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Purpose: To share our experience about partial resection (nephron sparing) in localized (T1aN0M0) renal hypernephroid cancer as organ preserved operation. Opportunities and longterm results., Material and Method: For last 10 years we have done 89 partial resections in patients with localized renal hypernehroid cancer. In all cases we have done lymphatic dissection of relevant lymph region of the affected side., Results and Discussing: All operated patients had five years of survival. We observed developing contralateral hypernefroid carcinoma in one patient that necessary performing a partial resection in this place. In two patients we performed a partial resection of a solitarykidney. The results of surgery are very good when we stage properly cancer process that allows organ preservation.

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.

The review of literature offerred discusses the opinions of different authors about indications and contraindications for radical oncological procedures in cases of renal and ureteral diseases.

Aim of the embolization of the renal artery is to provoke ischemia or shut out from blood supply of the kidney tissue including pathologically changed area. As a result of this procedure the affected kidney becomes suitable for surgical removal without significant loss of blood. In this study there are included 116 nephrectomies due to kidney carcinoma. Clinical diagnosis and treatment of the patients are held at the Clinic of Urology of the Alexandrovska Hospital for the period 1990-1995. Embolization of the renal artery is accomplished in 52 subjects (63.41%). The procedure was contraindicated in 10 subjects (8.62%). It was established intraoperatively that the affected kidney had good embolization in 46 subjects (88.46%), in 4 subjects (3.44%) it had excellent embolization, and in 2 subjects (1.72%) there was just peripheral embolization. Authors conclude that: 1) Nevertheless this method is invasive it still has a place in urologists' practice. 2) Preoperative embolization of the renal artery is a devise for surgical removal of the kidney as well as achieving maximum effect.

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.

Following animal experiments (Combair 1803, Prevost and Dumas 1823) and accidental removal of the kidney in humans (Spillgellberg 1867, Peaslee 1868, Wolcott 1886), it has been established that elimination of a single kidney does not lead mandatorily to fatal outcome if the second functioning kidney is preserved. The chronology of nephrectomy development on a worldwide scale, and in Bulgaria as well, after the first routinely scheduled nephrectomy performed by Gustav Simon (2 Aug 1869), is presented. In 1897, almost 30 years later, Ivan Mikhaylovsky from the Plovdiv Hospital performed the first nephrectomy in this country. In the late 19th and early 20th century, nephrectomy becomes one of the most often used kidney operations (H Kumill, 1913--49.3 per cent), but gradually parallel to improving the diagnostic technique it is less frequently applied (W Lutzer et al, 1976--28 per cent) at the expense of organ-salvaging interventions. The last decade marks the introduction of laparoscopic nephrectomy (RV Clayman et al, 1991, AD Joce et al, 1992, JJ Rassweller et al, 1993, Sy Nakada et al, 1996, CC Abbou et al, 1998) which is a safe procedure even in patients with malignant renal pathology and adequately selected cases presenting various urological diseases.

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.

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.

According to A. Someren (1989), R. Heicapell and R. Ackermann (1992), Ritchie A. W. S., de Kernion (1987) renal carcinoma is a condition clinically "imperceptible", lacking typical symptoms. The clinical characteristics presented by 509 patients, treated in the Department of Urology (Clinical Center of Urology at the Medical University--Sofia) over the period 1973--1994, are discussed. Symptoms typical of the urogenital system, and atypical ones as well, are separately classified. A catamnestic follow-up study of the complaints is also done. Pain is the most frequently noted (77.38 per cent), next ranking hematuria (59.92 per cent), tumor mass palpation (26.38 per cent), with the classical triad bing recorded in 11.50 per cent. Carcinoma of the kidney is considered as one of the major imitators, mimicking a diverse and atypical clinical picture.

As pointed out by J. R. McLaughlin et al. (1983), in the various countries worldwide there is considerable difference in incidence and mortality rates of renal carcinoma. In the period 1973 to 1994, a total of 509 patients with renal carcinoma are admitted to the Department of Urology (Clinical Center of Urology, Medical University--Sofia). They represent 0.82 per cent of the total number of admissions during the stated period, and 7.71 per cent of the patients with diseases of the urogenital system. According to data submitted by the National Center of Oncology, the incidence of renal carcinoma amounts to 1.53 per 100,000 of population. As shown by the results most of the patients come from Vratsa and Vidin districts. By incidence rate of the disease Bulgaria is assigned to the moderate morbidity type in Europe. Patients in active age amount to 66.46 per cent, and old age pensioners--to 31.74 per cent.