The use of mannitol in partial and live donor nephrectomy: an international survey.

PURPOSE: Animal studies have shown the potential benefits of mannitol as renoprotective during warm ischemia; it may have antioxidant and anti-inflammatory properties and is sometimes used during partial nephrectomy (PN) and live donor nephrectomy (LDN). Despite this, a prospective study on mannitol has never been performed. The aim of this study is to document patterns of mannitol use during PN and LDN. MATERIALS AND METHODS: A survey on the use of mannitol during PN and LDN was sent to 92 high surgical volume urological centers. Questions included use of mannitol, indications for use, physician responsible for administration, dosage, timing and other renoprotective measures. RESULTS: Mannitol was used in 78 and 64 % of centers performing PN and LDN, respectively. The indication for use was as antioxidant (21 %), as diuretic (5 %) and as a combination of the two (74 %). For PN, the most common dosages were 12.5 g (30 %) and 25 g (49 %). For LDN, the most common doses were 12.5 g (36.3 %) and 25 g (63.7 %). Overall, 83 % of centers utilized mannitol, and two (percent or centers??) utilized furosemide for renoprotection. CONCLUSIONS: A large majority of high-volume centers performing PN and LDN use mannitol for renoprotection. Since there are no data proving its value nor standardized indication and usage, this survey may provide information for a randomized prospective study.

[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.

Men with LUTS and diabetes mellitus.

INTRODUCTION: Diabetic urinary bladder disfunction is a common problem. Disfunction will occur in about 80% of diabetic patients. Comon symptoms include retention, overactive bladder, sfincted dissinergy and urinary tract infections. MATERIAL AND METHODS: In nine months period from 08.2013. to 05.2014. fourteen patients with lower urinary tract symptoms (LUTS) and diabetes were evaluated by uroflowmetry, cistotonometry with electromyography and pressure flow study. Including criteria consisted of IPSS more than 8, PSA lower than 4, RT carcinoma excluded and prostate size more than 25 cm3. REZULTS: Patient age was 50 to 77 years. In two patients due to acute retention urinary catheter was inserted. Only they were treated with alfa blockers while other patients received no therapy. Four patient had insulin dependant diabetes while ten of them had diabetes regulated with oral antidiabetics. Cistotonometry presented detrusor overactivity in two patients, treated with M cholinergics. In one patient overactive detrusor activity was in the same time presented with urge incontinence and treated in the same way. Normal detrusor activity was recorded in 14 patients on pressure flow evaluation. In 8 patients with Q max more than 15 ml/s treatment was watchfull waiting. In 4 patients with Q max more than 12 ml/s alfa blockers were introduced. In 2 patients with Q max less than 10 ml/s bipolar TURP was the treatment. CONCLUSION: Diabetes and diabetic bladder disfunction will have a great impact on quality of life due to an aging population. All specialities should be informed for diabetic bladder disfunction and necesssity for recognition and treatment. Further investigation is needed in terms of understanding the risk factors, mechanisms and the most adequate therapy.

[A comparison between clinical and echographic staging in bladder tumors]. / Sravnenie mezhdu klinichen i ekhografski staging pri tumorite na pikochniia mekhur.

In a series of 94 consecutive unselected patients with bladder tumors the authors determined the tumor infiltration stage (tumor staging) by two methods. In all patients the echographic stage was previously and independently established by transurethral echography. The clinical staging was subsequently made according to the requirements of the International Union for Cancer Control (IUCC). The results obtained by the two methods were compared and a high degree of coincidence (81 per cent) was found. The lack of coincidence in the borderline stages between superficial and infiltrative lesions is discussed. The ultimate staging in bladder tumors is recommended to be based on the complex data of all methods: echography, computer axial tomography and clinical examination.

[The transurethral use of laser therapy in urology]. / Transuretralno prilozhenie na lazerterapiia v urologiiata.

The utilization of laser energy plays an ever increasing role in medicine, surgical practice in particular. This is most clearly expressed in the field of urology where endoscopic access to the entire urogenital system is possible against the background of a continuous improvement of the surgical armamentarium over the past few years. The various types of lasers available, qualities of the laser source, and the physical and biophysical principles of their action are comprehensively described. The creation of this particular type of energy (laser), transmissible along flexible quartz fibers and not absorbed by water, considerably increases the interest in laser treatment of diseases of the urinary bladder and urethra. Laser therapy has important clinical implications, and broadens the scope of endoscopic treatment of a variety of urological diseases involving the upper urinary ways.

