Until then we have some old reports here:

1. Andrology
2. Endourology
3. Reconstruction
4. Calculus Disease
5. Incontinance
6. Oncology
7. Oncology Prostate
8. Prostate BPH
9. Equipment
10. Special Interest

Back home

Journal:	BJU International
Authors:	Kraus S and Weidner W	Issue:	2001, 165: 1984

Title:

Prolonged exposure to extracorporeal shock wave lithotripsy and noise induced hearing damage.

Abstract:
Any safety issue regarding medical equipment must be thoroughly investigated. This short paper, including a case report, raises the controversial issue that the noise from lithotripters may adversely affect the hearing of both patients and operators. This becomes even more important when taking into the account the fact that safety measures are not currently in place to protect patients and staff and the fact that any resulting hearing damage would be irreversible. The case history described regards a urologist who suffered irreversible high frequency hearing loss, possibly associated with a 1-year exposure to 5 lithotripsy sessions per week. Although this case may be isolated and the details suggest a rather high exposure to lithotripter sessions the fact remains that the noise from the lithotripter may contribute to hearing damage and, at present, no safety precautions are taken with regards to this possibility. Further evidence and other case reports are eagerly awaited but it may be shrewd to introduce simple safety measures for patients and staff on the basis of this evidence alone.

Reviewer: Paul William Foster

Journal:	Journal of Urology
Authors:	Hollenbeck BK, Schuster TG, Faerber GJ and Stuart Wolf J Jr	Issue:	2001, 57: 639-43

Title:

Routine placement of ureteral stents is unnecessary after ureteroscopy for urinary calculi

Abstract:
This single-centre retrospective case-controlled cohort study addresses the important issue of ureteric stenting following ureteroscopic retrieval of urinary stones (URS). Until recently, stenting had been standard practice, as it was thought to diminish stricture and renal colic rates. However, the significant morbidity associated with stents is now well documented, with up to 50% of patients developing moderate to severe problems. This is coupled with the additional economic cost and need for further instrumentation to remove them. A recent study has illustrated the benefits of not routinely stenting following treatment for distal ureteric calculi. This present paper further included patients with renal (35%) and proximal ureteric (22%) stones. 51 un-stented patients were included over 33 months and matched to a stented group with similar stone characteristics. 16 (stented) versus 4 (un-stented) postoperative complications occurred (p = 0.03). Multivariate logistic regression models excluded confounding variables such as age, ureteral dilatation and operative time from being predictive for complications and statistically confirmed the association with stenting. The authors highlight the weaknesses of the study, particularly the retrospective nature of analyses and the potential biases involved in choosing those patients that were not stented as well as the comparator group. They are however, planning to undertake a prospective randomised trial with long-term follow up to help clarify this important issue.

Reviewer: Sandy Gujral

Journal:	Urology
Authors:	Hollenbeck BK, Schuster TG, Faerber GJ and Wolf JS Jr.	Issue:	2001, 57: 639-43

Title:

Routine placement of ureteral stents is unnecessary after ureteroscopy for urinary calculi.

Abstract:
Although it is generally routine practice to place a ureteric stent after performing ureteroscopy, many patients complain of pain and urinary symptoms until the stent is removed. This paper represents an initial retrospective study on the elimination of routine ureteric stents following ureteroscopy for urinary calculi. 318 patients underwent either rigid or flexible ureteroscopy between January 1997 and September 1999. During that time the concept of not routinely placing a stent at the end of the procedure developed, although no formal criteria were used to decide on stent placement. 81 (25%) patients did not have a stent placed at the end of the procedure, and 51 of these had complete records suitable for analysis. The group included patients with the stone in the distal ureter (22), middle or proximal ureter (11), and kidney (18). This cohort was matched by stone size and location with a similar group of patients from the same period who had stents placed following ureteroscopy. There were significantly fewer complications in the non-stented compared to the stented group (4 v 16) and there was no further instrumentation in those that did not initially have a stent placed. However the operative time for the stented group was longer than the non-stented (67.4 v 46.4 mins) and was not thought to represent the extra time needed to place a stent, suggesting a bias in patient selection. The mean follow-up was only 5 months, so that an increase in delayed complications cannot be excluded. The authors’ current criteria for omission of a ureteric stent after ureteroscopy for urinary calculi include short operative time (< 90mins), no significant trauma at the site of the stone, and no significant trauma or bleeding of the ureter or kidney. They conclude that a prospective randomised study is needed to confirm that in such patients there is no need to place a ureteric stent following surgery.

