Search

We present our experience with three different lithotriptors: Dornier HM3, EDAP LT02 and Piezolith 2300. Materials and methods:1876 patients with ureteral stones were treated between 1 January 1988 and 1 January 1996. The above 3 lithotriptors were used. In 925 patients the stones were located in the upper ureter, in 182 in the middle ureter and in 769 in the pelvic ureter. Auxiliary procedures were performed in 37% of patients. A DJ stent was used to catheterise 299 (16%) patients and a nephrostomy was performed in 19 (1%). Catheterisation was carried out in 247 (13.1%) ureters to localise the stones, plus 83 (4.4%) push ups and 52 (2.7%) Dormia baskets. Results:one treatment was sufficient in 1395 (74.3%) patients, 2 treatments in 335 (29.1%), 3 in 114 (6%), 4 in 21 (1.1%), 5 in 10 (0.5%) and 6 in 1 (0.05%). Patients were considered stone-free when they had negative X-ray and sonography two months after treatment; stones smaller than 3 mm, capable of being spontaneously eliminated without retrograde dilatation, were considered as fragments. The results were 1475 (78.6%) stone-free patients, 246 (13.1%) with fragments and 117 (6.2%) failures. 38 patients failed to appear at follow-up. Complications:complications were considered as hyperpyrexia and colics. There was very little hematuria, which regressed spontaneously in any case within the first 24 hours. Conclusion:side effects were few and required no treatment, so in our experience lithotripsy is the first choice treatment for ureteral stones. Particular attention, however, must be paid to the size of the stone in predicting the number of treatments.

With the growing number of patients with Hiv infection there has been a marked increase in the incidence of unusual genitourinary pathologies. Urologists find themselves dealing with opportunistic infection (viral and fungal infection), penile and testicular neoplasm and neurological bladder. The Authors present their experience and describe the problems correlated with urogenital pathologies during Hiv infection.

The echo-doppler is a non-invasive diagnostic method that makes evaluation of the morphology and the renal intraparenchymal vessel flow possible. Due to the development and spread of percutaneous methods and to the large number of patients who undergo extracorporeal lithotripsy, the renal parenchyma suffers traumas of which neither the short no long term consequences are yet fully understood. We calculated the Resistive Index using echo-doppler in 10 pts. who underwnt extracorporeal lithotripsy and we looked for the possible presence of arteriovenous fistulae in 10 pts. who underwent percutaneous manoeuvres (nephrostomy, litholapaxy and endopyelotomy). The results showed an increased R.I. in all patients at the end of the treatment, and in only one patient was this elevated R.I. maintained at the follow-up after 30 days. Arteriovenous fistulae were not found in any of the other patients.

Treatment of benign prostate pathology often has no effect on the symptomatology of the patient. For this reason we used an infrared laser ray, of which the biophysical effects on tissue are well noted: stimulation of lymphatic drainage, pain reduction, microcirculation, trophism and tissue elasticity increase. The laser was used on the prostate via an endorectal probe that gave compactness and orthogonality to the ray that is transmitted along 5 optic fibres. Between January 1991 and January 1992 we treated, following a rigorous enforcement of the requirements of the inclusion protocol, 80 patients with ages ranging from 25 to 77 years. Of these 40 suffered from abacterial chronic prostatitis (ACP), and 40 from early symptomatic benign prostatic hypertrophy (BPH) with a prostate diameter of < 4 cm. The preliminary results (with a 3 month follow-up) were satisfactory especially regarding the subjective symptomatology: BPH 75%; ACP 85%. The advantages of this method are: good results in selected cases (follow-up still limited), complete harmlessness, high tolerability, possibility of repeating the treatment, excellent cost-benefit ratio. The limitations are: exclusion from the protocol of neurologic bladders, bladder stones, median lobe of the prostate and the progressive loss of efficiency with the growth of the prostatic diameter.

The Authors present a new infrared laser device with endourethral atraumatic optic fiber capable of effectively treating patients with newly acute chronic prostatitis. Cost-benefit ratio is excellent and the method is minimally invasive.