[A multicenter comparative observation on the effectiveness and the rapidness of the effect of Cystostop Rapid versus antibiotic therapy in patients with uncomplicated cystitis].

UNLABELLED: The currently available treatment for uncomplicated urinary tract infections includes only antibiotics and chemotherapeutic agents. Experience in the management of acute uncomplicated infections using non-antibiotic products is very limited. The aim of this observation was to study to what extent the response to Cystostop Rapid would be more rapid and more effective compared to antibiotic therapy in patients with acute uncomplicated urinary bladder infections. The secondary objective was to determine the time to improvement of cystitis symptoms following the start of treatment, as well as the duration of patients' disablement. A total of 158 female subjects were included, assessed microbiologically, and evaluated for incidence and severity of symptoms, before the start of treatment and after completion of treatment. A visual analogue scale was used for patient self-assessment of the severity of symptoms, the improvement of symptoms, as well as the time to improvement of symptoms. RESULTS: 158 females, eligible according to the inclusion criteria of the study, were allocated to one of the two groups according to time of enrollment: Group A included 86 subjects: assigned to Cystostop Rapid for 3 days and administered according to the manufacturer's recommended regimen; and Group B included 72 women: assigned to ciprofloxacin 500 mg twice daily for 3 days according to the Product Registration File with the BDA. The clinical and microbiological effectiveness of Cystostop Rapid was comparable to that of ciprofloxacin, providing a two-fold more rapid improvement of cystitis symptoms, at a mean time to improvement of 24 hours (p < 0.02) versus 46 hours for ciprofloxacin. Clinical improvement within 48 hours of Cystostop Rapid regimen occurred in 97% (p < 0.02) of patients, vs. 65.3% of patients on ciprofloxacin. Improvement of symptoms within 12 hours was reported in 36% of patients on Cystostop Rapid vs. 5.5% of patients in the ciprofloxacin group (p < 0.02). No adverse events or intolerability to the therapy were reported throughout the course of the study.

[Solifenacin in treatment of the overactive bladder syndrome--diagnosis, clinical management and results].

UNLABELLED: The overactive bladder syndrome (OAB) is a pathological condition that affects millions of people round the world. Its incidence increases with ageing. The main therapeutic option for OAB nowadays is anti-muscarinic drug therapy. AIM: To define and implement the diagnostic criteria, clinical guidelines in our country and to evaluate the results of Solifenacin therapy in patients with OAB. MATERIAL AND METHODS: Along a three years period (2006-2009) 163 OAB patients were analyzed followed and treated. In our group of patients 106 (65.2%) are females and 57 (34.8%)--males. The diagnosis is based mainly on the complaints of the patient, evaluated thoroughly with a detail anamnesis and questionnaires. Urodynamic studies were performed In some of the patients. The efficacy of Solifenacin therapy has been validated with the same methods used in SUNRISE and VENUS studies. RESULTS AND DISCUSSION: The mean age of female patients in our group is 63.8 years, and 65.6 years for males. The most commonly observed symptoms of OAB are urgency--88.3% and frequency--92%. Urge-incontinence is observed in 48.8% of the cases. Therapy with Solifenacin 5 and 10 mg has alleviated urgency in 82% and urge-incontinence in 88.9%. Mean number of pads used for 24 hours has decreased from 2.6 to 0.4 after therapy. CONCLUSION: Urgency is the main mandatory symptom for the diagnosis OAB. Therapy with Solifenacin 5 and 10 mg guarantees very good clinical results, and high degree of compliance of the patients.

[40 years of renal transplantation in UMHAT "Alexandrovska"].

The process of transplantation of tissues and organs, as a highly specialized treatment method, has a unique place in the field of medical science and practice. On occasion of the 40 anniversary of the first renal transplantation in adult in Bulgaria, the developments in this area are reviewed chronologically. The initial experiments on test animals, as well as the first renal transplantation in adult are described in details. For the abovementioned period 435 renal transplantations have been performed in UMHAT "Alexandrovska", 231 (53.2%) form living kidney donor and 204 (46.9%)--from cadaveric renal donors. The benefits of the existing organization of transplantation in UMHAT "Alexandrovska" are outlined, as well as the problems preventing the transplantation process to achieve even wider usage as a method for treatment of end-stage organ diseases.

[Urethroplasty with combined free tissue grafts].