Reviewer: John Parkin

Journal:	Journal of Urology
Authors:	Mokhmalji H, Braun PM, Portillo FJ, Siegsmund M, Alken P, Kohrmann KU.	Issue:	2001, 165: 1088-92

Title:

Percutaneous nephrostomy versus ureteral stents for diversion of hydronephrosis caused by stones: A prospective, randomized clinical trial.

Abstract:
This paper describes a prospective study carried out in two hospitals, one in Germany and the other in Syria. A total of 40 patients with stone-induced hydronephrosis were randomized between percutaneous nephrostomy and stent insertion. The two methods of management were then compared with regard to the procedure, relief of accompanying symptoms and quality of life taking into account patient age and sex. Even with these relatively small numbers, several statistically significant differences were found. Percutaneous nephrostomy was successfully completed in 100% of patients and stents were successful in 80%, with a 20% conversion to percutaneous nephrostomy. There was statistically significant lower x-ray exposure time and less need for analgesics and intravenous antibiotics in the percutaneous nephrostomy group. This group also had a shorter indwelling time, with 50% of patients having a nephrostomy for less than 2 weeks compared with only 25% having a stent for less than 2 weeks, in that group. Quality of life studies with questionnaires immediately, and 2 to 4 weeks postoperatively, showed moderate reduction, which was more pronounced in the stent group and deteriorated with time. However, in the nephrostomy group, patients became increasingly tolerant with time. The study concluded percutaneous nephrostomy to be superior to ureteral stents for diversion of hydronephrosis caused by stones, especially in patients with a high temperature, as well as in males and juveniles.

Reviewer: Justin Collins

Journal:	BJU International
Authors:	Lopes T, Dias JS, Marcelino J, Varela J, Ribeiro S and Dias J	Issue:	2001, 87: 322-325

Title:

An assessment of the clinical efficacy of intranasal desmopressin spray in the treatment of renal colic.

Abstract:
This paper seeks to prove the use, as an analgesic, of the anti-diuretic drug desmopressin as either a first line agent or an adjunct in the treatment of acute renal colic. Using 61 patients randomised into three groups (A desmopressin, B diclofenac, C desmopressin and diclofenac) analgesic response was measured using visual analogue scales. The results did not support the conclusion that desmopressin was a better analgesic, suggesting rather that it was as useful as diclofenac in the first 10 minutes but less effective at 30 minutes. The group of patients given both desmopressin and diclofenac did not show any significant improvement in analgesia compared to those given diclofenac alone. A major criticism is that the diagnosis of calculi was made on history alone and a plain X-ray was ordered. There is no mention as to whether patients were excluded following this, or of the results and correlation of IVU results. The paper does offer a relatively safe option in the treatment of acute renal colic although it is documented that patient response to intranasal desmopressin varies greatly amongst individuals.

Reviewer: Paul William Foster

Journal:	Journal of Urology
Authors:	Denstedt J, Wollin T, Sofer M, Nott L, Weir M and Honey R	Issue:	2001, 165: 1419-1422

Title:

A prospective randomised controlled trial comparing non-stented verses stented ureteroscopic lithotripsy.

Abstract:
As experience of ureteroscopic lithotripsy becomes more common, postoperative management may change. This paper attempts to advocate the option of not having to use a ureteric stent following uncomplicated ureteroscopic lithotripsy. Using 58 randomised patients all with stones less than or equal to 2cm stone ablation was achieved in 98% using a holmium laser. Stone fragments were left in situ and half of the patients left unstented, the remaining 28 were stented and formed the control group. Results were favourable, the stented group had more symptoms such as pain and dysuria at 1 week (measured by questionnaire and visual analogue scales) and no difference was seen subsequently. 1 stented patient developed sepsis and 1 unstented patient suffered excessive vomiting. The stone-free rate was equal in each group, 100%. The point was made that final inclusion criteria was an uncomplicated intra-operative period as any moderate ureteral oedema (as judged by the surgeon) resulted in stenting. Results could possibly be skewed following this as case selection may have occurred. It does remain, however, that the exclusion of ureteric stenting is a safe practice following uncomplicated ureteroscopic lithotripsy.

