[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.

[The use of BCG vaccine in the treatment of surface tumors of the bladder]. / Primenenie vaktsiny BTsZh v lechenii poverkhnostnykh opukholei mochevogo puzyria.

The paper presented results of the treatment of 110 patients with vesical surface tumors, 85 of them were postoperatively treated according to the regime suggested by Adolphs and Bastian and slightly modified for patients with relapsing vesical tumors. For the therapeutic or preventive effect (after TUR or transvesical electrical resection of the urinary bladder surface tumors), the authors used for 6 weeks after the operation intravesical instillations of BCG vaccine ("Calgevax", Bulgarian production) in a weekly dose of 120 mg per 50 ml of the serum. Previously, for this purpose intravenous injections of cyclophosphamide had been routinely used in a dose of 700 mg/m2 during 2 postsurgery weeks. Intracutaneous vaccinations were performed simultaneously. The follow-up which lasted from 18 to 48 months revealed tumor relapses only in 26 per cent of those under study. The patients with relapses were repeatedly operated on, but their postsurgical management was modified: 2 intravesical instillations of 120 mg of BCG vaccine during the first month after the surgery and then monthly instillations of the same dosages for the whole of the year followed. A subsequent 14-26-month follow-up revealed no relapse of the tumors. The authors concluded that the use of BCG vaccine was a practicable part of the combined treatment of patients with vesical surface tumors.

[Computed tomographic staging of bladder tumors]. / Kompiuturtomografsko opredeliane na stadiia pri tumori na pikochniia mekhur.

Cystoscopy plays a leading role in the diagnosis of bladder tumors. However, in filtration of the bladder wall in depth and the perivesical spreading remains a moot point. Computer tomography (CT) furnishes the opportunity for complex assessment of the stage of bladder tumors. Personal experience is recorded with the study of 43 patients with previously diagnosed bladder tumors. Once the tumor has been verified on surgical intervention, the exactness of CT in determining the T-stage was 88 per cent and of the H-stage--67 per cent. T3-A was the earliest stage susceptible to be demonstrated by CT. The morphologic patterns of perivesical dissemination of the tumors evaluated by CT are described. A scheme is suggested for the place of computer-tomographic examination in assessing the state of patients with bladder tumors.

[Adjuvant chemotherapy with biocisplatin, methotrexate and biocarbazine in advanced bladder tumors]. / Adiuvantna khimioterapiia s biotsisplatina, metotreksat i biokarbazin pri avansirali tumori na pikocniia mekhur.

In a series of 44 patients with advanced nonmetastatic bladder tumors the authors carried out complex treatment: operative removal of the tumor with subsequent (adjuvant) chemotherapy. Tumor transurethral resection (TuTUR) was performed in 26 patients and open operation in 18. The chemotherapeutic scheme included: biocysplatinum 60 mg/m2, methotrexat 15 mg/m2 and biocarbazin 200 mg/m2. Each patient received up to three therapeutic courses. The following late results were obtained: For a period of 6 to 12 months in 3 patients the tumor progressed and two of them died; twenty three patients, i.e. approximately half of the patients in this series (52.2 per cent) had no recurrences until the end of the second year. There was on essential difference between the number of recurrence-free patients for two years between the two approaches: TuTUR + chemotherapy--14 patients (53.8 per cent) and those subjected to open surgery + chemotherapy--9 patients (50 per cent). For a period of 3 years 12 patients had no recurrences (27.2 per cent). The most common side reactions to chemotherapy were leucopenia and vomiting. A few patients had transient renal dysfunction.

[The current concept of tumor markers in oncological urology--cell surface markers]. / Suvremenna kontseptsiia za tumornite markeri v onkourologiiata--marekri na kletuchnata povurkhnost.

Basic problem of the diagnosis and treatment of superficial noninvasive bladder cancer is the absence of criteria for its potential invasiveness. In recent years it became clear that cell differentiation in some cancer forms essentially depends on the presence or absence of some antigens on the cell surface. These may be demonstrated by means of appropriate methods and may thus serve as marker in determining the prognosis and the stage of the disease and for monitoring the therapy in patients with bladder carcinoma. Of major value for the clinical practice are the clinical practice are the T-antigen, the ABO(H) antigens and the tumor-assisted antigens. Demonstration of T-antigen is effectuated by means of a modified erythrocyte-binding test and of the ABO(H) antigens by the Davidsohn's test. Correlation of these antigens with the pathological and clinical stage in a series of studies has demonstrated their practical significance in choosing an optimal therapeutic plan. There also exists relationship between the blood group antigens and the degree of malignancy in urothelial tumors. This allows a more precise evaluation of the indications for organ-preserving operation in some cases.

[The gastrointestinal tract as the possibility for a reservoir for the urinary system. A modification of the Mainz pouch technic]. / Gastro-intestinalniiat trakt kato vuzmozhnost za rezervoar na pikocho-otdelitelnata sistema. Modifikatsiia na Mainz-pouch tekhnikata.

