Biomedical subjects
Publications and source records attributed to S Tachev.
Some hitherto unknown facts on the development of transurethral prostate resection in a historical aspect are reported. Creation of the modern resectoscope from the first punch-instrument till nowadays is followed up in detail, quoting original sources from the literature. Each stage of development of transurethral resection is briefly discussed.
Clinico-anatomical studies were carried out in patients with sclerosis of the bladder neck. Specimens for histologic examination were obtained by transurethral resection or transvesical excision of the bladder neck. Histologic changes indicative of chronic nonspecific inflammatory process were found in the majority of cases. The most seldom finding was hypertrophy of the bladder neck muscular tissue.
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Uroflowmetric measurements were performed in 143 patients with sclerosis of the bladder neck over a period of six years. Equipment for urodynamic examinations of the Danish firm DIZA (1982) was used. The uroflowmetric parameters for preoperative assessment of subvesical obstruction were specified. The uroflowmetric measurements during the postoperative period are presented on the 2., 6., 12. and 18. month, The results were processed by variation analysis and graphs presented from computer processing of "grapher" and "Statgraph" programs.
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Ninety two women with urogenital fistulas of obstetric-gynecological origin comprise the study group. In 23 patients (25 per cent) urine outflow from the vagina started immediately after the operation and in 69 (75 per cent) from the 3. day to 2.3 years after childbirth, obstetric operations and manipulations, gynecological and urogynecological operations, irradiation and nonsurgical gynecological diseases. Colpitis had 62 (68.9 per cent) of 90 women subjected to vaginal examination. Eighty patients (87 per cent) had clinical evidence of urinary tract infection and 92.2 per cent laboratory data. Predominated gram-negative bacterial causative agents. Impaired renal function including lack of function was demonstrated in 96.9 per cent of the patients with ureterovaginal fistulas, demonstrated by excretory urography, isotope nephrography and renal scintigraphy, whereas renal function in patients with vesicovaginal and urethrovaginal fistulas remained intact for a long time. In the authors' opinion, most important diagnostic methods are excretory urography, dye tests, cystoscopy with retrograde ureteral catheterization and ureteropyelography. Isotope methods of examination and renal echography are of major value for diagnosis of uretero-vaginal fistulas. Early in 1988 vaginography was included in the group of methods for diagnosis of urogenital fistulas.
Ninety-two patients with urogenital fistulas of obstetric-gynecological origin have been treated at the Department of Urology of the Medical Academy in Sofia for a period of 14 1/2 years. Eighty seven women (94.6 per cent) were operated, with a total of 97 operations being performed. Thirty two of 34 patients with ureterovaginal fistula were operated (94.1 per cent). The following operative interventions were performed: 1 definitive nephrostomy, 5 temporary relieving nephrostomies, 4 nephrectomies and 27 reconstructive ureteral operations. Of 51 patients with vesicovaginal fistulas, 48 were operated (94.1 per cent). The following operations were performed: 4 supravesicular derivations of the urine, 21 transvaginal fistulorrhaphies, 16 transvesical suturings of the fistula, 11 transperitoneal and 1 transperitoneal-transvesical fistulorrhaphies. Seven women with ureterovaginal fistulas were operated transvaginally. The time elapses from the appearance of the fistula to the reconstruction was 66.2 days in ureterovaginal fistulas and 5.8 months in vesicovaginal and ureterovaginal ones. Transurethral urinary drainage was the operative method of choice. Eighty-three per cent of the operated patients were cured after the first correcting operation in patients with vesicovaginal and urethrovaginal fistulas. Best were the postoperative results in patients with ureterovaginal fistulas after ureterocystoneostomy by Bömonghaus's method.
Ninety-two women with urogenital fistulas of obstetric-gynecological origin have been treated at the Department of Urology of the Medical Academy in Sofia for the period Jan. 1974-July 1988. The causes of the fistulas in 17 patients (18.5 per cent) were of obstetric origin and in 75 (81.5 per cent) of gynecological origin. Analysis of the causes revealed that the incidence of obstetric fistulas was higher than in other developed countries. Higher was also the incidence of radiogenic urogenital fistulas. Gynecological fistulas following operations of benign genital diseases were more common than those developing after total hysterectomies and Wertheim's operations for malignant tumors of the internal genitals. This is in contradiction to reports by other authors. It is suggested that urologist be included in the surgeons' staff in risk hysterectomies (in cervical myomatosis).
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A brief review of the literature on the physiology of ejaculation and the causes and treatment of retrograde ejaculation is made. Retrograde ejaculation following transurethral resection for bladder neck sclerosis is discussed in detail. Seventy four patients were under control for a period of 5 years--69 after transurethral resection and 5 after transurethral incision of the bladder neck. Retrograde ejaculation was observed in 8.6 per cent of the patients. The possibility to solve the fertility problems in young men, as well as to avoid this complication is discussed. Inferences are made and recommendations given for establishing the diagnosis, treatment and prophylaxis of this complication.
Postoperative sclerosis of the bladder neck is an operative complication after removal of prostate adenoma. It was originally described by the American urologist Danslow in 1918. Personal experience is recorded in the diagnosis and treatment of 43 patients with postoperative sclerosis of the bladder neck for a period of four years. They have been treated at the Department of Urology of the Medical Academy in Sofia. Some basic methods of diagnosis of postoperative sclerosis of the bladder neck are discussed; transurethral methods of treatment--TUR and TUI--are considered the methods of choice. The postoperative results are based on the patients' complaints, on the amount of residual urine and on uroflowmetry.
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