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This is a report on 754 new patients with urinary bladder tumors, registered on a nationwide scale during 1993. In 540 of them (70 per cent) the lesion is superficially located with involvement of mucosa and submucosa alone (Ti(s), T(a), T1). It is pointed out that after introduction of the modern treatment methods using intrabladder instillation of chemical agents and immunotherapeutics, the rate of relapses shows a significant decrease, and the tendency of the tumor to infiltrate is decreased.

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Using high-energy impulses from Dornier HM-3 lithotriptor, iliac ureteroliths were crushed in 18 patients for the period of 2.5 years. The mean age of the patients was 38 years. The lithotripsy was in all cases preceded by retrograde catheterization. Reposition of the stones was achieved in 6 patients. Prone-position lithotripsy was conducted in 12 patients. Specially designed support cushions helped to keep the patient in a steady position, speeded up the stones excretion, relaxed knee joints and reduced the exposure to the impulses. All the patients underwent antiinflammatory and spasmolytic therapy. The mean hospital stay reached 3.2 days. Good results were reported in 94.1% of those treated. Neither early nor long-term complications arose.

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Experience is recorded in the treatment of prostate cancer with Flucinom in 42 patients at mean age 64 years. This is a new synthetic patent medicine, a nonsteroid antiandrogen, product of the firm Schering (USA). It acts as concurrent inhibitor of the androgen acceptors in the cytoplasm of the glandular epithelium in prostate cells and averts the entry of the androgenic acceptor complex in the nucleus. Treatment was conducted with Flucinom tablets of 250 mg, 3 times daily 1 tablet. Patients in different stages of the disease were treated. The results were recorded for each patient individually at mean duration of the follow-up period 16 months. Twenty-eight patients received only Flucinom medication, in 14 drug treatment was combined with pulpectomy. The effect of treatment was as follows: regression--26 patients (61.9 per cent, stabilization--10 patients (23.8 per cent) and progression--6 patients (14.3 per cent). The results were superior when drug treatment was associated with pulpectomy. Treatment was well tolerated, including in patients with accompanying cardiovascular diseases and initial renal failure. Side reactions were seldom observed and were mild. It is recommended that Flucinom treatment of prostate cancer should gain acceptance, especially in patients with preserved potency.

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Experience is recorded with the operative treatment of congenital hydronephrosis in 56 patients, 14 to 59 years of age, over the period from January 1985 through July 1989. Of major importance for establishing correct diagnosis were excretory urography and ultrasound examination of the kidneys. Retrograde ureteropyelography was performed in only 5 patients on the operation day. Constrictions in the area of the pyeloureteral segment were the most common cause of hydronephrotic transformation of the kidneys. Because of the encouraging results, the authors give preference to the plastic operation by the method of Anderson-Hynes with drainage of the urine through nephrostoma and intubation drain for a period of 12 to 15 days. Operations for congenital hydronephrosis consisting only of removal of the adhesions in the area of the pyeloureteral segment are not advised.

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Experience is recorded with the treatment of calculi in the iliac segment of the ureter by extracorporal lithotripsy with high-energy stroke waves with lithotriptor of the firm "Dornier", model HM-3. For a period of 2 1/2 years 18 patients at mean age 38 years have been treated. Retrograde catheterization was always performed before lithotripsy. Successful reposition was achieved in 6 patients. In all others lithotripsy was performed in prone position. Special supporting cushions were manufactured and used; they helped for a more stable position of the patient on the stand, facilitate calculus positioning, the load to the knee joints is reduced, the fluoroscopic time is shortened, thus reducing the radiation load to patient and attending personnel. All patients received antibacterial and spasmolytic therapy. The mean length of stay in the clinic was 3.2 days. The results were good in 94.1 per cent of the cases. No early or late complications of urologic or other nature were observed.

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Clinical experience is recorded and summarized with the application of BCG vaccine for prophylaxis, treatment and immunochemotherapy of bladder tumors for the period June 1985-January 1988. Included in the study were 85 patients distributed in five groups: 23 patients treated for prevention of relapses; 26 treated for existing and residual surface tumors; 13 in whom BCG vaccine F-70 was applied for prophylaxis purpose; 17 with surface tumors treated only surgically--control group; 10 patients with advanced bladder tumor treated with immunochemotherapeutic agents. Once the results have been reported and discussed, the following inferences were made: 1. Intravesical BCG vaccine is a new effective and practicable method for prophylaxis and treatment of surface bladder tumors; 2. A 12-month course of treatment with the new Bulgarian Kalgevax showed high therapeutic activity; 3. Indications and possibilities for treatment of existing and residual surface tumors with intravesical BCG vaccine are given; complete effect of treatment was obtained in 21 patients (81 per cent); 4. The side reactions of the application of BCG vaccine and the possibilities for their reduction are presented; 5. The first results of application of immunotherapy in advanced bladder tumors are encouraging.

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Experience is recorded with the application of stroke-wave extracorporeal lithotripsy of calculi which have remained after open-technique operations for coral-shaped calculosis. Fifteen patients, 11 women and 4 men at mean age 43 years have been treated for the period 1.01.1989 through 7.02.1990. They all had nephrostoma placed by operation. Extracorporeal lithotripsy (ECL) was performed mean 14 days after the operation. The mean length of stay in hospital was 23 days. All patients were calculi-free 3 months after ECL. It is recommended to place nephrostoma when the kidney has not been fully freed from calculi during operation, to allow further performance of ECL. This helps to achieve quicker and complete removal of calculi from the urinary tract, which in turn contributes to successful of the urinary infection.