Reviewer: Paul William Foster

Journal:	BJU International
Authors:	Robert M, Segui B, Vergnes C, Taourel P and Guiter J.	Issue:	2001, 87: 316-21

Title:

Piezoelectric extracorporeal shockwave lithotripsy of distal ureteric calculi: assessment of shockwave focusing with unenhanced spiral computed tomography.

Abstract:
Extracorporeal shockwave lithotripsy (ESWL) has been proven to have a lower efficacy when used to treat distal ureteric stones compared to more proximal ureteric stones. This paper sought to evaluate shockwave focusing via assessing abdominal gas and pelvic bone interposition with the use of unenhanced spiral computed tomography (CT). 35 patients (26 men) with calculi below the sacro-iliac joint and full bladders were evaluated. It was shown that, in the sagittal plane, bone and gas interposition was less for an oblique access than a vertical approach. In the coronal views bone and gas interposition could be reduced significantly with contralateral inclination of the shockwave axis in the coronal plane. Patient sex, bladder volume and body mass index was found to be significant in shockwave focusing in the sagittal plane. Although clinical trials are awaited this paper does suggest that if CT becomes the first line option in the assessment of loin pain then it may also have a role to play in the preoperative evaluation of the optimum shockwave pathway. It does offer scientific evidence towards why ESWL is less effective in the treatment of distal ureteric calculi.

Reviewer: Paul William Foster

Journal:	Ann Intern Med
Authors:	McNaughton Collins M, MacDonald R and Wilt TJ	Issue:	2000, 133: 367-381

Title:

Diagnosis and treatment of chronic abacterial prostatitis: a systematic review.

Abstract:
This extensive review of the world literature seeks both to detect accurate, reliable tests to diagnose chronic abacterial prostatitis and effective therapies for this condition. The authors identified studies using MEDLINE, the Cochrane Library and bibliographies from identified articles and reviews with no language restrictions. For diagnostic tests, only articles describing controlled studies were selected, whilst for treatment studies both randomised or controlled clinical trials were included. 19 diagnostic test articles and 14 treatment trials met the inclusion criteria, although a formal meta-analysis was not possible because there was such heterogeneity amongst the studies and many were methodologically weak. Conclusions made are that there is no gold standard diagnostic test for chronic abacterial prostatitis, but that clinicians currently performing the ‘four-glass’ test should consider changing to the pre- and post-massage test. It is suggested that the NIH chronic prostatitis classification system should be used to group patients in future studies, and the NIH-CPSI is used to quantify symptoms and the impact on quality of life. Routine use of antibiotics or alpha-blockers is not supported by existing evidence, but deserve further scrutiny, and small studies have demonstrated significant benefit from thermal therapy. This paper highlights the deficiencies in our knowledge of how to manage chronic abacterial prostatitis, encourages further research of improved quality and, at the same time, deplores the use of unsubstantiated treatments.

Reviewer: John Parkin

Journal:	Urology
Authors:	Darouiche RO, Smith Jr JA, Hanna H, Dhabuwala CB, Steiner MS, Babaian RJ, Boone TB, Scardino PT, Thornby JI and Raad II	Issue:	1999, 54: 976-81

Title:

Efficacy of antimicrobial-impregnated bladder catheters in reducing catheter-associated bacteruria: A prospective, randomised, multicenter clinical trial.

Abstract:
A prospective randomised clinical trial was carried out to determine the efficacy of urinary catheters impregnated with minocycline and rifampicin in decreasing catheter associated bacteruria in patients undergoing radical prostatectomy. Patients were randomised intraoperatively to receive either regular silicone catheters or silicone catheters impregnated with antibiotics. Catheters were in place for a mean of two weeks. Patients were followed up with urine cultures at 3, 7 and 14 days and bacteruria was defined as the growth of organisms in urine at a concentration of 104 cfu/ml or greater. The results showed that patients with antimicrobial impregnated catheters (n=56) took significantly longer to develop bacteruria than those in the control group (n=68). There were significantly lower rates of gram-positive bacteruria in the study group, but similar rates of gram-negative bacteruria and candiduria. There was no significant difference between the two groups in the development of symptomatic urinary tract infections. Larger trials are required to demonstrate any clinical benefit in the use of these antimicrobial impregnated catheters.

Reviewer: Sunil Kumar

Journal:	Journal of Urology
Authors:	Grasso M and Ficazzola M	Issue:	1999, 162: 1904-1908

Title:

Retrograde ureteropyeloscopy for lower pole caliceal calculi.

