[Staphylococci as uropathogens-frequency of isolation in hospitalized patients and sensitivity to antimicrobial agents]. / Les staphylocoques comme uropathogènes-fréquence d'isolement chez des malades hospitalisés et sensibilité envers les substances antibactériennes.

For a period of 24 months (1997-1999) were isolated 266 clinically significant staphylococcal strains, S. aureus, 36 (13.5%) and 230 (86.5%) coagulase negative staphylococci (CNS) from urines of hospitalised patients (over 14 years) with UTI. The most frequently isolated strains from CNS was S. haemolyicus, 110 (47.8) strains, followed by S. saprophyticus 47 (20.4%) strains and S. epidermidis 18 (7.8%). The susceptibility of the isolates to 13 antimicrobial agents was determined by agar dilution method (NCCLS). From the isolated 36 strains S. aureus, 24 were sensitive and 12 were resistant to methicillin. From 230 CNS, 105 strains showed sensitivity and 125 strains resistance to methicillin. All staphylococci were sensitive to vancomycin and most of them (over 95%) to amikacin and rifampin. It was established a considerable difference between the sensitivity of methicillin-sensitive and methicillin-resistant staphylococci. The established resistance accompanied with high rate percentage methicillin resistance requires careful consideration to antimicrobial therapy of staphylococcal urinary tract infections (UTI).

[Associated trauma with urinary tract injuries]. / Traumatismes généraux avec participation des voies urinaires.

The authors analyze the peculiarities in the diagnostic and curative behavior in cases of associated traumatic injuries with participation of the urinary system in adults and children. A trauma is defined as associated when one kind of traumatic agent affects more then one organ or system. The authors do not discuss the combined trauma where we observed different damaging agents as for example mechanical trauma plus radiation or burn. The experience of the treatment of 64 children and 109 adults suffering from associated traumatic injuries for the period 1981-1997 has been summarized. In cases of associated traumatic injuries the kidneys are the most common participants on the part of the urinary system (70.3% of the children and 51.4% of the adults). On the second place we witness bladder damages in adults and urethra damages in children. The data concerning the combination between urological trauma and other organs traumas are available in details--the most common are: bone fractures, lesions of intraabdominal organs, skull and brain traumas, etc. The three basic problems caused by such kind of trauma are also discussed--organizational, diagnostic and curative. At the end the authors present the most typical characteristics of associated traumatic injuries in children compared to those in adults.

Application of clenbuterol in the treatment of urinary incontinence.

The treatment of urinary incontinence represents an important medico-social problem, notwithstanding the offered 90 products of treatment. The authors summarice their experience on the treatment of urinary incontinence with clenbuterol for the period 1988-1997. During this period total of 335 patients (163 women and 72 men), aged between 30 and 73 were treated. The medicine was used in the treatment of women with stress incontinence (60) and urge incontinence (103). In cases of combination between urinary incontinence and hyperreflexy of the detrusor, and antiholynergic therapy was used. It was used after surgery of the adenoma of the prostate in men, aged 62-73: in 50 of them after transvesical prostatectomy, and in 22 after transurethral resection of the prostate. The authors determine the period of using the product in the different kinds of incontinence. Clenbuterol can be effective only when sfincter activity is preserved, which is proved by means of urodynamic tests. The durability of treatment was stable in 86% of treated women, and in 76.3% of treated men. The authors determine the indications and contraindications of administration of celbuterol. They analise the changes in the hydrodynamic of the lower urinary tract in the patients with urinary incontinence after clenbuterol therapy.

A phase II trial with new triptorelin sustained release formulations in prostatic carcinoma.

