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Endoscopic treatment of urethral stenosis is not an alternative to surgical therapy but is an ideal therapeutical partner. The limits of endoscopic resection lie in the lack of anatomopathologican and clinical knowledge regarding the long-term maintenance of stability of the urethral lumen that in every case the internal urethrotomy manages to create. In fact internal urethrotomy is capable of almost totally eliminating the urethral stenosis but with a higher incidence of relapse, even in the short-term. The complications of endoscopic therapy of urethral stenosis are the usual local complications and of mild seriousness. Among the most frequently noted are the swelling and/or peno-scrotal suffusion by incorrect routes, and post-operative urethraemorrhagia. More rarely, but with serious effects, are purulent urethritis or sepsis. In our case list major complications such as priapism, cavernositis or septic shock were not noted. In conclusion endoscopic therapy of urethral stenosis is a simple technique, repeatable with low morbidity and is the best technique in the congenital 'ring'.

From June 1986 to November 1989, 7 patients (pts.) with transitional bladder cancer were treated with CDDP 70 mg/m2 i.v. on day 1 and MTX 40 mg/m2 i.v. on days 8 and 15. The initial stage was T2 N0 M0 (2), T2 N0 M0 (8), T4 N0 M0 (4) and T3-4 N+ M0 (3). The median age was 56 years. After a median number of two cycles (1-5) of CDDP-MTX, 3/17 pts. (17.6%) had a complete remission (CM), 9/17 pts. (53%) a partial response (PR) greater than 50%, 4/17 pts. (23.4%) a PR less than 50%, 1/17 pts. (6%) a stable disease. Nausea and vomiting occurred in almost all pts., 20% of pts. had grade 3 stomatitis, 35% of pts. had diarrhoea, 20% of pts. had conjunctivitis, 7% of pts. had a bone marrow depression and hair loss. One patient had severe renal and liver toxicity and grade 4 bone marrow suppression with sepsis, completely controlled after intensive care. The treatment after neoadjuvant chemotherapy was: radical cystectomy (11)- in one following radiotherapy -; partial resection + lymphoadenectomy (2); TUR (4) in 1 pt. with lymphoadenectomy. After a median follow-up of 28 months (6-36), 12/17, equivalent to 71% of pts. are disease free, 3/17 (17%) are alive with disease, 2/17 (12%) died. In conclusion the association of neoadjuvant CDDP-MTX can induce a high percentage of response, and can preserve bladder function in some patients. Further controlled trials and a longer follow-up are needed to better define the exact role of this combination in terms of disease free survival, total survival and quality of life.

Extracorporeal lithotripsy consists of applying shock waves (electrohydraulic and piezoelectric) from outside the human body, which pass through the body tissues without damaging them breaking down the urinary calculi into particles which can then be automatically expulsed through the excretory tract. The object of this study is to analysis some of the important parameters which affect the success of the extracorporeal lithotripsy. These factors are as follows: 1) type of shock wave: electrohydraulic or piezoelectric, their action mechanism, methods of fragmenting the urolites; 2) the chemical composition of the calculi and its consequential resistance to the fragmented shock waves; 3) Patency, tone and peristalsis of the intra and extrarenal excretory tract for expulsing the urolite particles; 4) general conditions of the urinary apparatus. From the interaction of these 4 variables arise different clinical situations which must be evaluated before operating in order to develop the proper therapeutic subscription for a renal-urethral lithiasis. The current therapeutic procedures for renal-urethral lithiasis are as follows: electrohydraulic and piezoelectric extracorporeal lithotripsy; electrohydraulic waves or ultrasound percutaneous litholapaxy; operative urethroscope; traditional surgery; chemolysis.

The Authors suggest a change in their surgical classification of renal calculi to conform the description to the new techniques in the treatment of renal calculosis. Category "C" describes the morphology and topography of renal stones in five degrees (C1-C5); small letters "p, s, m, i" indicate the pelvis, superior, middle, inferior calyces; "n" and "a" symbolize stone having a size similar to or exceeding normal shaped renal cavities. "Cu" indicates ureteral calculi; small letters "l, i, p" indicate lumbar, iliac, pelvic ureteral stones. "N" describes the nature of the calculi. Category "E" stands for the excretory tract; "+" and "-" indicate the presence or absence of dilatation, the small letters "e, i" show the extra or intrarenal position of renal cavities; "no" and "o" indicate absence or presence of intrinsic obstruction of the excretory tract. "R" points out the number of surgical recurrences. Category "P" indicates the function of the parenchyma; numbers 1, 2, 3, refer to normal renal function, moderate or serious insufficiency. "U" stands for unique functional or anatomical kidney; "I" indicates the presence of infection.