Abstract:
This study retrospectively analyses the safety and efficacy of retrograde ureteropyeloscopy for lower pole calculi. Seventy-nine patients with 90 lower pole stones underwent 101 procedures with a small diameter, actively deflectable, flexible ureterorenoscope and a 200m holmium laser fibre. Stones were classified as group I (10mm or less, n=47), group II (11-20mm, n=21) and group III (> 20mm, n=22). Success was defined as clear imaging on renal sonography with a minimum 3-month follow up. Anatomical variants were noted and correlated with surgical failures. Overall, stone free rates were 82%, 71% and 65% in groups I, II and III respectively. There were eight (9%) failures of endoscopic access of which two had infundibular strictures. Of the anatomical variants, a long lower pole infundibulum was the most statistically significant predictor of failure. A second procedure was performed in the majority of patients in group III especially if the stone size was in excess of 2.5cm. There were a few minor postoperative complications such as renal colic in 6 (8%), and 3 (4%) developed symptomatic urinary tract infections but no major intraoperative complications.There were no ureteral strictures reported in their 3-month follow up. In conclusion, retrograde ureteropyeloscopy is a safe and effective surgical treatment of lower pole stones in expert hands.

Reviewer: Sunil Kumar

Journal:	Journal of Urology
Authors:	Peschel R, Janetschek G and Bartsch G	Issue:	1999, 162: 1909-1912

Title:

Extracorporeal Shockwave Lithotripsy versus ureteroscopy for distal ureteral calculi: A prospective randomised study

Abstract:
This prospective randomised study was performed over a 19-month period to determine appropriate first line treatment for distal ureteral stones. Eighty patients with distal ureteral calculi (40 < 5mm and 40 > 5mm) were randomised and treated with lithotripsy or ureteroscopy. The groups were well matched in terms of average patient age, male to female ratio as well as stone size. All patients presented with radio dense ureteral stones distal to the bony pelvis that had not passed spontaneously within three weeks. Fluoroscopic imaging was performed upon completion of the procedure and abdominal radiographs were obtained on day 1, 8, 15, 22, 29, 36 and 43. If the calculi failed to pass within 43 days ureteroscopic removal of the stone was performed. None of the patients received repeat lithotripsy in the ESWL group and all the patients in the ureteroscopy group had a double pigtail catheter routinely inserted. The mean operating time, mean fluoroscopy imaging time and the mean number of days to being stone free was significantly lower in the patients undergoing ureteroscopy in both the groups. The only disadvantage in the ureteroscopy group was the stent placement. Of the lithotripsy patients, 15% in the group with stones < 5mm and 5% in the other group required re-treatment as compared to none in the ureteroscopy arm. In general, in both the groups patients were satisfied with their treatment option except for those who required re-treatment. There were no reported complications. This well designed study suggests that ureteroscopy should be the first line treatment in patients with distal ureteric stones especially those 5mm or less.

Reviewer: Sunil Kumar

Journal:	BJU International
Authors:	Al-Awadi KA, Halim HA, Kehinde EO and Al-Tawheed A	Issue:	1999, 84: 618-621

Title:

Steinstrasse: a comparison of incidence with and without J stenting and the effect of J stenting on subsequent management

Abstract:
A prospective randomised study to analyse the effect of ureteric stenting on the incidence of steinstrasse post lithotripsy in 400 patients with stone diameter ranging between 1.5-3.5cm. The patients were divided into 2 groups; one group (200 patients) had double J stents inserted prior to lithotripsy and the other group did not. Stone clearance rate was similar in both groups irrespective of the presence or absence of stents. The authors fail to mention the exact location of the calculi as well as the number of sessions that were required on the lithotriptor to achieve a stone free rate of 86%-87%. Only 6% of the stented group developed steinstrasse compared to 13% in the non-stented group (p<0.05). The incidence increased with increasing stone burden and 77% of the patients with stone sizes between 3.1-3.5cm developed steinstrasse. There was no statistically significant difference in the mode of presentation or subsequent management modalities after the development of steinstrasse in either group. It is rather surprising to note that five patients required ureterolithotomy to clear their steinstrasse. This raises the question, as addressed by the authors, about the feasibility of lithotripsy in large burden calculi in preference to PCNL.

Reviewer: Sunil Kumar

Journal:	Journal of Urology
Authors:	Chertin B, Fridmans A, Knizhnik M, Hadas-Halperin I, Hain D and Farkas A	Issue:	1999, 162: 1037-1040

Title:

Does early detection of ureteropelvic junction obstruction improve surgical outcome in terms of renal function?

