Nowadays HIV infection is considered to be a chronic disease, allowing infected HIV patients a solid chance for a quality life. The number of people infected by the Human Immunodeficiency Virus (HIV) has been rising each year. The number of HIV positive patients in Czechia (The Czech Republic) historically diagnosed from year 1986 was 3,644 as of 31^st March 2020. Such an increase has brought HIV positive patients into other areas of specialised medical care, including Urology. And since this field of medicine involves surgical procedures, treatment of HIV positive patients inevitably raises apprehension over their vulnerability, and, at the same time, about medical staff safety.

Overactive bladder is a syndrome that leads many patients to visit a urological specialist. Due to its high prevalence in both males and females of any ages, urologist should be well informed about the diagnosis and its treatment. Nowadays, in addition to recommendations of European Association of Urology Guidelines, the treatment tends to be highly individualized. Beside conservative treatment, such as lifestyle changes, pharmacotherapy represents a crucial treatment option. Antimuscarinics are considered a traditional pharmacological choice. Nevertheless, beta-3-mimetics have been successfully used as a combination therapy or even an effective replacement to antimuscarinics in recent years.

The author provides information on the diagnosis of male hypogonadism and practical testosterone replacement treatment - including the latest guidelines for the treatment and monitoring of patients according to the European Association of Urology.

Phimosis, a condition in which the foreskin is too tight to be retracted over the glans, is a frequent reason for a child's visit to the doctor. Its treatment depends on the correct diagnosis and patient complaints. In primary, or congenital phimosis, the approach is as conservative as possible; in acquired, or secondary, phimosis, most cases require a circumcision to be performed. The mainstay of conservative treatment is proper care of the boy's penis allowing a spontaneous development of the foreskin that can be promoted by local administration of a corticoid ointment. When circumcision is indicated, its extent will be determined by the intraoperative finding and the parents' wishes.

There can be a number of causes of unretractable foreskin. It can be due to a congenital narrowing of the foreskin (primary phimosis) or adhesions between the internal lamina of the prepuce and the glans penis. On physical examination, the general paediatrician should distinguish physiological causes of unretractable foreskin (primary phimosis, adhesions) from pathological ones (secondary phimosis). When preputial pathology is suspected, conservative treatment fails, or phimosis persists into puberty, it is advisable to refer the patient for specialist investigation. The treatment of phimosis can be initiated after the second or third year of life, or even earlier in the case of complicating factors. Conservative treatment with a corticoid ointment is the first choice; if it fails, circumcision can be considered. However, circumcision is necessary in secondary phimosis, particularly if balanitis xerotica obliterans is suspected. Complications associated with adhesions can be managed with dissolution. Acute conditions require immediate therapeutic intervention, preferably in the catchment facility.

Prostate cancer is the most common cancer that affects men (except of skin tumors). Although most cases of prostate cancer are diagnosed and treated at an early stage, some patients already have primary dissemination or metastatic spread during therapy. Current research has led to the expansion of the treatment armamentarium for patients with prostate cancer. Therapeutic options in patients with castration-resistant prostate cancer aim to prolong survival with minimal development of complications and with the highest possible quality of life.

The paper briefly describes and summarizes the current clinical knowledge and complex recommendations for differential diagnosis of proteinuria.

Surgical sperm extraction is currently the only option for patients with azoospermia to achieve genetically own offspring. The development of reproductive medicine brings infertile couples a more likely chance of achieving pregnancy. The task of urologist and andrologist in this process is to examine and treat the infertile man and also to choose the optimal extraction method, which will bring the greatest chance of obtaining quality sperm with minimal risks for the patient.

Diagnostics of urinary stones is an integral and everyday part of urologist´s activity. It requires essential cooperation with radiologist. CT enables not only the identification of the true cause of renal colic but it can also assess basic stone characteristic - size, number, location. Moreover, the CT scan can predict stone composition, its density, homogenity and predict the efficacy of the planned treatment. The aim of this article is to enlighten the basics of CT examination to ordinary urologist.

Uric acid (UA) is the end product of purine metabolism in man. There are three sources of UA in man: food nucleotides, degradation of tissue nucleoproteins, and biosynthesis. UA is eliminated by the kidneys in 75-80%, with the remainder being excreted from the body by the gastrointestinal tract and through perspiration. Plasma UA concentration depends on dietary purine intake, intensity of its intrinsic formation, and its elimination rate. Elevated levels of UA in the blood (hyperuricaemia) and increased urinary UA excretion (hyperuricosuria) are of clinical significance. In the case of disorders of UA metabolism, hyperuricaemia tends to be the major and most common problem for man since, when it is untreated and uncontrolled, it leads to the development of gout (gouty arthritis) with all its negative consequences for the human body, including uric acid lithiasis. Serious consequences for man are also associated with hyperuricosuria which may not necessarily be accompanied by hyperuricaemia. The review article presents in detail diseases that occur in the setting of underlying disorders of UA metabolism; also discussed are the options of treatment and prevention for disorders of UA metabolism.

