[Extra peritoneal anterior pelvic exenteration with total urethrectomy and vaginectomy for bladder and urethra cancer - clinical case and review of literature].

The anterior pelvic exenteration is technically demanding surgical intervention carried out in advanced malignant genito-urethral process origin. It is characterized by a high percentage of intra and postoperative complications. They can be reduced through new surgical techniques, such as extra peritoneal approach to perform this operation. We present a clinical case of 56 years old patient with adenocarcinoma of the urethra/bladder established histologically by TUR (Transurethral) - biopsy. Of the clinical and imaging studies - data for the invasion to the anterior vaginal wall. The patient is after Total Hysterectomy with bilateral salpingo oophorectomy on the occasion of the fibroids in the uterus. After a routine preoperative preparation, we did: extra peritoneal anterior pelvic exenteration with total urethrectomy and vaginectomy. Bilateral extra peritoneal ureterocutaneostomy with "JJ" stents. Bilateral extra peritoneal pelvic lymph dissection. Our clinical case, proves the thesis of many authors about the benefits of extra peritoneal approach for anterior pelvic exenteration. Reduce significantly the intra/post-operative complications, hospital stay and a time to follow postoperative therapy. We consider that the extra peritoneal approach for radical surgery should be applied whenever possible in the interest of the health of the patient.

[The diagnostic and treatment problems in kidney tumors]. / Po niakoi vuprosi na diagnostikata i lechenieto na tumorite na bubreka.

Experience is recorded with the diagnosis and treatment of 90 patients with tumors of the kidney and its pyelocalyx system. Of all methods of diagnosis major importance is attached to computer axial tomography. It is emphasized that the approach to the kidney, the type and scope of the operative intervention should depend on the stage of tumor development. For tumors of the pyelocalyx system it is recommended to perform nephroureterectomy, since this approach rules out the hazard of appearance of tumors in the ureter. The presence of isolated metastases is no contraindication for performing nephrectomy. Indications for organ-preserving operation should be strictly specified. They should applied in patients with single kidney, patients with bilateral tumors and patients with chronic renal failure.

[Diagnosis and surgical treatment of primary tumors of the renal pelvis and ureter]. / Diagnostika i khirurgichno lechenie na purvichnite tumori na bubrechnoto legenche i uretera.

The incidence of primary tumors of the renal pelvis and ureter is progressively increasing; now they account for about 10 per cent of all urothelial tumors with predominance of papillary ones. They metastasize early, most frequently in the liver, the bones and the lung. For a period of 10 years, 46 patients with upper urinary tract tumors of epithelial origin have been examined and treated. In 30 of these patients (65.2 per cent) the cancer was localized in the renal pelvis and in 16 (34.8 per cent) in the ureter. In 40 patients (87 per cent) the initial symptom was hematuria with dull or colic-like pain in the lumbar area. Excretory urography and retrograde ureteropyelography are essential for the exact diagnosis. Treatment should be early and radical--nephrectomy with total ureterectomy and excision of part of the bladder wall near the ureter orifice. Organ-preserving operations are indicated only in cases of single kidney or accompanying disease of the other kidney, which after some time may require its removal.