Abstract:
There is considerable controversy over the appropriate timing of surgical intervention in congenital ureteropelvic junction obstruction. Current practice is to interfere if the patient is symptomatic or if there is any evidence of functional deterioration. The authors attempt to prove that early intervention preserves, if not improves, renal function in a retrospective study involving 113 patients over an 18-year period. Fifty patients (group 1) had prenatal hydronephrosis and sixty-three (group 2) were diagnosed to have neonatal hydronephrosis. The patients in the second group were lost to follow up after initial diagnosis and presented later with symptoms at varying intervals. The median age at surgery in each group was 11 months and 5 years and the average post-operative follow up was 4.2 and 3.2 years respectively. All patients were assessed by renal ultrasound and isotope scan pre and post-operatively. The pre-operative renal function was < 30% in 89% of patients in group 2 compared to only 12% in the first group (p<0.05). Dismembered pyeloplasty was performed on all the patients by one surgeon or under his supervision. In the first group, 60% (n=30) had improvement in renal function (> 5% on renogram) compared to 16% (n=7) in the second group (p<0.05). None of the patients in either group had functional deterioration post-operatively. Although the results do suggest that early intervention improves and prevents deterioration of renal function, further prospective studies are indicated.

Reviewer: Sunil Kumar

Journal:	BJU International
Authors:	Agrawal MS, Aron M and Asopa HS	Issue:	1999, 84: 252-256

Title:

Endourological renal salvage in patients with calculus nephropathy and advanced uraemia

Abstract:
Over a period of seven years 78 patients with calculus nephropathy were reviewed with follow up ranging between 2.5 – 9 years after presentation. The mean serum creatinine level at presentation was 663.8 mmol/L (range 282.8-1449.7). Forty six had bilateral upper urinary calculi and the rest had solitary functioning kidneys obstructed by stone. A preliminary nephrostomy was inserted in 64 patients with subsequent stone extraction after improvement in their uraemic status. Stones were removed in the first session in the remaining patients. Anuric patients (n=20) showed the most dramatic improvement immediately after decompression. Serum creatinine level was found to be unreliable but the presence of pus and parenchymal thickness of < 4mm were reliable indicators of poor prognosis. Sixty four patients recovered well from uraemia, eleven showed no improvement and three died due to septicaemia. The mean serum creatinine at last follow up was 271.3 mmol/L. Only six patients are on haemodialysis. This retrospective study suggests that the percutaneous approach offers good results for patients who present in advanced uraemia with an obstructed infected system.

Reviewer: Sunil Kumar

Journal:	Journal of Endourology
Authors:	Maheshwari PN, Oswal AT, Andankar M, Nanjappa KM and Bansal M	Issue:	1999, 13: 441-444

Title:

Is antegrade ureteroscopy better than retrograde ureteroscopy for impacted large upper ureteral calculi?

Abstract:
A non-randomised prospective study comparing antegrade vs. retrograde ureteroscopy for impacted upper ureteral calculi (>1.5cm) was carried out. A total of 43 patients were included in the study. Antegrade ureteroscopy was performed in 23 patients and the remainder had the retrograde procedure. Intra-operative time, complications, hospital stay and stone free rates were noted in all patients. The only statistically significant variable was the higher immediate stone free rate (100%) following antegrade ureteroscopy as compared to the retrograde procedure (55%). The obvious advantage of the antegrade technique is that any associated pathology could be dealt with at the same time. The drawback of this study is the non-randomisation and instrumentation. The use of semi rigid or flexible ureterorenoscopes and laser lithotripsy may have given differing results.

Reviewer: Sunil Kumar

Journal:	Journal of Urology
Authors:	Trinchieri A, Ostini F, Nespoli R, Rovera F, Montanari E and Zanetti G	Issue:	1999, 162: 27-30

Title:

A prospective study of recurrence rate and risk factors for recurrence after a first renal stone