[The diagnosis, biopsy and treatment follow-up by ultrasound in patients with prostatic carcinoma]. / Diagnoza, biopsiia i kontrol na lechenieto chrez ultrazvuk pri bolni s kartsinom na prostatnata zhleza.

Prostate carcinoma accounts for 1-5 per cent of all neoplasms affecting men, and represents 29.2 per cent of the tumors involving the urogenital system. It is a disease encountered in advanced age mainly--between 60 and 70 years, and recently even earlier. It is pointed out that transrectal ultrasound examination is usually used for diagnosing prostate carcinoma, determination of its stage, and follow-up study of the treatment effect. The clinical relevance of transrectal echography augments whenever performed in conjunction with biopsy of the prostate under ultrasound control, especially in the event of impalpable neoformation, or in uncertain negative, digitally oriented biopsies. The screening method proposed is capable to provide for a sufficiently accurate orientation towards the site for performing control biopsy of the prostate, but it could hardly serve as a reliable, independent criterion for estimating the effect of the nonoperative treatment in course.

[The C-reactive protein level of patients after the extracorporeal lithotripsy of urinary calculi]. / Nivo na C-reaktivniia protein pri bolni sled ELPK.

Within 24 to 48 hours of sustaining a variety of severe clinical conditions, such as general bacterial infection, tissue necrosis, acute rheumatism, myocardial infarction, active pulmonary tuberculosis and neoplastic processes, the serum level of C-reactive protein may show a considerable increase. It may also serve as a criterion for the evolution of the disease, and for the effect of the therapy in course. The task undertaken is to use the serum level of C-reactive protein as a criterion for evaluating the extent of renal parenchyma damage following extracorporeal lithotripsy of urinary calculi (ELUC). Proceeding from the results of the study, it is assumed that ELUC is a nontraumatic operative intervention for the renal parenchyma. In case of extreme increase in C-reactive protein level, a higher incidence rate of post-ELUC complications may be anticipated.

[The diagnosis, biopsy and treatment follow-up via ultrasound in patients with prostatic carcinoma]. / Diagnoza, biopsiia i kontrol za lechenieto chrez ultrazvuk pri bolni s kartsinom na prostatnata zhleza.

According to data available in the literature prostate cancer accounts for 0.2 to 0.4 percent of all cancer diseases, 1 to 5 per cent of all tumors in males and 29.2 per cent of the tumors affecting the urogenital system. The consensus today is that prostate cancer is the most common tumor of the urogenital system. It is a disease of the advanced age, being most common in the age group 60 to 70. It is pointed out that transrectal echography has gained acceptance basically for the diagnosis of prostate cancer, for determining its stage and for check-up of the effect of treatment. According to M. Devonec et al., J. Pointes et al, the specificity of this method is 79 per cent and its sensitivity 48 per cent. The echographic diagnostic criteria for prostate cancer are described. The value of transrectal echography increases when performed with biopsy specimen examination under ultrasound control, especially in nonpalpable neoplasms or when digitally directed biopsy specimens have yielded doubtful or negative result. The method is noninvasive, practicable and well tolerated; this makes it particularly valuable for control of the effect of treatment.

[The treatment of prostatic carcinoma with cyproterone acetate]. / Lechenie na prostatniia kartsinom s tsiproteron-atsetat.

Prostate gland carcinoma is a common and serious disease affecting males. Application of steroid and nonsteroid antiandrogens for the purpose of palliative management of prostate carcinoma dates back to 1973. It is endowed with a dual action-central (antigonadotrophic) and peripheral (antiandrogenic). The preparation is used in the form of monotherapy and as a combined therapeutic approach with the analogues of LHRH or orchiectomy. The obtained results undergo comparative assessment. It is believed that the combination cyproterone acetate with other hormonal preparations or orchiectomy yield optimal results in all groups of patients. One is impressed by the fact that the combination used at the onset of treatment is more effective than late inclusion of the second preparation.

[A comparative assessment between transrectal echography, venous urography, CAT and morphology in patients with prostatic carcinoma]. / Sravnitelna otsenka mezhdu transrektalna ekhografiia, venozna urografiia, KAT i morfologiia pri bolni s kartsinom na prostatnata zhleza.