Experience accumulated over the past decade with utilization of the gastrointestinal tract in the formation of a reservoir of the urogenital system shows that the Mainz-pouch technique contributes greatly to obtain a continent reservoir, mainly by Bauhin's valve reconstruction. A procedure is suggested enabling retroperitoneal implantation of the reservoir, formed by the original Mainz-pouch technique, in the lower right quadrant of the posterior abdominal wall, instead of suspending it in the abdominal cavity where it anastomoses with the umbilical anulus and augments the hazard of ileus. The 63-year-old woman with urinary bladder carcinoma, operated according to the modification described, tolerates the intervention free of complications with very good immediate outcome in terms of continence.

[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)

[Initial clinical studies of the preparation Immucyst for immunotherapy in patients with carcinoma in situ (CIS) of the bladder]. / Nachalni klinichni prouchvaniia na preparata Immucyst za imunoterapiia pri bolni s kartsinom in situ (CIS) na pikochniia mekhur.

Over a 12-month period, thirteen patients, 10 men and 3 women, with recurrent surface transitional cell carcinomas of the urinary bladder in conjunction with CIS, are picked out and subjected to treatment. Distribution of the patients: primary multiple carcinomas combined with CIS, Ta-T1/G1-G2-4 cases; recurrent multiple carcinomas, with CIS, Ta-T1/G2-two, recurrent multiple carcinomas, combined with CIS, Ta-T1/G2-five, and T1/G3-two cases. In all instances transurethral resection (TUR) of both visible carcinomas, and CIS areas, is performed. Induction Immucyst therapy is carried out according to protocol: 3 vials BCG vaccine, dissolved in 50 ml serum, inserted intravesically once weekly over 6 weeks. The fluid is retained by the patients for up to 2 hours. Therapy is commenced within 7-14 days after TUR. Cystoscopy, cytology and biopsy of suspected areas ar done at 3, 6 and 12 days. Six of the patients reported on undergo 12-month follow-up study. The remainder (6 cases) are followed up for periods ranging from 3 to 6 months. At the actual stage of study, twelve patients are free of recurrences, and present negative cytological findings. One patient alone with carcinoma stage T1/G3 develops recurrence, treated with TUR and laser coagulation followed by immunotherapy. Two thirds of the patients sustain transitory pollakiuria and dysuria, and one third-subfebrile temperature persisting for 48 hours.

[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.

[The treatment of severe and complicated urethral strictures]. / Lechenie na tezhkite i uslozhneni strikturi na uretrata.

Stricture of the urethra is produced by a cicatrix causing narrowing of the urethral lumen subsequent to trauma or inflammation. The strictures are considered as serious whenever the meatus is involved, and total--in the event of obliteration of the urethra (H. Sachse, 1978). The complications are associated with perineal, scrotal or suprapubic fistulae (C. Devine, P. Devine 1989). This is a report on 37 men presenting severe complicated strictures of the urethra, treated over the period 1981-1995 in the Clinical Center of Urology. According to underlying cause the strictures are divided in: postoperative--7 cases, iatrogenic--6, inflammatory--1, traumatic--23, and patients with scrotal fistulae--3. The patients are operated using a combined method through open and endoscopic manipulation; in 3 cases plastic repair of the urethra with a preputial flap is done. The overall results are estimated as good.

[The comprehensive examination of patients with recurrent calcium nephrolithiasis]. / Kompleksnoe obsledovanie bol'nykh retsidiviruiushchim kal'tsievym nefrolitiazom.

Hypercalciuria is one of the main causes of recurrent generation of urinary calcium-containing calculi. 107 patients with recurrent calcium nephrolithiasis were examined and results presented. Concentrations of potassium, sodium, chlorides, calcium, phosphorus, uric acid and creatinine were investigated in serum and urine, as well as indices of acid-base balance in arterial blood. pH-metry, "preliminary" and oral calcium tolerance test were also carried out. The microcomputer data analysis established that the diagnosis of primary hyperparathyroidism may be identified in case of increased serum calcium level before and after calcium load test, the same of parathyroid, and increased urinary cAMP excretion. Renal hypercalciuria is characterized by low blood calcium level in both periods of the oral test, high basal calciuria, increased urinary cAMP excretion and its slight decrease after the oral calcium load test, by a tendency to lower serum magnesium levels in high magnesuria. The patients with absorptive hypercalciuria had an upper normal or increased blood calcium level, a significant calcemic and calciuric "response" to the calcium load, reduction in urinary cAMP elimination and more severe decrease (close to 0) of these indices after oral calcium load and normal magnesium levels in blood and urine. On a base of the "preliminary" test data the patients with relapsing calcium nephrolithiasis and metabolic disorders may be differed from those without calcium and phosphorus metabolic deteriorations. The "preliminary" test defines indications for the oral calcium tolerance test, automatic diagnosis and computer data storage facilitate physician to work and to solve problems of the patients' survey.