Abstract:
The ideal management after a first stone episode is controversial and this paper attempts to provide some guidelines. A prospective study was conducted where the records of 300 consecutive patients were studied. At first visit, serum samples and 24-hour urine samples were collected from all patients for metabolic assessment. Patients with remnant stones after the initial event were excluded. Mail questionnaires and telephone interviews followed up 195 (65%) patients over 13.9 ± 5.7 years (min 7 years). One hundred and sixty five patients responded to the questionnaires and 30 were interviewed by telephone. Fifty-two (27%) had symptomatic stone recurrences. Ultrasound examination of a random sample of 36 asymptomatic patients showed recurrent stones in 28% with more than 50% having <3 mm clinically insignificant fragments. Analysis revealed no real difference between patients with and without recurrences in regard to male to female ratio, family history of stones, ages at onset or incidence of various metabolic disorders. This paper suggests that although stones can recur up to 10 years after the first episode, the rate is lower than previously reported. The fact that x-rays and ultrasound examinations were not routinely conducted as follow up could have resulted in oversight of recurrence rates in symptom free cases. New minimally invasive techniques did not appear to have any appreciable impact on recurrence rates. The need for metabolic evaluation after a first episode needs to be reappraised, as recurrences were independent of urinary risk factors.

Reviewer: Sunil Kumar

Journal:	Journal of Urology
Authors:	Schwartz BF, Schenkman N, Armenakas NA and Stoller ML	Issue:	1999, 161: 1085-1087

Title:

Imaging characteristics of Indanivir calculi.

Abstract:
The preceding paper in this month’s issue of the Journal of Urology suggests that the incidence of Indanivir stones is higher than the reported 3.6% in clinical trials. In this paper, the authors review 36 patients with Indanivir calculi in an attempt to identify the imaging characteristics of these stones. Indanivir stones would appear to be radiolucent, none being clearly visualised on plain radiography. Intravenous urography and computerised tomography were both unhelpful in unequivically demonstrating the calculi. Ultrasound however provided diagnostic imaging in 1/3 of patients. The authors describe a management algorithm for patients with Indanivir calculi suggesting that imaging (ultrasound scan of the kidneys with pelvic spiral CT) be reserved for those patients with symptoms associated with fever. In those patients with no hydronephrosis or calcification, conservative management should be pursued.

Reviewer: Andrew Elves

Journal:	British Journal of Urology
Authors:	AA Shokeir and M Abdulmaaboud	Issue:	1999, 83: 378-382

Title:

Resistive index in renal colic: a prospective study.

Abstract:
The authors evaluate the sensitivity of the resistive index assessed by doppler ultrasound compared to IVU in the diagnosis of acute unilateral renal obstruction in a cohort of 117 patients presenting with unilateral loin pain. The resistive index in the 68 patients with obstructed kidneys on IVU was significantly higher than that seen in 166 unobstructed kidneys (0.73 versus 0.64). The sensitivity of the resistive index in detecting obstruction (as defined by hydroureter proximal to a stone) with or without delayed pelvicalyceal filling in an IVU, was 77% and specificity was 83%. The authors conclude that the doppler ultrasound assessment of resistive index is a sensitive and specific tool which may contribute to the diagnosis of unilateral renal obstruction where IVU is undesirable.

Reviewer: Andrew Elves

Journal:	British Journal of Urology
Authors:	Bombieri L, Dance DAB, Reinhardt GW, Waterfield A and Freeman RM	Issue:	1999, 83: 392-395

Title:

Urinary tract infection after urodynamic studies in women: incidence and natural history

Abstract:
The incidence of bacteriuria after urodynamics is variable from about 1.5% to 30%. This prospective study attempts to establish this incidence, to study its natural history and to detect risk factors. Two hundred and fourteen non-consecutive women attending for urodynamic studies were included in this study. All patients were screened two weeks prior to urodynamics using microscopy and semiquantitative culture. Mid-stream urine specimens were collected for culture at 2 and 7 days after the test. Eight percent (n=17) had bacteriuria but only one became symptomatic and 4 developed delayed infection. The organisms were coliforms (15 patients) and enterococci (2 patients). Occurrence of the late infections suggests that bacteria may enter the urinary tract at a later stage, possibly as a consequence of trauma. Irritative bladder symptoms developed in 34% of the cases. The only significant association was advancing age (P=0.05). The value of prophylactic antibiotics has not been shown. This study concludes that urodynamics have a low level of morbidity and are associated with a high incidence of transient irritative symptoms but a low incidence of bacteruria.