UNLABELLED: The treatment of the congenital and acquired diseases of the male urethra is a serious health and social problem. The lack of sufficient graft material from the genital area leads to the usage of free tissue grafts from other body parts. The combined usage of different tissue grafts is rare, but with a steady trend for expanding, particularly in patients with complications and deformations after surgery for hypospadia MATERIALS AND METHODS: Presenting the initial experience with using combined free tissue grafts in eight patients, aged 19 to 65 years. In 6 (75%) the indication for application of this technique are recurrent urethral fistulas and deformity of glans penis after surgery for hypospadia, and in 2 (25%) case patient with a severe form of Balanitis Xerotica Obliterans (BXO) and long urethral stricture. We used graft material form buccal mucosa and retroauricular skin. The buccal mucosa graft was used for correction of the stricture of the anterior urethra, and the retroauricular skin - for meatoglanuloplasty. RESULTS: In 75% of the cases we achieved very satisfactory results, consisting of: 1. Full patency of the urethra; 2. Definitive closure of the fistula; 3. Satisfactory correction of the deformity of glans penis. In 1 case we observed recurrence of the fistula, and in another one - formation of new fistula with full patency of the urethra Complications and deformities from the graft site had not been observed. CONCLUSIONS: initial experience with combined usage of buccal mucosa and free skin graft from the retroauricular area for reconstruction of the male urethra and penis gives promising results, especially in cases with "crippled" hypospadia and with severe forms of Balanitis Xerotica Obliterans (BXO).

[Urethroplasty in long strictures of the anterior urethra].

UNLABELLED: Strictures of the male urethra are always very serious therapeutic problem, regardless of their localization. The presence of variety of surgical modalities for their treatment, impose the need for differentiated approach and clear criteria for their use. Particularly interesting for the clinicians and the researchers are the long strictures of the anterior urethra MATERIAL AND METHODS: For period of 12 years (1992-2004) 56 patients with urethral strictures were diagnosed, operated and followed. Of them 38 (67.9%) have stricture of the anterior urethra and 18 (32.1%) strictures of posterior urethra. In patients with stricture of the anterior urethra in 16(42.1%) the length of the stricture was between 2 and 5 cm, in 13 (34.2%) over 5 cm, and in 9 (23.7%) had multiple strictures. In patients with length of the stricture over 5 cm three surgical modalities of urethroplasty were mainly applied: free buccal mucosa graft--7 (53.8%); pediculated preputial flap--4 (30.8%) and longitudinal ventral skin flap--2 (15.4). RESULTS: Late results of the treatment of patients with long strictures of the anterior urethra show that in 76.9% of cases there is good and lasting patency of the urethra. In 2 cases (15.4%) formation of pseudodiverticula was observed, in another 2 (15.4%)--restrictures in the site of anastomosis, and in 1 (7.7%)--formation of urethral fistula. CONCLUSIONS: The long strictures of the urethra are extremely serious therapeutic problem, which demands a precise choice of the surgical technique for their treatment. The introduction in practice of the buccal mucosa graft urethroplasty sharply improved the options for treatment of this disease.

[New metod for recovering of defects on Glans penis after partial or total glansectomy with transplantation of the oral mucosa].

OBJECTIVES: The aim of the present research is to present a new surgical method of treatment of tissue defects of Glans penis through cover of the wound surface with free transplantation of patient's oral muccosa patch graft. The Glans penis defects treated have formed from excision of primary tumor lesions through partial and total glansectomy. METHODS: For a 3-year period (2003-2005), 13 patients having penile cancer were diagnosed and treated at the Clinic of Urology, Medical University, Sofia In 7 (53.8%) of these, were found to be in phase T1NoMo. In 5 (71.4%) of the said cases, in order to cover the tissue defect, free mucosa transplant was used upon partial or complete glansectomy. In 4 (80%) cases, buccal mucosa patch graft was used, and in 1 (20%) case--patch graft from lower lip oral mucosa. RESULTS: The histological results from the operations performed have confirmed the staging of the disease, where they have shown 4 flat-cells and 1 verrucous cancers. Within the early post-operative period, no surgical complications were noted, not only at the place of extracting the transplant, but also at the place of its transplantation. Late complications and relapses have not been observed. CONCLUSIONS: Our initial experience with utilizing free transplantation of muccosa extracted from the oscular cavity for replacement of the surgical defect upon partial or complete glansectomy has shown it is an alternative to the rest of treatment methods. Buccal mucosa patch graft is more suitable in the case of partial glansectomy because it has a thicker wall.

[Partial glansectomy by organsparing therapy of penile cancer].