Urinary tract infections, along with respiratory tract infections, are the most frequent inflammatory diseases in man. Given the current situation of antibiotic resistance, non-antibiotic treatment strategies are also recommended in uncomplicated urinary tract infections. Non-antibiotic strategies can effectively be implemented by recommending appropriate daily routine measures supported by a well-chosen over-the-counter medicinal product, a healing tea blend, or a food supplement. Current knowledge of the microbiome as a modulator of a number of diseases has brought the anticipated positive use of probiotics and bacterial lysates as an interesting alternative in uncomplicated recurrent urinary tract infections.

Drug interactions are a problem in all medical disciplines including urology. A number of typically urological drugs such as drugs for the treatment of overactive bladder, benign prostatic hyperplasia or erectile dysfunction are substrates of CYP3A4 and the P-glycoprotein transport system. Combination of these drugs with inhibitors or inducers of CYP3A4 or P-glycoprotein can either lead to adverse events or reduce the effect to failure. In addition, manufacturers often recommend changes in drug dosage when combined with CYP3A4 inhibitors and it may be difficult for physicians to navigate such recommendations.

This case report introduce a patient who was admitted to urological department with left sided symptomatology of renal colic. Ultrasound and computed tomography findings showed retroperitoneal tumor with diameter 7 × 6 × 8 cm. After finishing all examinations was the final diagnose a retroperitoneal lymfatic nodule metastasis of seminoma with burned-out primary focus in the left testicle.

We present a case report describing a patient a with a horseshoe kidney who experienced several complications arising in the field of this congenital developmental defekt. We addressed blocking, bulky nephrolithiasis in the right kidney and bulky tumor in the left kidney. We first combined the endoscopic solution of lithiasis and then with the distance of removal of the left horseshoe tumor from transperitoneal open access. There may be a problem with the surgical approach to the horseshoe kidneys due to their atypical positions and vascular supply, where we could earn a balance as to how sufficient functional renal parenchyma is possible, even with sufficient oncological radicality on the other hand.

While systemic treatment in combination with surgery has very successfully been implemented into therapeutic practice based on studies demonstrating a clinical benefit, the utilization rate of radiotherapy as an alternative to cystectomy in highly selected patients varies in different countries. Bladder preservation therapy is particularly suitable for patients unable or unwilling to undergo radical surgery. In order to obtain good therapeutic results, it is essential to perform radical transurethral resection of the bladder tumour (TURBT) and administer concomitant chemotherapy that improves 5-year survival by as much as 13 %. Under these circumstances, it is possible to achieve preservation of a functional bladder in up to 80 % of long-term surviving patients, with severe late toxicity of grade 3 and higher (according to the RTOG scale) not exceeding 10 %. Conversely, when a conservative approach is indicated in patients with tumours not allowing TURBT, locally advanced disease (T3-4), and hydronephrosis, or when cisplatin is contraindicated, only a palliative effect of the treatment may rather be expected.

Lower urinary tract infections are the most common diseases in urological ambulance. Their treatment usually does not take long, usually 1-5 days. Diagnosis is mainly reflected in the symptoms of illness and examination of patient's urine. Although the treatment is not long, it accounts for almost 15 % of antibiotic prescriptions at all.

The incidence of lithiasis in children and adolescents is currently on the rise. The main factors of the increase are changes in eating habits in children, lower physical activity and improved diagnostic possibilities. On examination the focus is on the analysis of the stone and metabolic investigations, which then allows a specific metaphylaxis. Therapy has been based on extracorporeal lithotripsy for a long time, but with the miniaturization of instrumentation, the number of endoscopic procedures increases.

Induratio penis plastica (IPP - Peyronie's disease) is a connective tissue disorder, characterised by the formation of a fibrotic lesion or plaque in the tunica albuginea, which may lead to penile deformity. IPP is a relatively unknown cause of sexual dysfunction. Symptoms may include the occurrence of erectile deformity, pain in the penis, and erectile dysfunction (ED). The etiology of IPP remains mostly unexplained and the effectiveness of drug therapy is still insufficient. Surgical treatment remains the only option when the disease has stabilized in the event of significant erectile and sexual disability. The article gives a brief and up-to-date overview of current knowledge of etiopathogenesis, diagnosis and especially IPP treatment.

