[Immunotherapy with Solco Urovac vaccine in chronic genitourinary infection]. / Imunoterapiia s vaktsinata Solco Urovac na khronichnata genitourinarna infektsiia.

Twenty five patients with chronic urogenital infections (cystitis, pyelitis and prostatitis) were treated with Solco urovak infection which is active against Escherichia coli, Proteus, Klebsiella and Streptococcus fecalis organisms. This microbial flora has been isolated from these patients and proved resistant to the conventional antibacterial agents. The vaccine was very well tolerated, gave no side reactions, but transient short lasting rise of the temperature to 38 degrees C. The bacteriologic control on the 6. week after vaccination showed sterile urine in 68 per cent of the patients, no change in 20 per cent and recovery of other bacterial flora in 12 per cent. The vaccine is recommended for treatment of urinary tract infections caused by the microorganisms enumerated above.

[The indications and choice for open surgical intervention in hydronephrotic transformation]. / Pokazaniia i izbor na otvorenata operativna interventsiia pri khidronefrotichna transformatsiia.

Out of the total of 372 patients treated for congenital and acquired hydronephrotic transformations over a three-year period (1990 through 1992), seventeen cases are subjected to treatment with antibiotics and antispasmodics followed by observation, and in 124 cases various types of open pyeloplastic procedures are performed. The indications for operative management of hydronephrotic transformation depends on the results of objective and laboratory studies, and subjective complaints. Accidentally discovered hydronephrotic transformations, I-II degree, may be subjected to conservative management followed by an observation period with good results. Of the 17 patients deterioration occurs in three cases, and in one of the latter nephrectomy is necessitated. In case of markedly expressed hydronephrotic transformation, associated with additional complications and renal function impairment, operation aimed at restoration of the patency of urinary tracts should be undertaken. Various types of pyeloplastic reconstructive interventions are performed, with the procedure suggested by Anderson-Hynnes, Foley and Davis being mainly used. In two patients secondary nephrectomy is done with a 96.8 per cent rate of successful outcomes.

[The causes of urodynamic disorders of the urinary tract leading to hydronephrotic transformation]. / Prichini za urodinamichni narusheniia na pikochnite putishta, predizvikvashti khidronefrotichna transformatsiia.

Experience had with the treatment of 372 patients, admitted to the Clinical Center of Urology--Sofia, and 16 patients--to the Clinic of Urology of the Military Medical Academy, over the period 1990 through 1992, shows that the causes leading to hydronephrotic transformation comprise diseases of congenital and acquired nature involving upper and lower urinary tracts. Congenital disorders affect men and women at an equal male-to-female ratio--1:1, while acquired ones--at 1.8:1 male-to-female ratio; causes located in both upper and lower urinary tract are recorded at a 6.6:1 ratio. Proceeding from the analysis of the case material it is established that hydronephrosis is not a nosological entity of its own, but rather a symptom (complication) of a lesion (obstruction) located in the urinary tract. The compensatory mechanisms aimed at normalization of the elevated pressure affect in a varying degree the upper urinary ways, above the level of obstruction.

Characteristics of the tumours of the urinary tract in patients with endemic nephropathy.

The authors have studies in detail the development of tumours in the urinary tract of patients with endemic nephropathy (EN). They have found tumours in about 40% of these patients. They have performed operations for tumours of the urinary tract in 88 patients with EN, with a different localization in the upper part of the urinary tract. In 10% of the cases they have found bilateral tumours. The histological examination has revealed papillary tumours of a malignant character. They have shown specific symptoms of these tumours, not found with other tumours of the urinary tract. The main symptom is renal insufficiency which causes the death of the patients. The evolution of these tumours is comparatively slow and the nature of EN has determined the operative approach of the authors, a radical operation with haemodialysis when indicated. The paper is illustrated with four typical cases.

[A case of tumors of the kidney and bladder with differing histology]. / Sluchai na tumor na bubreka i pikochniia mekhur s razlichna khistologiia.

A case is presented being of interest because of the simultaneous development of two tumors at different sites of the urinary tract with different histologic structure. The patients, a 56 years old man entered the clinic on July 13, 1988 with painless hematuria. On examination, including intravenous urography, cystoscopy with transurethral echography and computer axial tomography, tumors of the right kidney and of the bladder were identified. The affected kidney was removed and the diagnosis was renal cancer (hypernephroma). A two-step transurethral resection of the bladder was also performed. The histologic diagnosis was moderately differentiated transient-cell carcinoma. The patient is under regular medical observation.