OBJECTIVES: The aim of the present research is to study the patients, having penile cancer diagnosis, treated at the Clinic of Urology, Medical University, Sofia, during the last 8 years. The study is focused on patients, undergoing T1 phase, treated through organsapring intervention partial glansectomia. METHODS: From all 37 patients treated during the period from year 1998 to year 2005, 15 or 40% were in phase T1. By 7 patients or 19% were in phase T1 with infiltration of less of the half from Glans penis. Organsparing operation partiale glansectomy was undertaken for the patients in phase T1, with wite tomor surface. RESULTS: A total number of 15 patients treated in T1 phase have been studied. The following interventions were undertaken: glansectomia partialis in the case of 7 patients. The results were followed. The types of organsparing surgical interventions have been researched. CONCLUSION: The partial glansectomy as kind of organsparing treatment may be successfully applied to cases of penile cancer in T1 phase. The experience of other authors implemented organsparing treatment has been shared.

[Amyloidosis of the urinary tract--case report and review of the literature].

Amyloidosis is a systemic disease which affects a variety of body organs and systems, and is characterized with the deposition of hyalin, eosinophilic, protein-like material in the tissues. Primary amyloidosis of the urinary tract is an extremely rare localization and every published case report represents interest. The authors present a rare case of primary localized amyloidosis of the bladder, which mimics itself as a neoplastic formation and imposes significant diagnostic and therapeutic difficulties. The correct therapeutic approach and the exact histopathologic diagnosis has enabled us to preserve the bladder of the patient and to achieve optimal therapeutic results.

[Urethroplasty in strictures of the posterior urethra with buccal mucosal graft]. / Uretroplastika pri strikturi na zadnata uretra s bukalna ligavitsa.

UNLABELLED: The treatment of the strictures in the posterior urethra and especially in its bulbar part is a serious therapeutic problem. The urethroplasty with a buccal mucosal graft is a good choice in solving this problem. MATERIALS AND METHODS: For a period of 8 months (11.2002-06.2003) 5 patients with strictures of the posterior urethra we operated and followed up. In 3 cases (60%) we made a ventral urethroplasty, and in 2 (40%) dorsal. The free buccal mucosal was taken from the inner part of the lower lip. We used an "onlay" technique in all patients. RESULTS: The patients were from 32 to 76 years old (on average 56.2). All of them suffered several operative procedures before that. The causes of the strictures in 3 (60%) cases were due to medical treatment, in 1 (20%) case due to trauma and in 1 (20%) case due to inflammation. After the removing of the catheter all patients were urinating spontaneously with a flow > 15 ml/sec. Only in 1 patient, 10 days after the removing of the catheter, an urethrocystoscopy was done with an UTI, because of a retention. CONCLUSIONS: The urethroplasty with a free buccal mucosal graft gives us great possibilities and priorities in the treatment of the strictures of the posterior urethra.

[LUTS in women and possible therapeutic effects of alfa1-adrenoblockers]. / LUTS pri zheni i vuzmozhnosti za terapevtichno povliiavane s alfa1-adrenoblokeri.

UNLABELLED: Lower Urinary Tract Symptoms (LUTS), including urinary incontinence, are one of the most common problems in women pathology. OBJECTIVE: The objective of the authors is to determine the symptomatic index, to perform an urodynamic assessment and to establish the therapeutic possibilities of the alfa1-adrenoblokers in women with LUTS. MATERIAL AND METHODS: In the course of a three year period (2001-2003) 74 women, ranging in age from 26 to 76 years old (average age of 48.6), have been examined and monitored. The symptomatic index was measured by a questionnaire, developed on the basis of IPSS and BFLUTS. The urodynamic study was performed with a multi-channel system Dantec-Meneut and includes multi-chanel cystrometry, followed by measuring of the pressure and the speed of urinary flow before the treatment and after it. Therapy with the L1-adrenoblocker Doxazosin was applied to 42 (56.7%) of the patients. RESULTS: 51 (68.9%) women were with predominantly irritative symptoms, and 23 (31.1%)--with predominantly obstructive. The urodynamic studies reval: 1. Obstruction of the lower urinary tract--7 (9.4%); 2. Obstruction with detrusor hyperactivity--15 (20.3%); 3. Detrusor hyperactivity--33 (44.6%); 4. Sensory urge-syndrome--6 (8.1%); 5. Disturbed contractility of the urinary bladder--4 (5.4%); 6. With no significant deviations--9 (12.2%) Total disappearance of the symptoms was achieved in 64.3% of the patients with the prescribed therapy, while in 11.9% symptoms have relapsed after discontinuation of the therapy. CONCLUSIONS: LUTS in women is not only a gerontology problem. It affects more and more often women in active and child-bearing age. The therapeutic use of alfa1-adrenoblockers is one alternatives in the treatment of these patients.