Prostate rebiopsy is indicated in case of the permanently elevated or increasing level of prostate specific antigen (PSA). Other indications include low free to total PSA ratio or high Prostate Health Index (phi). Histological parameters for the indication of rebiopsy include atypical small acinar proliferation (ASAP), high-grade prostatic intraepithelial neoplasia (HG-PIN) in more than two biopsy cores specimens, small atypical glands associated with HG-PIN (PINATYP) or intraductal carcinoma. Multi-parametric magnetic resonance imaging is used mainly in the repeat prostate biopsy because it can more often detect significant prostate cancer compared to standard biopsy.

We present the case of a 72-year-old man with leiomyosarcoma of spermatic cord. The patient presented with pain in his right groin and enlarged right scrotum. Physical examination showed a rigid mass reaching the lower half of the inguinal canal and filling the right scrotum. Ultrasound examination revealed a solid expansion of the heterogeneous structure with accentuated vascularization. A high-ligation radical orchiectomy was performed. Histologic examination verified low-differentiated leiomyosarcoma of spermaticus funiculus belonging to the group of paratesticular tumors. CT scan of the lungs, retroperitoneum and small pelvis showed no metastatic process or lymphadenopathy. The oncologists did not indicate an adjuvant oncological therapy, the reason being radical tumour removal. After 3 years, metastatic process into the retroperitoneal nodes was verified.

We report a case of a 27-year-old man with generalized sarcoma of the minor pelvis whose initial and rare manifestation was acute-onset hydrocele.

The present paper examines a case of a 76 year old patient with left - side ureterolithiasis and anuria with surprising findings of solitary kidney and genital hypoplasia. A ureteral stent was inserted and later an ureteroscopy was performed including a removal of a stone. Due to typical clinical findings including anosmia, and low testosterone, follicle - stimulating and luteinising hormone levels, a diagnosis of Kallmann syndrome was obtained. Testosterone supplementation was offered to the patient.

In this article we present the Swiss Lithoclast trilogy device and its use in percutaneous stone extraction. Next, we present a set of patiens using the device and the results.

Obstructive uropathy is a term that can be used for clinical and objective conditions, such as upper urinary tract obstructions or subvesical obstructions, i.e. lower urinary tract obstructions. In both cases, alpha blockers are used in pharmacotherapy. This article discusses the role of alpha blockers in treating subvesical obstructions causing lower urinary tract symptoms (commonly abbreviated as LUTS) as well as the use of alpha blockers in treating upper urinary tract obstructions due to urolithiasis.

Men with non-metastatic castration-resistant prostate cancer with short doubling time PSA are at risk for early disease progression. Results of new clinical studies with antiandrogens II. generations such as apalutamide, enzalutamide, darolutamide have been shown to delay the onset of metastatic disease and prolong survival in these patients.

Severe forms of early-onset polycystic kidneys in children represent a large group of diseases with overlapping clinical manifestations. A characteristic feature is enlarged kidneys with reduced function, which may be the result in Potter´s sequence in the prenatal period. However, the etiology of this manifestation is genetically very heterogeneous and can be caused by a disorder of a wide range of genes. The most common are PKHD1 mutations that lead to an autosomal recessive form of polycystic kidney (ARPKD). In almost the same number of cases the clinical manifestation of a severe form of polycystic kidney with onset in childhood is the result of PKD1 or PKD2 mutations associated with an autosomal dominant disease form (ADPKD). These mutations often arise de novo or can affect both alleles and lead to a recessive model of inheritance. Mutations in DZIP1L are a relatively new cause of the so-called ARPKD-like phenotype. Early and unambiguous diagnosis of these diseases will be confirmed by genetic testing. The current possibilities of next-generation sequencing allow simultaneous analysis of whole group of genes and represent a key role in the rapid diagnosis of these diseases. Causal gene identification is an essential tool for determining the correct diagnosis and parental counseling.

Urological surgery can lead to a sexual dysfunction as an erectile dysfuncion or disorders of ejaculation. It is very important to understand these consequences and to discuss it with the patient. The management of postoperative sexual dysfuncions is also very important part of urological care.

Spa treatment and rehabilitation care is follow-up care and can be applied in indicated cases in urological patients. Accurate groups are regulated by Law no. 48/1997. on public health insurance and the Ministry of Health Decree no. 2/2015 Coll. establishing technical criteria and other requirements for the provision of spa treatment rehabilitation care. In such a case, the urologist can be the referring physician or self-petitioner spa. If the patient meets the indication criteria, then the health insurance company will reimburse his care in a comprehensive manner, including accommodation and meals, or only in addition to the procedures.

The extra-anatomic stent (EAS) is a suitable alternative method for the derivation of upper urinary tract, especially when others routinely used options have failed. The report includes a case report of a patient with malignant disease and urinary derivation by extra-anatomic stent Detour® with late skin complication.