them together yielded a rate of 91,4%. Meanwhile for csPCa systemic, targeted and combined biopsy methods shown diagnostic rates of 55,3%, 67,7% and 70,5% respectably. Lesion targeted PB alone had the sensitivity and specificity of 89,9% and 47,8% for cancer, while PPV and NPV was 90,6% and 45,8%. Compared to combined diagnostics of S+T biopsy, we observed a sensitivity and specificity of 99,2% and 52,2%, with PPV and NPV being 92,1% and 92,3%. When taking into consideration the csPCa lesion targeted PB performed with 69,8% sensitivity and 54,5% specificity (PPV=94,2%; NPV=14,6%). Comparing with S+T biopsy we observed a sensitivity of 81% and specificity of 54,5% for csPCa (PPV=94,9%; NPV=21,4%). Finally, comparing microUS guided diagnostic modalities by ROC curve, we discover, that targeted PB alone (AUC=0,689) had a lower accuracy than S+T biopsy (AUC=0,757). This type of trend continues around csPCa diagnostics, since additional S+T biopsy (AUC=0,656) performs better than targeted biopsy alone (AUC=0,622). Conclusions: S+T PB guided by microUS has shown the best overall accuracy and performance in PCa diagnostics. The addition of systematic biopsy proves to enhance the specificity and sensitivity of diagnosis in PCa and csPCa groups, while lesion targeted prostate biopsy alone still has a likelihood to miss csPCa.

Introduction & Objectives: In 2020 there were over 300 000 new cases of prostate cancer (PCa), while it accounts for nearly 27% of all male neoplastic disorders in Lithuania. Standart systematic prostate biopsy (SPB) method has been proven to have its limitations, which result in diminished diagnostic rate of tumors. Micro-ultrasound (microUS) is an emerging high-resolution imaging technology used for prostate cancer diagnosis, particularly for guiding targeted biopsies. Compared to conventional ultrasound, microUS provides improved visualization of prostate tissue, allowing for better differentiation of suspicious lesions. This study aims to prospectively evaluate the effectiveness and diagnostic accuracy of microUS in guiding prostate biopsies for detecting clinically significant prostate cancer (csPCa). Materials & Methods: We conducted a prospective study on 152 patients who underwent systematic and lesion targeted (S+T) biopsy using ExactVu microUS system (29Hz frequency). Clinical indications for the biopsy were abnormal DRE, PSA and lesions in mpMRI. Tissue samples were sent for pathologic examination to determine the Gleason score of the tumor. All data were accumulated, analysed, and compared using the IBM SPSS Statistics package version 30.0. Results: Among the sample of 152 men (aged 47-86; median PSA: 7,76 ng/ml) 139 (91,4% ) of them were confirmed positive for PCa, while 70,5 % of them were csPCa. For PCa alone systemic and targeted biopsies alone diagnostic rate was 84,9% and 84,2%, while combining them together yielded a rate of 91,4%. Meanwhile for csPCa systemic, targeted and combined biopsy methods shown diagnostic rates of 55,3%, 67,7% and 70,5% respectably. Lesion targeted PB alone had the sensitivity and specificity of 89,9% and 47,8% for cancer, while PPV and NPV was 90,6% and 45,8%. Compared to combined diagnostics of S+T biopsy, we observed a sensitivity and specificity of 99,2% and 52,2%, with PPV and NPV being 92,1% and 92,3%. When taking into consideration the csPCa lesion targeted PB performed with 69,8% sensitivity and 54,5% specificity (PPV=94,2%; NPV=14,6%). Comparing with S+T biopsy we observed a sensitivity of 81% and specificity of 54,5% for csPCa (PPV=94,9%; NPV=21,4%). Finally, comparing microUS guided diagnostic modalities by ROC curve, we discover, that targeted PB alone (AUC=0,689) had a lower accuracy than S+T biopsy (AUC=0,757). This type of trend continues around csPCa diagnostics, since additional S+T biopsy (AUC=0,656) performs better than targeted biopsy alone (AUC=0,622). Conclusions: S+T PB guided by microUS has shown the best overall accuracy and performance in PCa diagnostics. The addition of systematic biopsy proves to enhance the specificity and sensitivity of diagnosis in PCa and csPCa groups, while lesion targeted prostate biopsy alone still has a likelihood to miss csPCa.

Background and Objectives: Seminoma is the most common solid malignant tumour in young men. Clear-cell kidney carcinoma is the most common malignancy of the genitourinary tract. However, the synchronous occurrence of both of these tumours is rare. Case presentation: We present the case of a 36-year-old patient who presented to a medical facility at the end of 2019 with an enlarged right testicle. A unilateral orchofuniculectomy was performed, and a mass measuring 30 cm was removed. During histological examination, testicular seminoma pT2, R0, was diagnosed. An abdominal computed tomography (CT) scan showed a 6.4 cm × 6.8 cm × 6.7 cm tumour in the right kidney and a metastatic-like lesion in the right adrenal gland. A right nephrectomy and an adrenalectomy and paraaortic and paracaval lymphadenectomies were performed. A histological evaluation confirmed the presence of clear-cell renal carcinoma pT2aR0 G2, adrenal hyperplasia, and seminoma metastases in the removed lymph node. Chemotherapy with a Bleomycin, Etoposide, and Cisplatin (BEP) regimen was carried out. Three years after the last cycle of chemotherapy, a follow-up CT scan showed metastases in the left kidney, the right ischium, and the right lung. A well-differentiated clear-cell carcinoma G1 of the left kidney and metastasis of clear-cell carcinoma G2 in the right ischium were confirmed after the biopsy, and no tumour lesions were found in the lung tissue specimen. Treatment with targeted therapy with Sunitinib was started because the risk was favourable according to the Heng criteria. Genetic testing was performed, and the following genes were analysed: VHL, BAP1, CHEK2, FH, MET, MUTYH, APC, and STK11. The testing did not reveal any pathogenic or potentially pathogenic mutations or sequence changes of unknown clinical significance in the genes analysed. Conclusions: According to the authors, the occurrence of synchronous primary tumours is linked to one’s genetic predisposition. DNA sequencing of tumour tissue could provide more information on the corresponding aetiopathogenesis.