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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.

From May 1992 to December 1993 (17 months), 18 patients with AIDS, 15 male and 3 female, age range from 25 to 50, were found to have severe voiding disorders related to neurogenic bladder dysfunction. All patients underwent neurologic, urologic and immunologic evaluation and were staged as AIDS-IVB. The neurological evaluation demonstrated: cryptococcal abscess of the brain in 1 patient, progressive and diffuse leukoencephalopathy in 3 patients, AIDS Dementia Complex in 3 patients and no neurologic abnormalities in 11 patients. The urodynamic tests demonstrated: detrusor areflexia in 5 patients, detrusor hyperreflexia with external sphincter dyssynergia in 5 patients, detrusor hyperreflexia with external sphincter dyssynergia and vesico-ureferai reflux in 1 patient, detrusor hyperreflexia without dyssynergia in 7 patients.

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.

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 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.

The results of treating kidney/ureteral lithiasis with piezoelectric lithotripters are reported. This paper contains the medium-term results of the treatment of 177 patients treated with piezoelectric lithotripsy using the EDAP LT01 and the Wolf Piezolith 2200 lithotripters.

The experience of our group in Milan covers 1,055 cases treated between the first of February 1985 and the first of September 1987. At the present time, the procedures used to treat staghorn calculi are to reduce the mass of the stone by conventional surgery or by a percutaneous nephrolithotomy and then to treat with shock waves. This means, however, that the staghorn calculus is still dealt with by surgery. We present some technical means which have enabled us to treat 84 large stones with ESWL without employing invasive surgical or percutaneous methods. The aim is to avoid complications due to the presence of an excessive mass of fragments to be eliminated. Immediately before treatment we perform a cystoscopy and insert into the ureter and then into the kidney a urethral catheter of large dimension (14 Fr.). Through this catheter, both during and after treatment, large masses of debris can be evacuated. Introduction of the large catheter is carried out as follows: (1) A guide wire is introduced into the ureter as far as the pelvis. (2) The ureter is dilated 12 or 14 Fr. with ureteral dilators. (3) The catheter is inserted into the pelvis along the guide wire. In some cases a second small catheter is introduced into the renal cavities through the catheter already in place. In this way, each single calix can be washed and the debris removed. We have treated 48 patients with this method.