[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.

[Orthoclone OKT3 (Muromonab CD3)--the indications for and manner of its use. Side effects and their prevention]. / Ortoklon OKT3 (Muromonab--SD3)--indikatsii i nachin na prilozhenie. Stranichni iavleniia i profilaktika im.

In the last decade renal transplantation has gained considerable development. This is due to the achievements of clinical immunology and refinement of the surgical technique. In spite of all this, the achievements of renal transplantation are variable. This primarily is due to T-lymphocyte mediation, causing hazards for graft rejection. At present, numerous therapeutic agents, blocking the immune response of the organism, are applied. They are most effective when block selectively the activity of the immune cells responsible for immune response. The first synthesized preparation is Orthoclone OKT3 (Muronab-CD3). It is a sterile solution of murine monoclonal antibody to T3 (CD3) antigen in human T-cells and functions as immunosuppressor. The first experimental data on its application have been published in 1975. In 1980 the preparation was applied for the first time for treatment of acute reaction for grafted kidney rejection. The authors set themselves the task to give a brief review of the nature of this preparation, mode of its storage, indications for use, side reactions and their prophylaxis.

[Echinococcus of the kidney]. / Ekhinokok na bubreka.

Echinococcus of the kidney is a rare form of hydatid disease, and accounts for 2 to 3 per cent of all echinococcoses. Over a ten-year period (1987-1996), eight patients with age ranging from 30 to 61 years are diagnosed and treated. Five of them (62.5 per cent) are discovered in the last two years. In seven instances (87.5 per cent) the diagnosis is made preoperatively on the ground of laboratory examinations; serological tests--intradermal test of Casoni and complement fixation after Ghedini-Weinberg, echographic and roentgenological methods. In two patients (33.3 per cent) scoleces and Echinococcus fragments are discovered in the urine. The serological tests are positive in five cases (62.5 per cent). All patients undergo operation, with nephrectomy performed in five (62.5 per cent), and capsula adiposa renis--in three (37.5 per cent). So far, no relapse of the disease is recorded.

[The incidence of kidney carcinoma and its occupational distribution in patients in the Republic of Bulgaria]. / Chestota na bubrechniia kartsinom i professionalno razpredelenie na bolnite v Republika Bulgariia.

As pointed out by J. R. McLaughlin et al. (1983), in the various countries worldwide there is considerable difference in incidence and mortality rates of renal carcinoma. In the period 1973 to 1994, a total of 509 patients with renal carcinoma are admitted to the Department of Urology (Clinical Center of Urology, Medical University--Sofia). They represent 0.82 per cent of the total number of admissions during the stated period, and 7.71 per cent of the patients with diseases of the urogenital system. According to data submitted by the National Center of Oncology, the incidence of renal carcinoma amounts to 1.53 per 100,000 of population. As shown by the results most of the patients come from Vratsa and Vidin districts. By incidence rate of the disease Bulgaria is assigned to the moderate morbidity type in Europe. Patients in active age amount to 66.46 per cent, and old age pensioners--to 31.74 per cent.

[Urological complications following kidney transplantation in childhood]. / Urologichni uslozhneniia sled bubrechna transplantatsiia v detskata vuzrast.

Five urologic complications in the posttransplantation period were performed in a case material of 68 renal transplantations in children, performed at the Transplantation Center in Lille, Northern France over the period 1981-July 1990. Three patients had ureteral stenosis (4.4 per cent), 1 urinary fistula (1.5 per cent) and 1 calculosis (1.5 per cent). All these cases are described and illustrated with figures. Comparing the results with those reported from other leading transplantation centers, the authors point to the low incidence of urologic complications in their case material (7.3 per cent). This encouraging result is attributed to the adequate selection of recipients, preliminary removal of accompanying urologic anomalies, early transplantation (82 per cent before the end of the second year after initiation of hemodialysis), as well as to precise explantation and transplantation.

[Strictures of the urethra--the etiological factors and therapeutic management]. / Strikturi na uretrata--etiologichni faktori i terapevtichno povedenie.

