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.

[Local recurrence of the renal cell carcinoma in renal fossa after complete radical nephrectomy. What are the risk factors?].

The local recurrence of the renal cell carcinoma in renal fossa after complete radical nephrectomy is uncommon. According to the latest articles related to this issue it ranges between 2% and 4%. For the period of 1999-2005 we evaluated 11 patients who underwent surgery for isolated renal cell carcinoma recurrence, all of them without clinical presence of distal metastases. 9 of the patients were operated for their first time in our department, and only two in other hospitals. These 9 patients represent 1.41% of the whole number of radical nephrectomies for RCC (637) which took place in our department for the same period of time. The tumor stage of the primary tumor varied from T1 to T3a. In addition lymph node dissection was performed on 7 of the patients. The average time for developing clinically significant fossa recurrence was 18 months. The current article has the purpose to present newer the data for the factors, which may be directly related to the risk of developing local recurrence in the renal fossa after complete radical nephrectomy--the initial tumor stage of the RCC, the relationship between the primary tumor and the histological type of the recurrent masses.

[Could the transrectal prostate biopsy predict the rate of positive lymph nodes in prostate cancer patients?].

Since 1989, when Hodge and al. demonstrated transrectal ultrasound guided prostate biopsy, it has become a "gold standard" for the diagnosis of prostate cancer. According to the experience gained in the period 1999-2003 in the Department of Urology-Medical University, Sofia, in a prospective follow-up of 20 prostate cancer patients, we found relationship between the positive tru-cut biopsy cores and the rate of positive lymph nodes.

[Single stage reconstructive operations of the male urethra]. / Ednoaktni rekonstruktivni operatsii vurkhu muzhkata uretra.

UNLABELLED: The male urethra with its anatomic and tissue characteristics demands a differential approach in its reconstruction. The single stage operations, with using of a different plastic material as a treatment of some diseases of the male urethra (hypospadias, strictures), are already quite common to the urological practice. The authors are offering a retrospective analysis to the reconstructive operations of the male urethra with using a plastic material from the preputium and the skin of the penis. MATERIALS AND METHODS: For a period of 10 years 94 patients were followed ont: hypospadias--51 (53.9%); strictures--27 (28.7%); fistulas--16 (18%). Were described different operative techniques, but in all patients were used a one stage act. In patients with hypospadias we used five different techniques according to the sort of hypospadias. In patients with strictures we used three methods: with preputial flap; with circular flap from the dorsum of the penis and with a parallel longitudinal to the urethra flap from the ventral surface of the penis. RESULTS: From the first group of patients we had 17 (33.3%) with anterior hypospadias, 28 (54.9%) with middle, and 6 (11.8%) with posterior hypospadias. We achieved a full correction of the penis in 96.1% of the cases. We marked postoperative fistulas in 7 (13.7%) patients. In the second group of patients we marked 4 (14.8%) cases with postoperative Fistulas; restrictures in 2 (7.4%) cases and diverticul of the urethra in 1 (3.8%) case. In the third group fistulas were formed after urethroplasty in 11 (68.7%) cases and traumas and uroflegmons in 5 (31.3%) cases. We marked refistulisation in 5 cases. CONCLUSIONS: The urethroplasty with pedicular skin flaps from the preputium and the skin of the penis is a method of choice in patients with anterior strictures of the urethra. The single stage reconstructive operations of the male urethra are quite effective and promising.

["Fossa" carcinoma - a relapse or "rest" carcinoma of the kidney?]. / "Fossa" kartsinom't - retsidiv ili rest na karetsinoma na b'breka?

The local relapse represents a unique variant of the advanced stage of a disease (A Esrig et 1992). Presumably, "fossa" carcinoma may result from incomplete resection or persisting tumor in the regional contiguous lymph nodes (JB D Kernion 1978). The average time interval for a relapse to occur is 31 months after nephrectomy, and in most patients it becomes manifest with symptoms, such as losing weight, fatigability and lumbar discomfort (D Esrig et al 1992). In cases with local recurrence a long-term survivorship may be attained by resorting to aggressive surgical intervention (S Tanguag et al 1996). This is a report on twenty-three patients with "fossa" carcinoma covering the period 1994 through 1999, with a total of 425 patients with renal carcinoma operated during the same period of time. All patients undergo operation--lumbar access is used in 22 cases, and transperitoneal--in one. In one patients resection of colon is necessitated, whereas in five the neoplastic mass hardly lends itself to complete excision, with enucleation alone being done. At follow-up study the survival terms are as follows: up to 1 year--18 patients, up to 3 year--16 patients, up to 5 year--12 patients.

[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.

[The results of a single-stage sex-change operation from male to female]. / Rezultati ot ednoaktna operatsiia za smiana na pola ot muzh kum zhena.

The authors report a result of single-act operation for sex changing from man to woman.

[The treatment of severe and complicated urethral strictures]. / Lechenie na tezhkite i uslozhneni strikturi na uretrata.