By incidence rate prostate gland carcinoma ranks second among all neoplastic diseases. As all tumorous neoformations, it is conspicuous for its progressive character. Clinical, laboratory and roentgen methods, thus far routinely used in practice, are hardly in a position to establish correct and accurate diagnosis alone. The diagnostic potentials of transrectal ultrasound examination, intravenous urography, CAT and morphological patterns are comparatively studied in patients presenting prostate gland carcinoma. The obtained results point to a greater diagnostic relevance of transrectal ultrasound examination, by comparison with CAT and intravenous urography. It is a matter of a noninvasive and highly effective procedure for primary diagnosis of the neoplastic process. Emphasis is laid on the necessity to confirm the echographic diagnosis in all instances by performing morphological study in conjunction with the remaining diagnostic methods.

[A comparative evaluation between transrectal echography, venous urography, computerized axial tomography and morphology in patients with prostatic carcinoma]. / Sravnitelna otsenka mezhdu transrektalnata ekhografiia, venoznata urografiia, kompiuturnata aksialna tomografiia i morfologiiata pri bolni s kartsinom na prostatnata zhleza.

Prostate cancer is a rather common and severe disease in man. It affects the age beyond 50, a tendency being recently observed towards affecting subjects of younger age. In the early stage the symptoms are scarce and vague. The diagnostic possibilities of ultrasound examination, intravenous urography, computer axial tomography and biopsy specimen examination were compared in patients with prostate cancer. The authors consider the possibilities of transabdominal and transrectal echography for diagnosis of prostate cancer to be superior to those of intravenous urography. H. Watanabe even recommends and uses transrectal echography as screening method. The possibilities and results of transrectal echography and computer axial tomography for evaluating tumor growth and infiltration outside the prostate capsule are compared. Ultrasound examination is recommended as a more exact method, with a view to radical prostatectomy. The good correlation of the echographic patterns with tumor development are also recorded.

[The early scintigraphic diagnosis of bone metastases in prostatic carcinoma]. / Ranna stsintigrafska diagnostika na kostnite metastazi pri kartsinom na prostatata.

Fifty-nine patients, 58 to 88 years of age, with prostate cancer comprise the study group. Screening studies were made in doubtful diagnosis and vague complaints, as well as repeated scintigraphic controls in histologically proven cancer. The most common localization of the bone lesions were: pelvis, ribs, lumbar and thoracic vertebrae. Distribution of the zones of enhanced drosition, effect of treatment and eventual connection between scintigraphic and histologic finding are noted. Patients without X-ray evidence of bone metastases or with evidence of single metastases, frequently had extensive dissemination of the metastatic process when whole-body bone scintigraphy was made.

Freeze drying of biomaterials for the medical practice.

Experimentally determined thermophysical characteristics of the new antifibrinolytic bacteriostatic biomedical preparation CAPROCOL are reported. Experimental and theoretical temperature histories at selected locations in a sample of CAPROCOL undergoing freeze drying are compared. The advance of the moving phase interface is also predicted.

[Intraoperative effect of preoperative embolization of the renal artery in patients with kidney carcinoma]. / Intraoperativen efekt ot predoperativna embolizatsiia na bubrechnata arteriia pri bolni s kartsinom na bubreka.

Aim of the embolization of the renal artery is to provoke ischemia or shut out from blood supply of the kidney tissue including pathologically changed area. As a result of this procedure the affected kidney becomes suitable for surgical removal without significant loss of blood. In this study there are included 116 nephrectomies due to kidney carcinoma. Clinical diagnosis and treatment of the patients are held at the Clinic of Urology of the Alexandrovska Hospital for the period 1990-1995. Embolization of the renal artery is accomplished in 52 subjects (63.41%). The procedure was contraindicated in 10 subjects (8.62%). It was established intraoperatively that the affected kidney had good embolization in 46 subjects (88.46%), in 4 subjects (3.44%) it had excellent embolization, and in 2 subjects (1.72%) there was just peripheral embolization. Authors conclude that: 1) Nevertheless this method is invasive it still has a place in urologists' practice. 2) Preoperative embolization of the renal artery is a devise for surgical removal of the kidney as well as achieving maximum effect.

[Radical operative treatment (nephrectomy and nephroureterectomy) in urology. Aspects and opinions]. / Radikalni operatsii (nefrektomiia i nefroureterektomiia) v urologiiata. Aspekti i mneniia.

The review of literature offerred discusses the opinions of different authors about indications and contraindications for radical oncological procedures in cases of renal and ureteral diseases.