Reviewer: Sunil Kumar

Journal:	Journal of Urology
Authors:	Turk TMT and Jenkins AD	Issue:	1999, 161: 45-47

Title:

A comparison of ureteroscopy to in situ extracorporeal shockwave lithotripsy for the treatment of distal ureteral calculi

Abstract:
The authors present a retrospective comparison of in situ ESWL versus ureteroscopy for the treatment of 187 patients ( 91 treated with ESWL, 96 treated with ureteroscopy) with distal ureteric calculi. In concordance with a number of other studies, ureteroscopy appears to offer higher stone free rates (71% for ESWL versus 95% for ureteroscopy), but at the expense of short term morbidity including 4 ureteric perforations requiring long-term stenting. No comment is made upon the cost implications of either approach.

Reviewer: Andrew Elves

Journal:	Journal of Urology
Authors:	Hosking DH, McColm SE and Smith WE	Issue:	1999, 161: 48-50

Title:

Is stenting following ureteroscopy for removal of distal ureteral calculi necessary?

Abstract:
This study included a total of 93 patients who were not stented following uncomplicated ureteroscopy for distal ureteral calculi. The majority of procedures (n=80) were performed under intravenous sedation and 82 patients underwent prior balloon dilatation of the intramural ureter. Patients were contacted 1 to 3 days and 7 to 10 days postoperatively by telephone to determine analgesic requirements and time of return to normal activity. The results suggest that postoperative discomfort is modest and occurred in 57% of the patients, while 43% reported no discomfort at all. Only 13% (n=12) required intravenous narcotics postoperatively. Of the patients in whom discomfort did occur, 77% resolved in 2 days or less. There were no patients with stricture formation although follow up was inadequate for this assumption. The authors conclude that routine placement of a ureteral stent following uncomplicated ureteroscopy for distal ureteral calculi is unnecessary. These conclusions are difficult to support as there was no control group and it was not possible to predict who would have pain and who would not.

Reviewer: Sunil Kumar

Journal:	Journal of Urology
Authors:	Teichman JM, Champion PC, Wollin TA and Denstedt JD.	Issue:	1998, 160: 2130-2132

Title:

Holmium:YAG lithotripsy of uric acid calculi.

Abstract:
Uric acid stones irradiated with holmium:YAG energy have been shown to produce cyanide. Concerned about the possibility of clinical cyanide toxicity when using the holmium:YAG laser to treat uric acid stones the authors present a retrospective series of 18 patients with uric acid stones treated with holmium:YAG laser. No patient had increased end tidal C02, ECG changes, or significant decrease in post-operative serum bicarbonate. No cyanide related neurological, cardiac or respiratory complications were noted.

Reviewer: Andrew Elves

Journal:	Urology
Authors:	Kapoor DA, Klimberg IW, Malek GH, Wegenke JD, Cox CE, Patterson AL, Graham E, Echols RM, Whalen E and Kowalsky SF.	Issue:	1998, 52 (4): 552-558

Title:

Single-dose oral ciprofloxacin versus placebo for prophylaxis during transrectal prostate biopsy.

Abstract:
This prospective randomised double blind placebo controlled trial compared the administration of 500 mg ciprofloxacin or placebo before transrectal needle biopsy of the prostate. Urine was examined on day 2-6 and day 9-15 post procedure for bacteriuria. Out of 537 patients, 269 received ciprofloxacin and 268 received placebo. A hundred patients were excluded from the analysis due to insufficient culture data. Bacteriuria was recorded in 3% of patients on ciprofloxacin and 8% on placebo. Symptomatic UTI was recorded in 3% of patients on ciprofloxacin and 5% on placebo. In this group, 4 patients were admitted for treatment of septicaemia. The authors conclude that single dose oral ciprofloxacin reduced bacteriuria after transrectal biopsy of the prostate and established that the rate of bacturia is 8% for this procedure.

Reviewer: Jonathan Cartledge

Journal:	Urology
Authors:	Hayes WS, Tohme WG, Komo D, Dai H, Persad SG, Benavides A, Juttner HU, Fleming MP, Wonsetler B, Mun SK and Pahira JJ.	Issue:	1998, 51 (1): 39-43.

Title:

A telemedicine consultative service for the evaluation of patients with urolithiasis.

Abstract:
The authors report their experience using PC based video-conferencing software to transfer radiographs and allow live consultation between a peripheral hospital and a specialist stone centre. Previous consultation had included ‘phone calls and sending patients and radiographs on a 90 mile journey. The telemedicine consultation changed the advice given after a ‘phone consultation in 37.5% of cases. The authors conclude that telemedicine enhanced the clinical decision process by allowing immediate access and effective transfer of information .