OBJECTIVES: The objectives were to assess if a single intramuscular (i.m.) injection of the GnRH agonist triptorelin, as pamoate Sustained Release (RS) 11.25 mg, was able to induce pharmacological castration and to maintain the plasma testosterone levels in the castrate range (< 1.735 nmol/l) up to 3 months in prostatic carcinoma. METHODS: Two different formulations of triptorelin pamoate 11.25 mg were assessed in 2 groups of 10 patients suffering from prostatic carcinoma. Each patient received one i.m. injection of triptorelin pamoate SR 11.25 mg. Triptorelin and testosterone levels were measured over 3 months. Pain, micturition difficulties, performance status, local and general tolerance, and the occurrence of adverse events were evaluated. RESULTS: Both formulations were able to induce castration levels (<1.735 nmol/l) of testosterone within 3 to 4 weeks post-injection, and to maintain levels below 1.735 nmol/l till the end of 3rd month. The bioavailability of one formulation (DLGSD-3-95-21) tended to be greater. This may explain the quicker onset of castration and the slight better maintenance of low testosterone levels during the 3rd month observed with this formulation. In terms of clinical end-points, the local tolerance of both formulations was excellent. No serious adverse events were recorded except transient hot flushes in 2 cases and slight bone pain in one. CONCLUSION: Triptorelin pamoate 11.25 mg given in microgranules is a 3-month sustained-release administration form which appears to be safe and effective in advanced prostatic carcinoma. Based on the findings of this study, the formulation with greater bioavailability (DLGSD-3-95-21) was selected as formulation of choice to be used for clinical treatments and further clinical investigation.

[Intrascrotal nontesticular tumors]. / Intraskrotalni netestikularni tumori.

This is a review of literature data on rarely met with intrascrotal non-testicular tumors still not well enough clarified in clinical practice. Histologically these tumors derive from: 1. Epididymis. 2. Funiculus spermaticus and/or tunica vaginalis. 3. Tissues within the scrotum (fatty, fibrous, muscular, lymphatic, nervous). 4. Metastases. The individual types of neoplasms, some of them representing casuistic rarity, so far described as sporadic observations in the pertinent literature, are discussed. Adenomatoid tumor of epididymis and rhabdomyosarcoma are the most frequently encountered. Clinically paratesticular tumors do not lend themselves to differentiation from the ones involving the testis regardless of the fact that for some of them data on specific laboratory and serum or tissue tumor markers have been duely reported. Diagnosis is made histologically following operative management--orchiepididymectomy. According to histological pattern, if necessary the treatment proceeds with radio- or chemotherapy. Finally, two personal observations are described.

[Enterococci as uropathogens. Frequency of isolation and sensitivity to antibacterial agents]. / Les entérocoques comme uropathogènes. Fréquence d'isolement et sensibilité envers les substances antibactériennes.

221 clinically significant enterococcal strains (191: E. faecalis, 27: E. faecium, 3 others) were isolated from the urine of patients hospitalised with UTI over an 18-month period (1995-1996). The susceptibility of the isolates to 8 antimicrobial agents was determined by agar dilution method (NCCLS). All enterococci were sensitive to vancomycin and most of them (over 92%) to penicillin and ampicillin. Only 3.14% of E. faecalis and 3.70% of E. faecium were resistant to ciprofloxacin. A relatively high incidence of resistance of enterococci to aminoglycosides was observed: 46.07% and 51.85% to streptomycin, 42.41% and 44.44% to gentamicin, 70.68% and 77.78% to amikacin for E. faecalis and E. faecium, respectively. Among the resistant to penicillin and amino glycosides enterococci of the two species was found a great percent "high level" resistance. There were no beta-lactamase producers among our strains. The established multiresistance accompanied by "high level" resistance requires careful consideration of antimicrobial therapy of enterococcal UTI.

[The role of urinary tract infections in burn patients]. / Rolia na infektsiite na urinarniia trakt pri bolni s izgariane.

Patients with burns are predisposed to a variety of infectious complications, urinary tract infections inclusive. It is the aim of the study to assay the incidence rate, etiology and antibacterial sensitivity of the leading pathogens causing bacteriuria in burnt patients, and compare them with the respective characteristics of the pathogens causing wound infection in the same contingent of patients, and urinary tract infection in uro-nephrological patients. Over a five-year period, a total of 2452 urines and 4236 wound exudates from 963 patients with burns, and 8800 urines from 2908 uro-nephrological patients are studied. In 35.4 per cent of patients positivation of 29.2 per cent of the urines being examined is noted. The major causing agents producing bacteriuria in burns--E. coli (19.2%) and Proteus mirabilis (13.9%)--are similar to the ones found in uro-nephrological patients, and differ from the causing agents of wound infection (the isolates concur in 16.7 per cent of the cases only). The inference is reached that strict monitoring of burnt patients is absolutely necessary because they run a high risk of urinary infection development, most frequently caused by multiresistant hospital strains, worsening the prognosis of either of the conditions. Monotherapy prescription with broad-spectrum antibacterial agents, based on the sensitivity of isolates in vitro, is strongly recommended.