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Experience is recorded with the diagnosis and treatment of 90 patients with tumors of the kidney and its pyelocalyx system. Of all methods of diagnosis major importance is attached to computer axial tomography. It is emphasized that the approach to the kidney, the type and scope of the operative intervention should depend on the stage of tumor development. For tumors of the pyelocalyx system it is recommended to perform nephroureterectomy, since this approach rules out the hazard of appearance of tumors in the ureter. The presence of isolated metastases is no contraindication for performing nephrectomy. Indications for organ-preserving operation should be strictly specified. They should applied in patients with single kidney, patients with bilateral tumors and patients with chronic renal failure.

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Balloon dilatation is a new method in endourological treatment of diseases of the urogenital system. Personal experience is recorded with the treatment of ureter strictures by balloon dilatation. Thirteen patients were treated. In 10 the strictures were congenital and in 3 acquired. Fifteen dilatations on the pyeloureteral segment and the distal portion of the ureter were performed. The method is practicable, low traumatic and is well tolerated by the patients. The limited experience does not allow general inferences to be made for the early and late results of application of balloon dilatation. Its advantages however allow to recommend its wide acceptance for treatment of strictures of the ureter in all of its segments.

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The incidence of primary tumors of the renal pelvis and ureter is progressively increasing; now they account for about 10 per cent of all urothelial tumors with predominance of papillary ones. They metastasize early, most frequently in the liver, the bones and the lung. For a period of 10 years, 46 patients with upper urinary tract tumors of epithelial origin have been examined and treated. In 30 of these patients (65.2 per cent) the cancer was localized in the renal pelvis and in 16 (34.8 per cent) in the ureter. In 40 patients (87 per cent) the initial symptom was hematuria with dull or colic-like pain in the lumbar area. Excretory urography and retrograde ureteropyelography are essential for the exact diagnosis. Treatment should be early and radical--nephrectomy with total ureterectomy and excision of part of the bladder wall near the ureter orifice. Organ-preserving operations are indicated only in cases of single kidney or accompanying disease of the other kidney, which after some time may require its removal.

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A new method is reported for operative treatment of urine incontinence, following transversal adenomectomy and transurethral resection of the prostate gland. The operative technique is described in detail. Its basic point is placing of a small "Ampoxen" ball over the urethral bulbus. Disappearance of the incontinence after such an operation is due both to the compression on the bulbar part of the urethra and to the formation of connective tissue, which proliferates into the sheet being placed. Twelve patients from 62 to 75 years of age were treated in this way. In 10 of them the immediate and the late results are considered very good. Incontinence disappeared until the 3. day after removing the indwelling catheter. In the other two patients the result is considered satisfactory. The encouraging results make the authors prefer the method which they suggest for postoperative urine incontinence.

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Seven cases are reported of patients with renal tumors in whom organ-preserving operations were performed. Two patients had only one kidney, the contralateral had been removed in the past. They had only partial resection of one third of the kidney performed. In five patients, in whom parenchymal renal tumor was accidentally detected, with normal contralateral kidney, enucleation of the tumor was performed. On histologic examination one had hypernephroma, three--adenoma with atypism, one--leiomyoangiolipoma. The size of all enucleated tumors varied from 25 to 55 mm with distinct fibrous pseudocapsule, without proliferation in it and without vascular invasion of the neoplastic process. It is assumed that patients with tumor of the only kidney when possible should be subjected to organ-preserving operation. In the event of a small encapsulated tumor and normal contralateral kidney, organ-preserving operation may be performed when there is low-grade malignancy.

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Experience is recorded with the combined treatment of 53 patients with coralliform renal calculosis. Combined application of bypass lithotripsy (BLT), percutaneous lithotripsy (PLT) and ureterorenoscopy (URS) is an alternative to open surgical intervention. Depending on the size, form and position of the calculus, the degree of destruction of the residual concrements, combined therapy was applied, as follows: 17 patients--PLT and BLT, 7 patients--PLT, BLT and URS, 7 patients--URS and BLT, 13 patients--BLT and URS, 8 patients--BLT and URS. Very good results were obtained--complete cure in 51 patients (96.2 per cent), which encourage the authors to recommend the three methods for routine application in the treatment of coralliform renal calculosis.

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Blunt bladder injuries occupy a particular place among the problems of modern emergency urology. Regardless of their rarity, recognition of this type of traumatic injury is of exceptional importance for the urologist in his efforts to establish precise diagnosis and undertake rational treatment. Comprehensive knowledge is necessary both of the nature of the trauma and of its duration and the changes occurring in the damaged tissues in the different stages of treatment. The diversity of the clinical pattern prompts thorough and purposely carried out investigations in a strictly defined order, to reach at exact diagnosis and provide effective treatment. Analysis is made of 45 patients treated over a period of 38 years, and the most common diagnostic and therapeutic errors are pointed out. Recommendations are given on the order of diagnostic studies and the extent of operative intervention, conformed to the factor time and other conditions. Inferences are also made.

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Experience is recorded with the study of 16 patients with neurogenic disorders of urination following radical operative interventions for rectal cancer. Their causes and the changes which they produce in the urinary tract are discussed in detail. The need of purposely carried out urologic investigations, such as excretory urography, cystography in anteroposterior, lateral and oblique projections and during micturition, bladder tonometry and measurement of residual urine is emphasize. The experience gained with conservative, operative and physical therapy is discussed. Particular attention is focused on the provision of adequate drainage of the urine from the bladder during the early postoperative period and the prophylaxis of urinary infection. Inferences are drawn on the complexity of the problem and the need of early diagnosis, treatment and repeated check-up of the patient state.

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