Radioisotopic detection of sentinel lymph nodes in clinically localized high-risk prostate cancer.

PURPOSE: To explore the efficacy of a radioisotopic (RI) method in detecting sentinel lymph nodes (SLNs), known as sites of harboring metastases, in localized high-risk prostate cancer (HRPC). METHODS: The RI method was applied to 26 males with clinically localized HRPC, subjected to radical prostatectomy in 2006-2008. All had poor pathological characteristics: initial PSA > 15 ng/ml, Gleason score > 7, clinically suspected extracapsular extension, seminal vesicle invasion, and/or positive pelvic lymph nodes (LNs). The radiopharmaceutical (Tc-99m) was injected preoperatively at 4 zones of the periphery of the prostate. Tc-99m-nanocolloid particles were

[Local screening program for prostate cancer]. / Lokalna programa za skrining na raka na prostata.

OBJECTIVE: By massive screening of men between 50 and 75 years of age, to find those of them that are in the early stage of the carcinoma of the prostate and evaluate the usefulness of applying this method nationwide. PATIENTS AND METHODS: 183 male Pleven citizens between 50 and 75 years of age underwent clinical examination, digital rectal examination (DRE) and serum prostate-specific antigen (PSA) determination. Those with suspicious DRE or PSA > 4 ng/ml underwent further examinations: transrectal ultrasonography (TRUS) and biopsy. The sensitivity and specificity of these tests were determined. RESULTS: The mean age of the patients was 63.66 years. Six of them (3.28%) had suspicious DRE while PSA was > 4 ng/ml in 10 (5.46%) patients. Biopsy proved cancer in 2 (1.09%) patients. We needed 6 biopsies to prove one cancer. PSA had the highest sensitivity (100%), while DRE had the highest specificity (97.8%). CONCLUSION: Because of its high sensitivity, PSA could be used for massive screening of the carcinoma of the prostate. However, the low percent (1.09%) of the new-found patients with cancer and the relatively high price of the investigation leave this question open for the time being.

[Treatment of benign prostatic hyperplasia with tamsulosin]. / [Lechenie na dobrokachestvena prostatna khiperplaziia s tamsulosin]

The past few decades mark a rejuvenation of the contingent of benign prostate hyperplasia (BPH) patients. The condition affects mainly the active age in men, with the substantial financial burden of treatment leading to a surge of interest in the disease. The hazards of postoperative complications development constrain modern urologists to seek for new, safer and more effective methods of conservative management. The task undertaken is to assay the effect of application and possible side phenomena of Tamsulosin treatment in BPH patients, administered at dose 0.4 mg a single time on a daily basis over 12 to 24 weeks. A nationwide multicenter, parallel, randomized study is conducted in seven urological clinical units throughout the country, covering a one year period. For the purpose a total of 310 men, aged 52 to 68 years, presenting moderately expressed BPH symptomatology are investigated. IPSS improvement is documented in 229 patients (74%), and a significant MUD improvement is observed in 115 patients (37%), with the residual urine quantity decreasing significantly in 108 patients (35%). In conclusion, it is believed that Tamsulosin administration as a superselective alpha-1-A adrenoblocker is one of major achievements in the conservative therapeutic approach to prostate adenoma.

[Mathematical analysis in the prognostic determination of survivorship in patients with urothelial tumors of the upper urinary tract]. / Matematicheski analiz pri opredeliane prognozata na prezhiviaemostta na bolnite s urotelni tumori na gornite pikochni putishta.

Mathematical analysis of the probable five-year survivorship is performed in patients operated on for neoplasms involving the urothelium lining the upper urinary tracts. The prognosis groups thus obtained are compared with the results of 5- to 10-year-long observation on the postoperative survival in fourty-one patients. It is established that the anticipated survivorship is determined with a high-degree probability by resorting to the mathematical method described.

[A paraneoplastic syndrome in patients with a carcinoma of the upper urinary tract]. / Paraneoplastichen sindrom pri bolni s kartsinom na gornite pikochni putishta.

Evidence of a paraneoplastic syndrome is established in 21/63 patients (33.3 per cent) presenting upper urinary tract tumors. It becomes manifest 2-5 months before diagnosing the basic malignant disease. Subfebrility and anemia are the commonest paraneoplastic symptoms, clinically expressed in 15.87 per cent of cases. As the result of radical treatment, this symptomatology disappears within 10 days to two months after resorting to radical surgery. The paraneoplastic syndrome may be interpreted as a clinical "tumor marker;, indicating whether or not the treatment is radical, or the occurrence of a relapse and metastases may be anticipated.