Problems in the treatment of urinary infections caused by Streptococcus agalactiae.

Authors have investigated the therapeutic problems in urinary infections caused by Streptococcus agalactiae in men and nonpregnant women. It is obvious from the literature that this problem has been considered mainly in pregnant women. On the basis of 86 patients (67 women and 19 men aged 14 to 81 years) it was established that the in vitro sensitivity of this Streptococcus was high (above 95%) to ampicillin, augmentin, cephalothin, lincomycin, chloramphenicol and erythromycin and 100% to rifampicin. For a successful treatment it is of great importance to establish the presence or lack of reservoirs of this infection (vagina, urethra, gastrointestinal tract). Mono- and combined antibiotic therapy was applied, as well as local treatment with vaginal lavages. Successful treatment is guaranteed by a thorough examination, identification of infection foci, including those outside the urinary system and choice of adequate individual approach to the patient. These variants are presented in detail.

Streptococcus agalactiae as a urinary tract pathogen in males and non-pregnant females.

The role of Streptococcus agalactiae (group B streptococci, GBS) was investigated for a period of one year in different clinical forms of urinary tract infection in males and non-pregnant females over 14 years of age. The pathogen has been isolated in quantities of greater than or equal to 10(5) cfu/ml in midstream voided urine from 32 patients with clinical signs of urinary tract infection and pathologic urinary sediment. In every group of B isolates the antibiotic sensitivity to antimicrobial agents was determined by the single disk method of Kirby-Bauer. GBS with the same characteristics were established in urethral specimens of 4 males as well as in the vagina and faeces of 11 females. As a rule, peroral treatment with ampicillin proceeded successfully. In addition, women with streptococcal vaginitis were treated topically with 2% solution of chlorhexidine. Our results have demonstrated that GBS might cause urinary tract infection, but the evaluation of GBS isolated in urine specimens is complex.

[Problems in the introduction of endourology]. / Problemi na vnedriavane na endourologiiata.

The technical progress in medicine has produced a turn in the classical principles of the operative treatment of numerous diseases, including urological ones. Endourological methods are gaining increasing acceptance in such urologic diseases as renal calculosis, prostate adenoma, etc. They have considerable health and social effect. Their successful implication in every urologic unit requires planned and centralized supply with endourological equipment and training urologists for mastering endourological methods of diagnosis and treatment. Indicated are the factors, which may help for high-quality training of urologists and nurses and technicians. The role of health and other authorities in solving the problems of endourology are pointed out.

[Treatment of urinary infection with cephadroxyl (Pharmachem)--microbiological and clinical research]. / Lechenie na uroinfektsiiata s tsefadroksil (Farmakhim)--mikrobiologichni i klinichni prouchvaniia.

The bacteria isolated from the urine of renal patients were tested for sensitivity towards cephadroxyl (Pharmachem) and other beta-lactam antibiotics--altogether 654 examinations were made. It was established that the gram-positive bacteria (excluding the Enterococcus) are sensitive towards cephadroxyl. From the Gram negative bacteria E. Coli, Klebsiella sp., Enterobacter sp., P. mirabilis, Citrobacter sp. showed the greatest sensitivity towards cephadroxyl, while the indole positive Proteus were with low sensitivity and P. aeruginosa, Acinetobacter sp., Serratia were resistant towards cephadroxyl. 30 patients with persistent mainly secondary urinary infection were treated with cephadroxyl. The clinical symptoms disappeared in 63.3% of the patients and another 26.7% of them showed considerable improvement. Bacteriological sterility of the urine was achieved in 61.29% of the patients. The side effects were mild and rare, only in single cases.

[Treatment of urologic infections with cefamandole (Pharmachim)--the microbiological and clinical results]. / Lechenie na uroinfektsiite c tsefamandol (Farmakhim)--mikrobiologichni i klinichni rezultati.