[Intravesical distension in the corrugated tuberculotic bladder]. / Intravezikal'naia distenziia pri tuberkulezno-smorshchennom mochevom puzyre.

The treatment problem of urinary tract post-tuberculous changes is not completely solved. Current methods do not always give good results and are accompanied by some complications. The authors describe their own modified method of hydrostatic intravesical distension of the tuberculotic-cirrhotic bladder, using epidural anesthesia, and worked out indications for it. The results show an increase in the bladder volume from 100-120 to 250-300 ml with a decreased urination frequency in 8 patients. The method occurred to be very convenient-to-use due to the absence of any complications.

[The diseases causing stenosis and obstruction of the ureter]. / Zaboliavaniia, predizvikvashti stesneniia i obstruktsii na uretera.

A total of 681 patients with stenosis and obstruction of the ureter (SOU) have been observed over a period of 5 years. The male/female ratio was 1:1.25. The etiologic factors for development of SOU have been as follows: calculus in the ureter--78 per cent of the total number of patients; infections of the ureter--8.1 per cent; posttraumatic injury to the ureter--6.5 per cent; congenital malformations of the ureter--4.2 per cent; papillary tumors of the ureter--2.7 per cent; retroperitoneal tumor--0.3 per cent.

[Drainage (prosthesis) of the pyelocaliceal system]. / Drenirane (protezirane) na pielo-kaliksnata sistema.

Of 372 patients, treated in the Clinical Center of Urology-Sofia, and sixteen patients treated in the urological clinic at the Military Medical Academy-Sofia, in 241 cases various types of polyethylene drainage systems and prostheses are used, classified into two basic groups: intraoperative prosthetic replacement, and therapeutic prosthetic replacement. Intraoperative prosthetic replacement of the pyelocaliceal system reduces intrarenal pressure, promotes uneventful operative wound healing, precludes obstruction due to the so-called sterile edema at the site of operation, and serves as a drainage and splint; nephrostoma is indicated in selected cases against the background of additional complications, whereas prosthetic replacement during endourologic manipulations is mandatory. The complications associated with prosthetic replacement of the pyelocaliceal system are rare, and lend themselves readily to nonoperative treatment, but in isolated cases surgical intervention is necessitated.

[The procurement and preservation of cadaveric kidneys for transplantation]. / Vzemane i konservirane na trupni bubretsi za transplantatsiia.

In comparison with other organ transplantations, renal transplantation has in recent years shown significant progress. It turned to be a routine and highly physiological method of treatment of patients with terminal renal failure who had been on chronic dialysis treatment. For a successful outcome of renal transplantation essential is the early and competent ascertaining that brain death of the potential donor has occurred. Intensive care (resuscitation) starts for saving the life and when this is impossible, the efforts turn into measures for conditioning the donor. Thus both kidneys are preserved for transplantation. Another important prerequisite for successful renal transplantation is the adequate sampling, effective perfusion and adequate storage of the donor kidneys. The donor-recipient couple is selected by up-to-date immunologic studies. The authors debate in brief the indications and contraindications for organ donorship, the legal aspects in establishing the brain death diagnosis. Measures for conditioning the donor and the surgical technique for obtaining the kidneys, their perfusion and storage are discussed.

[The modern treatment of stenosis and obstruction of the ureter]. / Suvremenno lechenie na stesneniia i obstruktsii na uretera.

The methods used for treatment of stenosis and obstruction of the ureter (SOU) are: conservative treatment, extracorporal lithotripsy, transureteral operations, surgical management. The different genesis of the nosologic entities underlying--SOU requires adequate effective and organ preserving treatment. In the authors series of 681 patients the mot common approach to treatment und transureteral operations (46.7 per cent) with surgical treatment ranking next (44.5 per cent), presented by organ preserving, organ removing, palliative and reconstructive procedures. Third in incidence was extracorporal lithotripsy of ureteral calculi (31.3 per cent). Judirrdual conservative treatment was least common (7.6 per cent). As a result of treatment in 76 per cent of the patients with "mute kidney" renal and ureteral function were re-established after removal of the stenosis and obstruction of the ureter.

[The M-VEC chemotherapy of advanced bladder tumors]. / M-VEC khimioterapiia na avansiralite tumori na pikochniia mekhur.

