Prof. Dr. Chavdar Slavov: Distortion of the penis often leads to erectile dysfunction

Prof. Dr. Chavdar Slavov: Distortion of the penis often leads to erectile dysfunction
Prof. Dr. Chavdar Slavov: Distortion of the penis often leads to erectile dysfunction

Prof. Dr. Chavdar Slavov was born in 1953 in Sofia. In 1979, he graduated from the Medical Academy in Sofia, and in 1984 he acquired the speci alty "urology". Since 1988, he has been a candidate of medical sciences, and 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. In 2010, he received a master's degree in "He alth Management" at UNSS. From 2009 to 2013, he was the head of the Urology Clinic at the "Alexandrovska" UMBAL, Sofia. From 2013 to 2014, he was deputy minister of the Ministry of He alth.

He is currently the head of the Urology and Andrology Clinic at the "Tsaritsa Joanna - ISUL" UMBAL - Sofia and the methodical head of the Urology Clinic at the "Deva Maria" University Hospital, Burgas. He is a national consultant in urology.

He was the deputy dean of the Faculty of Medicine at MU-Sofia and a long-time member of the faculty and academic council at MU-Sofia, a member of the Standing Committee at the WHO Regional Council, chairman of the Expert Council on Preventive Medicine; Chairman of the Expert Council for Rare Diseases, etc. In 2014, he was elected a member-correspondent of the BAS.

He specialized in Russia, France, England, USA, Germany, Belgium in the problems of reconstructive, transplant and laser urology.

Over 10 diagnostic and 15 operational 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. Long time member of kidney transplant teams.

He is the author of over 415 scientific works, seven of which are published in the prestigious "Nature Genetics", as a member of the PRACTICAL worldwide project. He is the leader and participant in 10 scientific projects of the Ministry of Education and Culture and the Sofia University. He has published 18 monographs and textbooks, some of which are also in English.

There are 13 rationalizations and inventions. It has been cited over 1600 times in some of the most prestigious journals in the world with a total IF - over 8000.

He is a member of a number of international and our scientific organizations - AUA, EUA, SIU, BUD, etc. He was the editor-in-chief and deputy editor-in-chief of "Bulgarian Transplantology" magazine, "Andrology" magazine, "Surgery" magazine, etc.

He has been awarded numerous times with our and foreign awards. The last of them was in 2018, when President Rumen Radev awarded Prof. Chavdar Slavov with the "Stara Planina" order.

Prof. Slavov, what is Peyronie's disease?

- It is a disease of the male genital organ. It was described as far back as 1742 by the French doctor François de la Peyronie and is, simply put, distortion and shortening of the penis.

What changes exactly does it cause?

- Causes changes in the fibrous capsule of the penis. Fibrous plaques form and cause the penis to bend, which can be painful. The distortion is felt mostly during an erection of the penis. It is about men of active sexual age, between 40 and 55 years old. In this range, the disease occurs most often.

What are the reasons for the development of the disease?

- The causes are multifaceted, in the sense that there is no categorically clarified etiology for the disease. It is considered an autoimmune disease, and the most common cause is the so-called microtraumas of the penis, which the man does not notice. They are usually obtained with more violent sex, more violent masturbation.

And, of course, smoking and some other harmful habits are related to the causes. This is what all the world's researchers are united around.

Initially, the distortion may be slight, not paying attention to it, but over time it may become more pronounced, which already interferes with the normal performance of sexual intercourse. This is the thing that most often bothers patients, besides the pain I mentioned, in the initial stages.

And so there is a period of healing the pain and then a period of healing the distortion. Anatomically, when the patient is examined, fibrous changes are found. That is, fibrosis is connective tissue, it is not cancerous, it is not a life-threatening disease, it simply worsens a man's quality of life.


Prof. Dr. Chavdar Slavov

You mentioned about the treatment. What does it mean more precisely?

- The treatment, as I said, is in two directions: conservative, with various types of drugs, and operative, surgical in the more severe cases. In the conservative treatment, in the acute phase, when this distortion is painful, anti-inflammatory drugs are given, including antibiotics, along with drugs that reduce the growth of connective tissue.

There are also preparations that are injected around the plaque itself and very quickly affect precisely the pain in this disease caused by the distortion. Vitamin E is also included in high doses of 400 to 600 milligrams over a long period of time, usually three to six months. This is the most widespread and effective therapy.

I must note that attempts to inject cortisone preparations directly into the plaque, as well as the so-called extracorporeal lithotripsy with shock waves to break up the plaques, unfortunately, did not give good results and have been abandoned in world practice.

Treatment with potassium para-aminobenzoate (Potaba) has also had variable success. It is a drug that stops the growth of connective tissue, simply put.

But again I say it has variable success. It is given only at the discretion of a specialist doctor - urologist-andrologist. Our urology and andrology clinic at ISUL is specifically focused on the treatment of this disease.

I do not advise patients to self-medicate or to listen to the recommendations of non-specialists. The disease, like all other diseases of the human body, has strict individuality and individual parameters. Therefore, each case must be approached individually.

When is surgical treatment necessary?