The authors study the possibilities of cephalosporin antibiotic cefamandol, new for our clinical practice, in the treatment of uroinfections. The microbiological study on a total of 2301 bacterial strains, isolated from patients with uroinfections, reveals that cefamandol excels in its action against gram-positive microorganisms, all beta-lactam antibiotics, used in our country. As regards E. coli, Citrobacter, Klebsiella, Enterobacter, P. mirabilis and indole positive pro cefamandol is better than ampicillin, carbencillin and cefalotin. A resistance to the preparation showed the majority of the isolates of Enterococcus, Serratia, Acinebacter and Pseudomonas aeruginosa. Excellent result was attained in 60% of all the 35 patients with uroinfections treated, manifested in "sterilization" of urine and in 5.71% bacteruiria became insignificant. In parallel, the clinical and laboratory symptoms of uroinfection were favourably influenced. The preparation has a good tolerance. Finally it should be underlined that this antibiotic must be introduced in the routine clinical practice for the treatment of adequate forms of uroinfections.

Profuse haematuria.

Out of 1170 patients with macrohaematuria treated at the Clinic of Urology, "Pirogov" Institute, Sofia, 592 had profuse haematuria. With reference to the volume of blood loss the criteria for haematuria to be designated profuse are discussed. The most frequent diseases which led to profuse haematuria, as well as the methods for the etiological diagnosis of haematuria are reviewed. The authors present the experience they obtained from conservative and operative treatment of the syndrome, and stress that preference is given to the methods aiming at radical sanation of the basic disease.

[Treatment of acute and chronic urological infections with azlocillin--clinical and microbiological research]. / Lechenie na ostri i khronichni uroinfektsii s azlotsilin--klinichni i mikrobiologichni prouchvaniia.

The authors present their results from the treatment of urological infections with the new semisynthetic penicillin antibiotic azlocillin (acyl-ureide-penicillin) in 86 patients with various, in kind and clinical manifestations, infections of the urinary system. The susceptibility was determined of the isolated bacterial causative agents of the urological infections to azlocillin and to the other antibacterial preparations available in our country. It was established that 52,7% of Gram-negative microorganisms were susceptible to the preparation, and over 80%--of the Gram-positive microorganisms. The highest number of susceptible strains were established in pseudomonas, coli, enterobacter, klebsiella and proteus. The results from the clinical study reveal that 51,2% of the patients were cured by the end of the therapeutic course and abatement or considerable improvement, was observed in all, of the clinical and paraclinical indices, suggesting urological infection. No allergic or toxic manifestations were observed. The absence of nephrotoxicity makes that new, for our practice, antibiotic extremely valuable for the patients with renal insufficiency. The most general conclusion from that study is that azlocillin, with its effectiveness, comes close to the most potent modern antibacterial preparations, with no toxicity characteristic for aminoglucoside antibiotics.

[Pipemidinic acid as a urinary antiseptic--microbiological and clinical study]. / Pipemidinovata kiselina kato uroantiseptik--mikrobiologichni i klinichni prouchvaniia.

The authors present the results from the microbiological and clinical studies about the potentialities of pipemidinic acid in the treatment of uroinfections. Pipemidinic acid was established with the study on 375 bacterial strains, isolated from the urine of urological patients to have a very good in vitro effect as regards E. coli, Citrobacter, Proteus retgeri, Proteus mirabilis, Klebsiella and Enterobacter, and in case of those microorganisms, it gives way only to some aminoglucoside antibiotics. The admit that with those causative agents of uroinfections, the pipemidinic acid could be the agent of choice. The percentage of susceptible strains is low in case of Seratia, Proteus vulgaris, Pseudomonas and Acunetobacter. Sanation of the uroinfection was attained in 56.2 per cent of the patients from the 32 patients treated with persistent, most often nosocomial uroinfection, by the pipemidinic acid (in the form of the preparation palin), and a reduction of the bacterial number to insignificant values--in 12,6%. Obvious clinical improvement was established in almost all patients treated, manifested with fading or considerable reduction of the subjective and physical symptoms of the uroinfection, in parallel with a normalization or improvement of the paraclinical laboratory indices as well. In conclusion, it was emphasized that the introduction of that uroantiseptic in the practice will broaden the possibilities of effective treatment of uroinfections.