Stricture of the urethra is produced by a cicatrix causing narrowing of the urethral lumen subsequent to trauma or inflammation. The strictures are considered as serious whenever the meatus is involved, and total--in the event of obliteration of the urethra (H. Sachse, 1978). The complications are associated with perineal, scrotal or suprapubic fistulae (C. Devine, P. Devine 1989). This is a report on 37 men presenting severe complicated strictures of the urethra, treated over the period 1981-1995 in the Clinical Center of Urology. According to underlying cause the strictures are divided in: postoperative--7 cases, iatrogenic--6, inflammatory--1, traumatic--23, and patients with scrotal fistulae--3. The patients are operated using a combined method through open and endoscopic manipulation; in 3 cases plastic repair of the urethra with a preputial flap is done. The overall results are estimated as good.

[Initial clinical studies of the preparation Immucyst for immunotherapy in patients with carcinoma in situ (CIS) of the bladder]. / Nachalni klinichni prouchvaniia na preparata Immucyst za imunoterapiia pri bolni s kartsinom in situ (CIS) na pikochniia mekhur.

Over a 12-month period, thirteen patients, 10 men and 3 women, with recurrent surface transitional cell carcinomas of the urinary bladder in conjunction with CIS, are picked out and subjected to treatment. Distribution of the patients: primary multiple carcinomas combined with CIS, Ta-T1/G1-G2-4 cases; recurrent multiple carcinomas, with CIS, Ta-T1/G2-two, recurrent multiple carcinomas, combined with CIS, Ta-T1/G2-five, and T1/G3-two cases. In all instances transurethral resection (TUR) of both visible carcinomas, and CIS areas, is performed. Induction Immucyst therapy is carried out according to protocol: 3 vials BCG vaccine, dissolved in 50 ml serum, inserted intravesically once weekly over 6 weeks. The fluid is retained by the patients for up to 2 hours. Therapy is commenced within 7-14 days after TUR. Cystoscopy, cytology and biopsy of suspected areas ar done at 3, 6 and 12 days. Six of the patients reported on undergo 12-month follow-up study. The remainder (6 cases) are followed up for periods ranging from 3 to 6 months. At the actual stage of study, twelve patients are free of recurrences, and present negative cytological findings. One patient alone with carcinoma stage T1/G3 develops recurrence, treated with TUR and laser coagulation followed by immunotherapy. Two thirds of the patients sustain transitory pollakiuria and dysuria, and one third-subfebrile temperature persisting for 48 hours.

[The parascapular fasciocutaneous flap in the surgical treatment of deep burns in the axillary area]. / Paraskapularno fastsiokutanno lambo pri khirurgichno lechenie na dulboki izgarianiia v oblastta na aksilata.

An original operative approach to severe defects of the axilla--periscapular fasciocutaneous flap according to Pontaine--is recommended. It is a matter of a procedure which surgeons dealing with the problems of plastic and reconstructive surgery become acquainted with for the first time. A classification of axillary defects, contributing to the most adequate choice of operative approach, is also suggested. Typical cases where this operative method is used are illustrated.

[The treatment of extensive burns using a primary biological dressing in the Clinitron fluidized bed]. / Lechenie na obshirni izgarianiia posredstvom purvichna biologichna prevruzka v usloviia na fluidno leglo "Klinitron".

The treatment of extensive burns using a method recently adopted in this country, namely application of primary biological dressing in patients undergoing treatment under conditions of "Clinitron" fluid bed, is discussed. The ten-year follow-up study covers 1100 patients with extensive burns, distributed in three groups according to the method of local treatment employed: 1) Patients treated by closed method in conventional conditions. 2) Patients treated by closed method under fluid bed conditions. 3) Patients treated on a fluid bed plus primary dressing with the newly obtained biopreparations for local application--Cypocol and skin collagen transplant. The approach outlined is consistent with the traditional treatment procedures. By combining the curative properties of biopreparations, used as primary biological dressing, with those of the fluid bed, a clinical effect considerably superior over the one thus far recorded is attained. Emphasis is laid on the advantages of the therapeutic approach proposed-suppressing endo-and exogenous infections, and substantial reduction of the hospitalization term.

[Effect of beta-adrenergic blockade on acid-base balance in experimental hypertension]. / Vliianie na beta-adrenergichnata blokada vurkhu kiselinno-alkalnoto ravnovesie pri eksperimentalna khipertoniia.

On rats with experimental hypertension by method of Selye, modified by Kolarova, distributed in two groups--treated by obsidan and untreated, the following parameters on the 1st and the 3rd month after the operation were studied: pH, BB, SB, AB, BE, PaCO2, TCO2, PaO2, and SaO2. In the hypertonic animals we establish a decompensated metabolic acidosis on the 1st month and a metabolic acidosis with a marked respiratory compensation on the 3rd month. The hypertonic animals, treated by obsidan, demonstrate a sharp tendency to normalise the parameters of the acid-base status on the 1st month and normal values on the 3rd. The protective obsidan effect observed on the hypertonic rat we discuss as a result of metabolic and functional influences of the beta-adrenergic blockers.