Acad. Prof. Dr. Chavdar Slavov, PhD, is the head of the Urology and Andrology Clinic at Tsaritsa Yoanna UMBAL – ISUL. He is a National Urology Consultant. He graduated from Medical University – Sofia. In 1984, he acquired the specialty “Urology”. In 1995, he became an associate professor of urology, head of the department. Since 2007 he has been a doctor of medical sciences, and since 2008 he has been a professor of urology. From 2009 to 2013, he was the head of the urology clinic at “Alexandrovska” UMBAL. In 2013 – 2014, he was Deputy Minister of Health. He was deputy – dean of the Faculty of Medicine at Medical University – Sofia and long-time member of the Faculty and Academic Council at MU-Sofia. He was also a member of the Standing Committee of the WHO Regional Council. In 2014, he was elected a corresponding member of the BAS, and a few days ago he became an academician of the Academy. He specialized in Russia, France, England, USA, Germany, Belgium in the problems of reconstructive, transplant and laser urology. More than 10 diagnostic and more than 15 operative methods have been developed and put into practice. One of the first in the world to develop and put into practice urethroplasty with buccal and lingual mucosa. He is a long-time member of the kidney transplant teams. Academician Prof. Dr. Slavov’s scientific production includes over 420 scientific works with an impact factor of more than 850, eight of the publications are in the prestigious “Nature Genetics”, as the main researcher of the pan-world PRACTICAL project. Member of a number of international and our scientific organizations. – Prof. Dr. Slavov, your clinic is distinguished from other urology clinics in the country. What is different? Our clinic is unique in the country. She deals with both general urological diseases and andrological problems – diseases of the male reproductive system. Here, patients with diseases of the prostate gland predominate, oncourological patients – patients with an oncological disease of the excretory system. Recently, patients with kidney stone disease or urolithiasis, as it is properly called, are more and more frequent, because the clinic has extremely modern equipment for breaking the stones in question throughout the excretory system. Of the andrological cases, patients with strictures of the urethra predominate, as we are a referral center for performing urethroplasty and restoring the patency of the urinary canal. We also often see Peyronie’s disease as we specialize in its treatment as well. Of course, all other general urological and general andrological problems are also part of our activity. – What is Peyronie’s disease? In Peyronie’s disease, fibrous plaques form in the sheaths of the penis, especially those that surround the corpora cavernosa. The disease was described as early as the 18th century by Dr. Peyronie, after whom the disease is named. The medical name is Induratio penis plastica. These plaques cause the penis to bend in one direction or another,but most often upwards and this leads to a painful erection and also difficulties in sexual functions. – Do you think that these diseases are increasing recently and does it have anything to do with the quality and lifestyle of modern society? Of course! Here is the place to note that prostate cancer in the last decade has seen a serious growth and reached epidemic proportions. In order not to be vocal, I will also share some statistics. In 2018, the GLOBOCAN platform shows that there are almost 1 million and 300 thousand new cases, as well as about 365 thousand who died from prostate cancer. Last year, the number was even higher. There are already 1,400,000 new cases and 375,000 deaths. It is expected that by 2040, the number of newly discovered cases of this disease will be over 2 million and 400 thousand. Of course, the death rate will increase in proportion to the number. Our country has not been spared at all by this epidemic surge of the disease and for 2018, 5,613 cases were registered, of which 1,042 died. All this is related to the dynamic lifestyle, the way of eating, the intake of GMO products and many other factors. – What are the symptoms that should signal to men that they should seek a urologist? In urology and especially in the emergency, the symptoms that usually bring the patient to the urologist are a triad – pain, blood in the urine (hematuria) and urination problems, which more often affect men – frequent urination at night, difficulty urinating, etc. Pain can be in the lumbar region, originating from the kidney, pain in the abdominal region, originating from the ureter and bladder, as well as pain in the pelvis and groin, with inflammation of the prostate gland or testicles. Hematuria is usually associated with oncological diseases, but it is also often found in diseases of an inflammatory nature. Last but not least, a symptom that brings patients to us, as an andrological center, is sexual weakness and reproductive problems – impossibility of fertilization. – What is prostate hypertrophy and how does it affect a man’s life? As urologists, we consider diseases of the prostate gland in three main aspects – first of all is the inflammation of the gland, which occurs between the ages of 20 and 40, the so-called prostatitis. Chronic prostatitis is a very unpleasant affliction, with many problems in the quality of life of a young man. The other disease is prostate cancer, which most often occurs between the ages of 40 and 70. The third is benign prostatic hyperplasia or hypertrophy of the prostate gland, which usually occurs after the age of 60. In this condition, growth of some glands is observed, which are located around the urinary canal, the so-called. paraurethral glands, and this process begins immediately after the maturation of the man, which is usually due to a genetic predisposition, but also to the ongoing endocrine processes in the male reproductive system, to which the prostate gland belongs. Figuratively speaking, growing up,these glands pressurize the urinary canal and this is where the symptomatic form of hyperplasia begins – urges to urinate frequently, difficulty urinating, weak stream. Accordingly, most patients seek help then. – Is it linked to prostate cancer? Basically no. These are two separate diseases, having a completely different morphological substrate. As I said, benign hyperplasia, which is also a type of tumor, but benign, develops from the growth of the paraurethral glands, and prostate cancer develops in the true glandular tissue of the organ located in the periphery. Of course, this