[Ketamine at low doses + etomidate or diazepam--a comparative clinical study of anesthesia in urology]. / Ketamin v niski dozi + etomidat ili diazepam--sravnitelno klinichno prouchvane na obezboliavaneto v urologiiata.

Eighty urological patients, divided in two equal groups, are anesthesized using two anaesthetic combinations: small dose kaliposol + etomidate, or diazepam. The obtained results point to a stability of the arterial pressure and pulse rate and prompt recovery, rendering the kalipsol-etomidate combination an alternative to the kalipsol-diazepam one which is well affirmed in urological practice.

[Urethral stricture and chronic recurrent cystitis in women]. / Striktura na uretrata i khronichen retsidivirasht tsistit pri zhenite.

The study covers eighty-seven women, aged 21 to 68 years, presenting chronic recurrent cystitis. In 53 of the total number (60.92 percent) no evidence of intravesical obstruction is found. In the remainder 34 (39.08 percent), following urethral calibration and urodynamic investigations, direct and indirect data pointing to urethral stricture are established. Urethrotomy is done in thirteen women, and dilatation of the urethra (up to 30)-in twenty-one. After the manipulations described, a six-month antibiotic prophylaxis against urinary infection relapse is conducted. It is demonstrated that urethrotomy and dilatation of the urethra lead to normalization of the urodynamic indicators and subjective miction improvement. Within a year, one to several cystitis recurrences are recorded in all women documented.

[An analysis of the surgical treatment of tumors of the upper urinary tract]. / Analiz na operativnoto lechenie na tumorite na gornite pikochni putishta.

Over a ten-year period (1982-1993), forty-three patients with tumors of the upper urinary tract are operated in the urological clinic of the Medical University--Pleven. The types of operative interventions used include: radical nephroureterectomy with resection of the urinary bladder in 23 patients, with a postoperative incidence of recurrences amounting to 21.7 per cent; nephroureterectomy (7 cases) with 42.85 per cent recurrences; nephroureterectomy plus postoperative endoscopic electrocoagulation of the ureteral residue (9 cases) with 11.85 per cent recurrences; resection of the distal portion of the ureter plus ureterocystoneoanastomosis (4 cases) with 25 per cent recurrences. Analysis of the incidence rate of recurrences after various types of operations shows that nonradical procedures carry greater risk. Patients where for various reasons radical operation is impracticable, postoperative endoscopic electrocoagulation of the ureteral residue and bladder mucosa surrounding its orifice, substantially decrease the incidence rate of recurrences.

[Preoperative immunoprophylaxis in wound and urinary infections in urological patients with Urostim]. / Predoperativna imunoprofilaktik na ranevata i uroinfektsiiata pri urologichno bolni s urostim.

In two groups of 25 urological patients each, with and free of urinary infection, Urostim is administered fifteen days before and after the operation. The prophylactic effect of the drug in terms of hospital transmitted wound and urinary infections is recorded on the basis of comparative study with control groups. As shown by the results obtained, Urostim immunoprophylaxis yields positive results in urological practice. In 80 per cent of the cases development of the complication is prevented. Vaccine administration in conjunction with an updated antibiotic broadens the therapeutic scope in patients with urinary infection.

[The clinical and anesthesiological aspects of ambulatory pediatric urological operations]. / Klinichni i anesteziologichni aspekti na ambulatornite detski urologichni operatsii.

Over a five-year period, a total of 838 children, aged 0.5 to 15 years, undergo surgical treatment in the urological clinic, accounting for 16.49 per cent of all operations performed. Of the total number of children subjected to surgery, 772 (92.12 per cent) are operated on an outpatient basis which is 15.19 per cent of all operations. In case of correct assessment of the indications and contraindications, the postoperative anesthesiological and clinical complications prove to be rather low--less than 0.5 per cent, and what is more, they are of a mild nature and do not threaten the life and health of the patient. The combination ketalar+diazepam, administered intravenously at small doses, is recommended as the most suitable anesthesia for outpatient urological operations in pediatrics. It secures good anesthesia with a residual analgetic effect lasting 3-4 hours postoperatively.

[Oleogranuloma of the penis]. / Oleogranuloma na poloviia chlen.