Strictures of the urethra pose problems still disputable in the literature owing to the variety of etiological factors involved, and difficulties encountered in choosing the most adequate therapeutic approach. Ninety-six patients presenting urethral stricture are studied over a 5-year period (1991-1995). The commonest causes of stricture formation are postinflammatory (51 per cent), postoperative (34.4 per cent) and posttraumatic (14.6 per cent). The study covering 578 patients, treated by transurethral resection for other disease during the aforementioned period, shows that postoperative strictures develop in 2.6 per cent of them. In 81.2 per cent of cases the stricture involves the anterior urethra, and in 18.8 per cent--the posterior. The presence of multiple strictures is found in 27.1 per cent. Visual internal urethrotomy is the operative procedure most frequently used--in 85.4 per cent of cases. In 3.1 per cent urethroplasty with a pedicled preputial flap is performed. Recurrences are recorded in 7.3 per cent. Emphasis is laid on the direct interdependence existing between etiological factors and pathoanatomical stage having an essential practical bearing on the choice of optimal therapeutic approach.

[Uroinfections and the possibilities of therapy with levofloxacin]. / Uroinfektsii i vuzmozhnosti za terapevtichno povliiavane s levofloxacin.

UNLABELLED: The common occurrence, of inflammatory diseases in the urinary tract and the genitals in men, is quite a reason for identification of the agents and looking for some new chances of therapeutic treatment. MATERIALS AND METHODS: For a period of two years (2002-2003) we accomplished 4810 microbiological tests of urine and prostate secretion on patients with uroinfections. The cultures are completed on standard nutrition medium, as the biochemical identification of the strains is accomplished by the systems mini API and "bio Merieux" BBL Crystal, "Becton Dickinson". Meanwhile for a period of one year, 113 patients with different uroinfections are treated and studied. In 16 (14.1%) Levofloxacin (Tavanic-R) is applied i.v. 500mg/daily as in the rest cases 97 (85.9%) Tavanic are applied per oral in different therapeutic doses. RESULTS AND DISCUSSIONS: The most common agent in our study was the E. Coli, as for the year 2003 we read an increase of the infections caused by E.Coli with 3.4% comparing to the previous one (38.5% to 35.1%). The differentiation of patients treated with Levofloxacin in groups is completed as follows: with acute uncomplicated cystitis--pyelonephritis after ESWL--15.9%; with postoperative uroinfections--20.3%; with chronic post-tuberculosis pyelonephritis--4.4%; and with inflammatory diseases of the male genitals--37.2%.

[Continent derivation of urine (a Modo) Mainz II]. / Kontinentna derivatsiia na urinata tip (a Modo) Maints II.

The improved intestinal dissection technique and antibiotic agents, and the development of new resorptive suture materials have led to renewed surge of interest in ureterosigmoidostomy as a practicable procedure for continent derivation. Based on data from urodynamic assessment of diverse forms of urinary derivation, M Fisch and R Hohenfellner in 1991 propose a modification of the classical technique of ureterosigmoidostomy, coined with the term Sigmarectum pouch or Mainz pouch (M Fisch, R. Wammack, R Hohenfellner 1991). Over the period 1992 through 1999, 46 operations type "Mainz II" are performed in the Department of Urology--University Hospital "Alexandrovska". The series includes 41 men and 5 women with age range 42 to 80 years. All patients present urinary bladder tumors. The usual surgical technique is used. The severest postoperative complications include: urinary fistulae--3 (6.52%), local relapse--4 (8.69%) and distant metastases--2 (4.35%). In six patients the outcome is fatal (0.7%). This type of continent derivation following cystectomy is recommended since it is convenient, practically atraumatic and well tolerated by the patients. Complications encountered seldom necessitate operative intervention.

[Post-cystectomy derivations - a rule or control of technical skills?]. / Derivatsii sled tsistektomiia - pravilo ili ovladeni tekhniki?

Limitations in gaining better understanding of bladder tumor responsiveness do exist, and accordingly the therapeutic interventions undertaken in diverse forms of the disease are conspicuous for discrepancies (M. J. Droller, 1990). E. Bricker in 1950 is the first to practically implement ileal conduit for urine derivation, and thus initiates the new and newest continent derivations. Over the period 1992-1998, in the Chair of Urology are performed 76 cystectomies with different urine derivations, using seven methods for the purpose: [table: see text] Also discussed are the conditions a derivation should mandatorily meet. Emphasis is laid on the fact that the choice of derivation is still largely dependent on the skill and experience of urologists.