does not mean that we cannot have benign hyperplasia and prostate cancer at the same time. – Considering the number of cases in recent years, how can we protect ourselves from prostate cancer? First, the so-called primary prevention, in which every man should follow a certain healthy lifestyle, namely – maintain a normal weight, exclude animal fats and heavy animal products in his diet as much as possible, increase the intake of vegetables, especially broccoli and tomatoes. Alcohol and smoking, of course, have a negative effect here as well. I would like to emphasize nutritional supplements. In their quest and desire to gain muscle mass, shape and impress others, many young men take various nutritional supplements. Taking these supplements, they must be aware that they lead to very serious consequences, both in the reproductive system, for example in spermatogenesis, and in the excretory system – very often they can lead to kidney failure, which brings its own serious consequences. Of course, it’s also important to deal with stress. Secondary prevention, which has been introduced in Bulgaria since 2010, the so-called opportunistic screening based on the tumor marker discovered already in the last century – prostate-specific antigen. In our country, for all men over the age of 50, this screening has been introduced, which takes place every 1 or 2 years. A test is done for the antigen in question and an examination by a specialist urologist, because in about 10-15% of cases the test may be normal, despite the presence of gland cancer. In this screening, the next step is to perform an MRI, not a CT scan, I emphasize. Possibly, in case of doubt, one can then move on to taking a biopsy from the prostate gland, which is performed in several ways. – And what is the treatment of prostate cancer? I must say that the early forms of the disease, in Bulgaria, despite the introduced screening, for reasons such as fear, shame, etc., are still rarely caught. The percentage is around 46%, and, for comparison, in Germany it is 76%. Depending on the stage of the diagnosis, the corresponding treatment is undertaken. The main treatment is surgery, in which the prostate gland is removed, along with its capsule, seminal vesicles and part of the urethra.It is a rather debilitating operation and therefore has its disadvantages – leakage of urine after the operation, loss of erectile function at least for a certain period of time, etc. Recently, more modern methods have been introduced, such as low-dose brachytherapy, which we are ready to introduce in Bulgaria at any moment. It is not new abroad, it was introduced in the United States in the 1990s. We also had a legal attempt to introduce it, but, alas, it did not materialize. I hope that soon, with the help of our team, the Ministry of Health and the health fund, we will be able to offer it to the right patients. – What exactly is brachytherapy? Brachytherapy can be low- or high-dose. At the moment it is about the low dose. High-dose therapy is something else, and it is performed in our country, but there are also certain reservations regarding complications and the effect of the therapy. With the low-dose, isotopic grains of iodine-125, about 2 mm in size and compatible with human tissues, are introduced with special equipment. About 35-45 such low-dose grains are introduced, which in total reach 190 Gy of radiation and within a few weeks irradiate the prostate gland, respectively the tumor cells, and achieve up to 96% cure. I observe patients who were treated abroad more than 10 years ago and it is really good that soon we will be able to treat with this method here as well. – What innovations and innovative approaches can urology boast? As I already said, we have modern equipment for the treatment of urolithiasis, which allows us to break stones in all departments of the excretory system, from the bladder, through the ureter, to the kidney itself. We achieve this with a hybrid laser of the latest generation, with which the clinic is equipped. The other thing we can boast about is the modern treatment of strictures of the urethra and in general the so-called reconstructive urology, which makes it possible to restore the patency of not only the urethra, but also the ureters, using various methods. Regarding urethral strictures, we are one of the first clinics in the world to introduce the use of buccal mucosa. It is a mucous membrane on the inside of the cheek and on the sides of the tongue. We have also developed our own methods, such as reconstruction of a missing part of the urinary canal. – Can you explain exactly what urethral stricture is? A urethral stricture is a blockage of the urinary tract. This is actually treated in two ways. The less invasive method – internal urethrotomy, involves cutting the canal in the area of ​​obstruction and inserting a catheter for a certain time. Unfortunately, the stricture very often recurs after this treatment. Usually, after two relapses, urethroplasty is required, i.e. widening the canal or replacing the narrowed area with a graft of another tissue. In this case, the buccal mucosa is the gold standard. The mucosa is taken,processed and grafted to the site of the narrowing, thereby restoring the patency and integrity of the urethra. Alas, urethral strictures have become more common in recent years for two reasons. First, the presence of frequent transmissible infections such as gonorrhea, mycoplasmosis, etc., which lead to inflammation of the urinary canal and narrowing during recovery. The use of single urological treatment methods of the excretory system, the so-called cystoscopies, ureteroscopies, where it is possible to iatrogenically develop such a stricture, are the second most common cause. Fortunately, the results of the treatment in our clinic are comparable to those of the world. Depending on the different methods we use, the success rate is 86-96%. – In the month of men’s health, what will you advise men? I would advise any man who has not been vaccinated against COVID-19 to get vaccinated. Vaccines are the only available alternative to protect ourselves. Getting sick from covid leads to disorders in spermatogenesis, i.e. the man’s ability to fertilize. Don’t count on getting sick and building immunity, because the disease leads to severe problems that are not always fixable. Of course, follow health guidelines and have a safe sex life. Do not shy away from sex life and have regular urological examinations. Especially for men over the age of 50, this is extremely important and is covered by the national health fund.