Based on literature data and personal clinical experience with twenty patients presenting sex organ oleogranuloma, summed up inferences are reached about the choice of a rational therapeutic approach. The conservative treatment in both acute and chronic stage of the disease proves ineffective. Operative treatment is the basic one, and is aimed at radical removal of the granulation tissue and injected lipid material deposits. The resulting skin defect may be covered using diverse procedures, briefly outlined in the paper.

[The problem of paramedicine and the therapy of urologic patients]. / Otnosno problema parameditsina i terapiia na urologichno bolnite.

A questionnaire study covering a large number of urological patients is carried out in an attempt to establish the extent to which the services of paramedical healers are sought, as well as the underlying motivation involved. It is demonstrated that 13.12 per cent of the inquired refer to alternative medicine specialists. Usually it is a matter of patients with chronic and incurable conditions, such as nephrolithiasis, adenoma of the prostate gland, oncourological diseases, chronic prostatitis and cystalgia. Of the vast variety of healers, herbalists and extrasensory perception therapists appear to be the most attractive. Nearly one-third of the patients appear to be the most attractive. Nearly one-third of the patients attain temporary effect of a varying degree, estimated subjectively. All patients with some improvement have undergone parallel treatment by urologist and healer. The problem is comprehensively discussed.

[The complications of the polycystic kidney requiring surgical treatment]. / Uslozhneniia na bubrechnata polikistoza, nalozhili khirurgichno lechenie.

The complications--incidence, relation with renal function and treatment--and the results of treatment are analyzed in 87 patients with autosomal-dominant polycystic disease of the kidneys. Complications requiring surgical management developed in 16 patients (18.4 per cent). In 8 patients there was infection of cysts, 3 had obstructive calculous uropathy and the rest--other complications. Nine patients were operated. In patients with suppurated cysts the surgical method of choice was excision of the cysts and ignipuncture. Taking into account the significantly higher incidence of infections in patients on hemodialysis (p less than 0.05), the ultimate results of treatment are evaluated as very good--control of the septic state, no case fatalities.

[Rare complications in polycystic kidney--the difficulties in their diagnosis and treatment]. / Redki uslozhneniia na bubrechnata polikistoza--trudnosti pri diagnostikata i lechenieto im.

The development of some rare complications of renal polycystosis is discussed. Four patients with chronic polycystosis with complications are followed up. In 3 of them (2 of them on chroniodialysis) the cysts suppurated and after an infective conservative treatment they were treated surgically-puncture, cyst excision and unilateral nephrectomy. To the fourth patient bilateral nephrectomy had been performed 5 years ago because of other reasons. All 4 patients are alive at present with a fairly good end result.

[Ketamine analgesia with low (subanesthetic) doses during endoscopic urological operations]. / Ketaminova analgeziia s malki (subanestetichni) dozi pri endoskopski urologichni operatsii.

The aim of the study is analgesia of patients in urologic practice with unusual (subanesthetic) ketamine doses from 0.5 to 1 mg/kg body mass. It was applied in 50 men 50 to 70 years of age for the period 1986-1988--in 40 for transurethral resection (TUR) and in 10 for urethrotomy. The average duration of the operative interventions was 25 minutes. After standard premedication--droperiodol, phentanyl, atropine, 30 to 40 minutes before the operation ketamine 0.5--1 mg/kg and diazepam 0.2 mg/kg were administered intravenously and in case of need--maintenance dose from 0.25 to 0.50 mg/kg. Pulse rate, breathing rate and arterial pressure were followed up. Analgesia was evaluated by anesthesiologist, operator and patient. The disadvantages, which have been avoided and the advantages over other types of anesthesia, as well as the final positive assessment, allow recommendation of this form of anesthesia in urologic practice.

[The diagnostic difficulties in multiple tumors of the urothelium]. / Za trudnostite pri diagnostikata na mnozhestvenite tumori na urotela.

Early diagnosis of all the foci in multiple urothelial tumors keeps on being difficult. On comparison of the clinical and postmortem diagnosis the tumor of the renal pelvis remains unrecognized in about 31 per cent of the cases and the tumor in the ureter in more than 50 per cent. A case is reported of primary multiple urothelial tumor, for whose diagnosis all modern methods were used. In spite of all this, the focus in the renal pelvis was diagnosed four years after the onset of clinical manifestations of the disease. In this connection, the possibilities of the different methods of examination are discussed.