[Surgical treatment of hydrocele--modern aspects]. / Operativno lechenie na khidrotsele--suvremenni aspekti.

Basically no one has ever introduced into practice any better procedure in cases of hydrocele than those of Winkelmann and Bergman. We recommend always a resection of the covering sheets of the testis as a profilactic measure against recurrency. Our study included 192 patients with hydrocele who were operated during the period 2000-2001 in the Clinic of Urology, Medical University of Sofia. The surgical procedures included: Winkelmann's procedure--in 118 cases (61,45%); Bergman's procedure--in 63 cases (32,81%);Orchiectomy--in 3 cases (1.56%) of total testicular atrophy; Combination of hydrocele and co-existing groin hernia was found in 4 cases (2,08%); Orchiectomy--in 1 case (0.52%) of bleeding which lead to hematoma on the 4th postoperative day; Reoperation--in 1 case (0.52%) of compression of the testicular blood vessels (after Winkelmann's procedure); Suppuration of the operative wound-- in 2 cases (1.02%) after Winkelmann's procedures. The authors consider that: 1. Winkelmann's and Bergman's procedures prooved to be quite satifactory as surgical treatment of patients with hydrocele. 2. Diagnosis and surgical treatment are easy to be performed. Postoperative complications are possible in cases of poor surgical technics, damaged local status and shortened time for hemostasis. 3. The well-known method of Lord was not used in our practice, but we do not deny it.

[Current diagnosis of upper urinary tract obstructions (UUTO) of gynecologic origin]. / S'vremenna diagnostika na obstruktsiite na gornite pikochni p'tishta (OGPP) ot ginekologichen proizkhod.

Upper urinary tract obstructions represent a problem faced by urological specialists for many decades. Regardless of the updated methods of diagnosing and management, as well as the attempts at early detection of neoplastic diseases and their complications, there is a permanent tendency of the morbidity rate of carcinoma of the uterine neck and body to increase. What is more, age stratified morbidity most frequently demonstrates involvement of women in the 40-49 years age group. In the daily routine urological practice cases presenting UUTO are by no means rare, and not infrequently urologists confront a queer challenge necessitating to make exact diagnosis in opportune time. It is the purpose of the study to present a summed up assessment of the diagnostic methods most frequently used.

[The place of interventional ultrasound in urology]. / Miastoto na interventsionalniia ultrazvuk v urologiiata.

The search for new methods of diagnosis, treatment and prognosis and their introduction in practice is a stable process in world urologic practice. It was not until after the first echographic apparatuses were produced in the fifties that the introduction of interventional ultrasound in urology became feasible. The authors set themselves the task to study and summarize the possibilities of this method for treatment of diseases of the kidneys, upper urinary tract, bladder and prostate. Renal cysts were diagnosed by ultrasound in 312 patients; in 229 of them percutaneous puncture was performed under ultrasound control. To reduce relapses, different sclerosing substances were applied, peak success being obtained with tetraolean. For establishing the exact cause of obstruction of the upper urinary tract the authors used antegrade pyelography under ultrasound control in 92 patients. Percutaneous nephrostomy for drainage of the upper urinary tract, a new endourologic operation was performed in 67 patients. To raise the radical approach to transurethral resection of the prostate and of bladder tumors, intraoperative transurethral ultrasound control was adopted for all patients operated by this technique.

[A comparative study of the effect of Zoladex treatment versus orchiectomy in patients with advanced prostatic cancer]. / Sravnitelno prouchvane efekta ot lechenieto sus Zoladex spriamo orkhiektomiiata pri bolni s naprednal rak na prostatnata zhleza.

The study entered sixty patients with advanced carcinoma of the prostate that were treated and followed-up by the authors. The median age was 70.3 years (range 58-83 years). In all patients a prostatic carcinoma has been morphologically proven. Orchiectomy was performed in 27 of them. Conservative treatment with Zoladex-monotherapy was applied in 21 patients and a combination of orchiectomy plus Zoladex-in 12 of the remaining. All patients were followed-up for the period of 3 months. Subjective and objective parameters were evaluated at 2, 4, 8 and 12 weeks during the treatment. Positive response to treatment was reported in 76% of the patients from the group of orchiectomy alone, 72% among the patients in the group of Zoladex depot and up to 80% in patients treated with orchiectomy plus Zoladex. The average time to achieve positive response was stated to be seven weeks for orchiectomy and Zoladex as a monotherapy and six weeks for the combination therapy.