The authors have treated 34 patients (32 men and 2 women) with advanced transient-cell bladder tumors. Depending on the degree of their infiltration, the tumors were divided in two groups: I. Locally advanced resectable tumors T2-T3B--25 patients, in 16 of whom TUR and in 9 open operation was performed; II. Locally advanced nonresectable tumors T3B-T4--9 patients, 8 of whom were not operated and in 1 ureterocystoneostomy was performed because of hydropyonephrosis. Modified M-VAC chemotherapeutic scheme was applied--M-VEC (epirubicin was substituted for adriablastin): methotrexat 30 mg/m2, vinblastin 3 mg/m2, pharmorubicin 30 mg/m2, biocysplatinum 70 mg/m2. This constellation was applied as adjuvant therapy for group I patients and as nonadjuvant for those of group II. The patients received from 1 to 4 treatment courses. The results of the postoperative application in group I patients were: 7 of those treated with M-VEC after TUR have no recurrence for a period of 12 months and 9 are still under treatment; 4 of the open operation group + M-VEC have no recurrence for 12 months and 4 are still under treatment. In group II where M-VEC was applied as nonadjuvant therapy partial remission was recorded in 3 patients. The authors' early studies on the M-VEC chemotherapeutic scheme in advanced bladder tumors assert the data of other authors: as adjuvant chemotherapy it guards against recurrences, as nonadjuvant may make 50 per cent of the patients operable; reducing the tumors to stages T0, T1 or T1S makes cystectomy unnecessary, thus preserving bladder and sexual function.(ABSTRACT TRUNCATED AT 250 WORDS)

[The clinical course and diagnosis of urogenital fistulae of obstetrico-gynecologic origin]. / Otnosno klinichnoto protichane i diagnostikata na pikochno-polovite fistuli ot akushero-ginekologichen proizkhod.

Ninety two women with urogenital fistulas of obstetric-gynecological origin comprise the study group. In 23 patients (25 per cent) urine outflow from the vagina started immediately after the operation and in 69 (75 per cent) from the 3. day to 2.3 years after childbirth, obstetric operations and manipulations, gynecological and urogynecological operations, irradiation and nonsurgical gynecological diseases. Colpitis had 62 (68.9 per cent) of 90 women subjected to vaginal examination. Eighty patients (87 per cent) had clinical evidence of urinary tract infection and 92.2 per cent laboratory data. Predominated gram-negative bacterial causative agents. Impaired renal function including lack of function was demonstrated in 96.9 per cent of the patients with ureterovaginal fistulas, demonstrated by excretory urography, isotope nephrography and renal scintigraphy, whereas renal function in patients with vesicovaginal and urethrovaginal fistulas remained intact for a long time. In the authors' opinion, most important diagnostic methods are excretory urography, dye tests, cystoscopy with retrograde ureteral catheterization and ureteropyelography. Isotope methods of examination and renal echography are of major value for diagnosis of uretero-vaginal fistulas. Early in 1988 vaginography was included in the group of methods for diagnosis of urogenital fistulas.

[The surgical treatment of urogenital fistulae of obstetrico-gynecologic origin]. / Operativno lechenie na pikochno-polovite fistuli ot akushero-ginekologichen proizkhod.

Ninety-two patients with urogenital fistulas of obstetric-gynecological origin have been treated at the Department of Urology of the Medical Academy in Sofia for a period of 14 1/2 years. Eighty seven women (94.6 per cent) were operated, with a total of 97 operations being performed. Thirty two of 34 patients with ureterovaginal fistula were operated (94.1 per cent). The following operative interventions were performed: 1 definitive nephrostomy, 5 temporary relieving nephrostomies, 4 nephrectomies and 27 reconstructive ureteral operations. Of 51 patients with vesicovaginal fistulas, 48 were operated (94.1 per cent). The following operations were performed: 4 supravesicular derivations of the urine, 21 transvaginal fistulorrhaphies, 16 transvesical suturings of the fistula, 11 transperitoneal and 1 transperitoneal-transvesical fistulorrhaphies. Seven women with ureterovaginal fistulas were operated transvaginally. The time elapses from the appearance of the fistula to the reconstruction was 66.2 days in ureterovaginal fistulas and 5.8 months in vesicovaginal and ureterovaginal ones. Transurethral urinary drainage was the operative method of choice. Eighty-three per cent of the operated patients were cured after the first correcting operation in patients with vesicovaginal and urethrovaginal fistulas. Best were the postoperative results in patients with ureterovaginal fistulas after ureterocystoneostomy by Bömonghaus's method.