- Surgical treatment is usually done for curvature over 60 degrees, where the possibilities of sexual contact are very limited. It is a disease that, unfortunately, with and without treatment very often leads to erectile dysfunction.

And in two directions: organic dysfunction, precisely due to changes in the shape of the penis, and psychological - due to the experienced stress.

The surgical treatment that we also apply is very interesting. We have different methods that we apply according to strict indications.

For example, for milder distortions, the Nesby operation can be applied.

The rest of the operative techniques are applied when the fibrous plate is movable, limited, did not cover the entire shell of the cavernous bodies (these are the bodies responsible for the erection of the penis and for performing sexual intercourse).

In this situation, another operation is performed - Lou's, which consists in cutting out this plaque and replacing it with a piece of other tissue, most often factory-made human tissues: skin, dura mater, venous vessels, etc..

We in Bulgaria introduced the replacement of plaque with buccal mucosa and were one of the first in the world to use this approach. Of course, there are other followers of this methodology, but I can say that we achieve very good results with it: the erectile function is preserved, which is the most important thing in these cases. And I emphasize again that everything must be evaluated by a specialist doctor to make the diagnosis and the indications for this operation.

What is your opinion on penile implants?

- In very extreme cases, in some countries they also do penile implants, which straighten the penis by themselves. But it is a foreign body that carries many risks: inflammation of the cavernous bodies, the so-called caverns.

And if I have to summarize, it is an extremely serious disease when it comes to treatment. It does not threaten the patient's life, but it threatens his quality of life, which in turn is associated in some cases with mental disorders.

You also apply a new method in operations to restore the urinary channel in case of ureteral stricture. Why is this type of pathology becoming more frequent?

- This is, as you mentioned, a common pathology. The increase in its frequency is related to the progress of technology, which is proof that this progress is not always 100% positive.


What do you mean?

- The introduction of endourology, i.e. operations through the urinary canal, very often lead to its injury and hence to the development of stricture of the ureter - certain sections of the urethra shrink and are also replaced by connective tissue. And it is a far more common disease than Peyronie's disease.

What are the options for her treatment?

- There are two methods of treatment. In case of short, small strictures, the so-called internal urethrotomy. And in case of second and third recurrence, urethroplasty is performed. And what we have introduced is urethroplasty using mucosa from the oral cavity: from the cheek and from the tongue.

In this regard, we are one of the first, I would even say that we are among the first 10. Separately, we also have our own techniques that have been accepted by the world and European societies for such surgery. The results are very good. Usually, with such a urethroplasty, 85-86% restoration of the patency of the urinary canal is achieved. That is, the urethra that was previously structured.

We have had cases where we have restored a urethra up to 15 centimeters, bearing in mind that its entire length is about 18 centimeters. You understand that we have restored almost the entire channel. The second similar operation was for a shorter stricture - 8 cm. We restored it with part of the mucous membrane of the oral cavity.

How many patients have you already applied the method to?

- We already have over 500 patients treated with this method. In this respect, we are also a center for the country. We perform all these operations. Of course, I have my students, followers like Dr. Elenko Popov, who works in a hospital in Sofia, Dr. Mateev - in Plovdiv.

And I am happy about that, but I say again that the specialized center, if we have to define it that way, is in the University Hospital "Tsarica Ioana-ISUL", in the urology and andrology clinic.

In the treatment of ureteral structure and Peyronie's disease, is there a co-payment from the patient? Is treatment affordable?

- The treatment is fully available. In Peyronie's disease, if such cultured material from human tissue is inserted, it is more expensive - over 600 euros. But we rarely use it because we have innovated this approach of replacing the plaque with a piece of buccal mucosa.

And this is included in the clinical pathway?

- Yes, this treatment can be done through a clinical pathway. Unfortunately, the clinical pathway is so underappreciated that it is insulting to colleagues to work on it and therefore they do not want to develop this surgery.

And for this operation that I mentioned to you, for stricture of the ureter - urethroplasty, in which a mucous membrane is taken from the oral cavity, in neighboring Serbia it was 5,000 euros, now it has become 10,000 euros. And even further, in England, it is 15 thousand pounds. For comparison, our cash register gives BGN 1000

And in this situation, how can we motivate people in Bulgaria to perform this surgery, and practice it well?

Only enthusiasts like you keep it going…

- And they will finish, these enthusiasts. I am not the only specialist to diagnose Peyronie's disease. The diagnosis can be made by any urologist with the chosen speci alty. The point is to choose the right approach to treatment, to choose the most suitable option.

Because an operation can also lead to the development of erectile dysfunction. That's why I mentioned that everything is extremely individual, as people are different.

At the end of our interview, what will you wish our readers in the new year?

- My wish for your readers for the new year is to be, first of all, he althy and not to overdo anything. I personally do not give advice - stop this or that, but anything too much is harmful. I mean food, alcohol, smoking, which have been categorically proven to harm the body.

And to believe in prevention. That is, once a year nothing prevents them from going he althy for a preventive examination. When male patients come to my office and tell me that they are here to be examined, it makes me so happy that there are such intelligent people with responsibility for their he alth.

So this is my wish: he alth, luck and a more serious attitude towards disease prevention. Undoubtedly, medicine gives chances.

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