[Problems relating to vascular reconstruction in renal transplantation from a living donor]. / Problemi na s'dovite rekonstruktsii pri b'brechni transplantatsii ot zhiv donor.

We discuss vascular surgical problems in 59 kidney transplantations using alive donors. From April 96 till May 99 we harvested 59 kidneys from relatives (44 women and 15 men), mean age 54.33 years. Those kidneys were transplanted to 37 men (mean age 55.71 years), and 22 women (mean age 36.85 years). Preoperative dialysis was performed for a period of 5.015 years (mean). Thirty eight of the kidneys are right, and 21 of them are left. Six kidneys have two renal veins (10.16%), and 5 of them have two renal arteries (8.47%). We prefer end-to-end anastomosis between the donor renal artery and the recipient hypogastric artery. It ensures best regional hemodynamics, long-term patency and best positioning of the kidney avoiding vascular compression. The venous anastomosis is performed end-to-side to the iliac vein of the recipient. In 7 cases of short renal artery of the donor kidney greater saphenous vein is used as arterial conduit to ensure tension-free anastomoses. Only 1 patient (1.74%) of 59 cases (71 venous anastomoses) suffered thrombosis of the iliac vein, which caused kidney rupture. We had 5 cases of postoperative bleeding (8.47%), three of them were from the kidney hilus, and two from exposure sites. After reexploration all of them have normal function. Vascular anomalies and/or vascular disease do not preclude the procedure. Atraumatic harvesting of the kidney is critical.

[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.

[Therapeutic approach to upper urinary tract obstructions (UUTO) of gynecologic nature]. / Lechenie na obstruktsiite na gornite pikochni p'tishta (OGPP) ot ginekologichen kharakter.

The existence of numerous treatment methods for upper urinary tract obstructions (UUTO) following gynecological interventions, taken alone demonstrates that it is a matter of a complex surgical problem, hardly lending itself to solution. There is no ideal operation, manipulation or procedure. It is precisely the role of the urologist to choose and implement in practice the most adequate therapeutic approach to each individual case. Urology is an interdisciplinary and extensive surgical speciality, disposing of both classical, well-tried operative procedures, and vast possibilities for performing minimum invasive interventions and manipulations. All treatment approaches to UUTO after gynecological operations used in the Chair of Urology are described and comprehensively discussed.

[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.

[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.

[Urothelial tumors versus "endemic" nephropathy - myth or reality?]. / Urothelial tumors versus "endemic" nephropathy - myth or reality?

Malignant tumors of the renal pelvis account for over 78 per cent of all malignant tumors of the kidney, and less than 1 per cent of all urogenital neoplasms. At the time of diagnosing, almost one third of these patients present with tumor of the ipsilateral ureter or bladder, and 40-50 per cent have ureteral tumor located elsewhere (D. Crawford, S. Das, 1990). After World War Two, the frequency of publications on cases of primary tumors of the pelvis show a noticeable increase, e.g. in Yugoslavia and Bulgaria the ratio of parenchymatous renal tumors to those of the renal pelvis is conspicuously altered. S. Petcovic (1970) and S. Lambrev (1972) attribute this fact to the existence of endemic "nephropathy" foci. It is the purpose of this work to analyze twenty-nine patients presenting carcinoma of the upper urinary ways, studied in the Chair of Urology in the period 1991 through 1997. Of them only four come from "endemic" regions. Over the period 1972-1975, fifty-nine patients with the same condition undergo treatment in the aforementioned Chair. It is worth noting that patients from the so-called "endemic" regions lack the typical signs of "endemic" nephropathy. The assumption is warranted that "endemic" nephropathy is a still not well enough clarified nosological entity, bearing resemblance to contamination with radioactive elements with a "boom" during the half-life period gradually subsiding.

[Conservative surgery in renal carcinoma in case of contralateral kidney involvement]]. / Konservativni operatsii pri kartsinom na b'breka - pri uvreden protivopolozhen.

A serious problem faced in renal carcinoma treatment are patients presenting bilateral tumor, or those with virtually one kidney. Over a 2-year period, in the Department of Urology three patients are subjected to operation--one with bilateral renal carcinoma, one with dysfunction of the contralateral kidney, and one with a large cyst of the contralateral kidney. In the patient presenting bilateral tumor, nephrectomy on one side and partial resection on the other are performed, and in the remainder two--enucleation of the neoplasm. The patient with contralateral loss of renal function is subjected to ipsilateral operation for calculosis before the intervention with ensuing lithotripsy--three times. Within a year of the operation the same patient undergoes operation for ipsilateral pyonephrosis. At the time of study, all three patients are in a good general condition with values of the residual nitrogen bodies within normal limits.

[One-stage surgical techniques in various hypospadias locations]. / Ednoaktni khirurgichni tekhniki pri razlichni lokalizatsii na khipospadiia.

Hypospadias is a common developmental anomaly in the male (8.2@1000). Over the last twenty years, one-stage operative techniques for the correction of this anomaly have been widely adopted. Two-stage procedures remain a method of choice in strictly selected cases only. In the period 1992 through 1997, thirty patients aged 2-19 years presenting different locations of hypospadias are picked out in the Department of Urology-"Alexandrovska" University Hospital. The following operative techniques are used: Magpai-Duplay-Fierlit, Flip-Flap, Duket De-Sey, Huchson, Ducet-Duplay, Ducet-Flip-Flap. The complications resulting are operatively closed within 3 months of plastic repair, and in case of stenosis of the meatus meatoplasty is done. The good results of one-stage operations in hypospadias, irrespective of the location, justify their adoption as a plastic repair method of choice.