[The surgical and spontaneous elimination of kidney calculi--the type, incidence and treatment]. / Operativno i spontanno eliminirani bubrechni konkrementi--vid, chestota i lechenie.

Results are reported of chemical (derivatographic and polarization microscopic) analysis of 2630 calculi removed by operation and 8607 spontaneously eliminated calculi. It was found that 82.7 per cent of the calculi removed by operation and 19.4 per cent of those eliminated spontaneously were mixed--composed of two or more components. The most common "pure" concrements were composed from oxalates and uric acid. The difference in the chemical types of the renal calculi of the two compared groups (removed by operation and spontaneously) is shown and followed up. Of interest is the different incidence of the two calcium oxalate hydrates in the two compared groups of renal calculi. Vevelite was more common in calculi removed by operation, while vedeline was the more common form in spontaneously eliminated calculi. Precision of the chemical form of the calculosis is recommended, with a view to including the genesis of stone formation for effective prophylaxis, treatment and metaphylaxis of the disease.

[Cases of the regression of advanced bladder tumors (T2-T4) after the use of chemotherapy]. / Sluchai na obratno razvitie na avansirani tumori na pikochniia mekhur (T2--T4) sled prilozhenie na kemoterapiia.

A. Yagoda reports that modern therapeutic schemas applied for treatment of bladder tumors have essentially increased the response rate: more than 50 per cent with full response (CRs), within the range from 28 to 40 per cent persisting for a period from 11 to more than 32 months. What appears new, noted by this author, is the complete disappearance of the tumor (restaging) following chemotherapy, demonstrated surgically and on pathologic examination. Proceeding from the current trends in the treatment of bladder tumors and the use of modern chemotherapeutic schemes, the authors describe 4 cases of regression of advanced tumors. This was based on criteria of clinico-laboratory assay, which included urethroscopy with transurethral echography and biopsy specimen examination, computer axial tomography of pelvis and kidneys, radioisotopic examination of kidneys, chest X-ray. Two patients received combined treatment by a scheme with methotrexate, biocysplatinum and biocarbazine; a three-year survival without relapse was recorded. The other two patients were treated using M-VAC scheme (methotrexate, vinblastine, adriamycin and biocysplatinum). They have been under observation for 18 months and had no relapse.

[A case of malignant intestinal lymphoma following a successful kidney transplant]. / Sluchai na malignen chreven limfom sled uspeshna bubrechna transplantatsiia.

A rare case (the first one described in Bulgaria) of malignant intestinal lymphoma, developing in a 50-year-old patient 9 years after transplantation of a normally functioning corpse kidney, is reported. Basic predisposing factor for the lymphoma was the long-term maintenance immunosuppressive therapy with azathioprine and corticosteroids. Apart from this finding, a dissecting aneurysm of the abdominal aorta with partially obliterating thrombus was found. The patient died in a state of severe toxemia of suppurative peritonitis after perforation of the intestines heavily affected by the lymphoma.

[A case of tertiary hyperparathyroidism following kidney transplantation complicated by lithiasis]. / Sluchai na tretichen khiperparatireoidizum sled bubrechna transplantatsiia, uslozhen s litiaza.

For the first time in Bulgaria the authors present a case of tertiary (autonomous) hyperparathyroidism, persisting in a patient who had successful kidney transplantation. Subtotal parathyroidectomy six months after the transplantation led to complete cure. Associated with the underlying disease, a rare complication was also observed in the patient--calculosis in the grafted kidney, spontaneously eliminated 40 days after the parathyroidectomy.

[The endoscopic transurethral treatment of ureterocele]. / Endoskopicheskoe transuretral'noe lechenie ureterotsele.

The authors describe results of transurethral endoscopic treatment of ureterocele in 61 patients, two techniques of a relevant operative intervention, indications, complications of an early (pyelonephritis) and late (vesicoureteral reflux) postoperative period, measures of their prevention. Advancing impairment of the urine outflow via the upper urinary tracts on ureterocele side necessitates earlier surgery (transurethral dissection or resection of ureterocele). Good 4-year follow-up results (normal function of the kidney, absence of pyelonephritis attacks and vesicoureteral reflux) suggest endoscopic transurethral treatment of ureterocele to be a method of choice the failure of which implies open surgical intervention.