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Early and late complications of nephrectomy include: chronic renal failure (CRF), haemorrhagic events, lumbar fistulas and other complications of different origin. This study covers 388 nephrectomies due to different diseases of the kidneys and the urethra. Clinical diagnosis and treatment of the patients are held at the Chair of Urology of the Alexandrovska Hospital for the period 1990-1995. There are established the following early and late complications: renal failure--in 37 patients (9.53%), haemorrhagic events--in 2 patients (0.51%), lumbar fistulas--in 4 patients (1.03%). Other complications are calculous anuria in 1 patient (0.25%), nephrectomy following plastic surgery of a kidney calyx--in 1 patient (0.25%), nephrectomy in a case with one functionally preserved kidney--1 patient (0.25%), nephrectomy in a case following kidney transplantation--1 patient (0.25%), and fatal outcome through the early postoperative period--in 2 patients (0.51%). Authors conclude that: 1) nephrectomy is followed by complications through the early and the late postoperative period; 2) complications following nephrectomy are rare but they are one of the most serious and important sequella in urologic surgery.

The increasing number of renal transplantations in Bulgaria and the increased survival rate of renal transplantation patients lead to an increase of the number of complications (vascular, urological, liquid collections) requiring surgical intervention. One hundred and ninety renal transplantation patients have been treated in the Department of Renal Transplantation for the period 1997-2003. Of these 12 were admitted to the Clinic of Vascular Surgery. We observed 36 surgical complications: arterial thrombosis--7, venous thrombosis--1, arterial stenosis--7, lymphocoele--4, hematoma--4, ureteral fistula--6, ureteral stricture--6, ureterolithiasis--1. We undertook following surgical interventions: vascular reconstruction, thrombectomy, lymphocoele punction, fenestration towards peritoneal cavity, reimplantation techniques (a modo Gregoari, Boeminghausi, Boari), termino-terminal anastomosis with native ureter, uretero-enteric anastomosis, ESWL of ureteral stone. Renal transplantation complications requiring surgical interventions are serious urological problem. The severity, the type (vascular, liquid collection, urological), and the diagnosis of these complications determine patients' prognosis. Urgent surgical interventions lead to rapid recovery of graft function, eradication of the infection, amelioration of blood flow, and improved graft survival.

A series of 147 patients subjected to transurethral prostate resection (TUPR) are followed up for seven years with a special reference to urethral strictures development. The patients' age varies from 52 to 78 years, with an 18-month average postoperative observation term. The methods of diagnosis used comprise uroflowmetry, retrograde urethrography and urethrocystoscopy. Obstruction of the lower urinary ways and urethral strictures are documented in 16 cases (10 per cent). Usually, post-TUPR strictures occur within one to three months after the operation. A brief literature survey on the incidence rate of this complication, reported by other authors, along with a comparative assessment of the results, is done. The likely underlying causes involved, and the prophylactic measures against the complication are discussed.

Vascular complications following renal transplantation are by no means rare. Usually they are multifactorial in nature, and eventually require operative management. Arterial and venous thromboses, arterial stenosis and hemorrhages are among the most frequently encountered vascular complications. In 1994, in the renal transplantation department of the Clinical Center of Urology three patients presenting vascular complications after renal transplantation are observed and treated. Two of them undergo surgery: resection of the stenotic segment of arteria renalis is done in one of them, and explantation-in the second. In the third case it is a matter of tense terminoterminal anastomosis due to technical reasons with ensuing venous thrombosis-here no operative correction is considered owing to intercurrent ischemic attack. In patients with transplantation the timely made diagnosis of vascular complications, and their surgical management prolongs the survival term.

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.