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Sabnis RB, Naik K, Patel SH, Desai MR, Bapat SD.	Issue:	1997, 80: 853-857.

Title:

Extracorporeal shock wave lithotripsy for lower calyceal stones: can clearance be predicted?

Abstract:
PCNL is the treatment most likely to give stone clearance for most lower pole stones but ESWL is still used extensively in an attempt to avoid an invasive procedure. This simple and clear paper defines 3 parameters that will prerdict if stone clearance is likely to follow ESWL: pelvicalyceal angle, lower pole calyceal diameter and lower pole calyceal pattern.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	MV Hansen and A Zdanowski	Issue:	1997, 80 (5): 787-792.

Title:

The agreement among urological experts on the diagnostic management of patients with common urological problems.

Abstract:
Thirty three urologists were asked to investigate and treat 53 simulated urological conditions. The probability of the urologists using a certain test in a certain patient was recorded and the cost implications evaluated. Most consistency was seen treating stone patients, then bladder cancer, prostate cancer and lastly BPH. These were all university based consultants.

Reviewer: Mark Feneley

Journal:	Urology
Authors:	Liberman S, Halpern EJ, Sullivan K and Bagley DH.	Issue:	1997, 50 (4): 519-524.

Title:

Spiral computed tomography for Staghorn Calculi

Abstract:
Ten patients referred for treatment of staghorn calculus were studied. All had routine pre-operative investigations, which included KUB & IVU, and in addition a spiral CT scan of the stone bearing kidney. All studies were reviewed by the interventional radiologist and urologist prior to the treatment procedure, either ESWL or PCNL. In 9/10 patients spiral CT added no further helpful information to IVU. In 1 patient, an obese woman, review of spiral CT located residual stone fragments not clearly seen on tomographic images. The authors conclude that although spiral CT gives good quality images it does not add significant information to current imaging practice and cannot be justified in routine evaluation of patients with complex renal stones.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Uehling DT, Hopkins WJ, Balish E, Xing Y and Heisey DM .	Issue:	1997, 157: 2049-2052.

Title:

Vaginal mucosal immunization for recurrent urinary tract infection: phase II clinical trial.

Abstract:
Recurrent urinary tract infection among women is common and often difficult to treat without recourse to long-term antibiotic prophylaxis. In this phase II randomised, double blind, placebo-controlled study 91 women who had 3 or more urinary tract infections over the preceding 12 months received a placebo vaginal suppository or 3 weekly high or low doses of SolcoUrovac vaccine in a vaginal suppository. Each patient was followed for 5 months. The predominant difference seen between treatment and control groups was an increase in the interval to reinfection among the treatment arm without significant side effects. Immunological responses in serum, urine, and vaginal fluid were variable.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Goel MC, Ahlawat R, Kumar M and Kapoor R.	Issue:	1997, 157: 1574-1577.

Title:

Chronic renal failure and nephrolithiasis in a solitary kidney: role of intervention.

Abstract:
The authors examined the role of intervention and its outcome in 20 patients with a solitary kidney, nephrolithiasis and chronic renal failure and 16 patents with a solitary kidney and nephrolithiasis with normal renal function. Eight patients with normal renal function underwent percutaneous nephrolitholapaxy, 4 under went extracorporeal shock wave lithotripsy (ESWL) and 4 underwent open surgery. In the group with chronic renal failure 15 underwent percutaneous nephrolitholapaxy, 2 under went ESWL, and 3 underwent open surgery. Total stone clearance was defined as 16 mm3 or less, or no residual stone on plain X-ray of the kidney, ureters, and bladder at three months. Glomerular filtration rate (GFR) was calculated by the Cockcroft and Gault formula. Total clearance was achieved in 25 (69%) patients (75% with normal renal function, 65% with chronic renal failure). Hospital stay was significantly longer for those patients with significant residual calculi. No significant improvement was seen in GFR for the patients with normal renal function however a significant improvement in GFR was seen in those patients with chronic renal failure which remained at 12 months.

Reviewer: Mark Feneley

Journal:	Urology
Authors:	Morales A, Johnston B, Heaton JP and Lundie M.	Issue:	1997, 157: 849-854.

Title:

Testosterone supplementation for hypogonadal impotence: assessment of biochemical measures and therapeutic outcomes.

Abstract:
While hypogonadal impotence is rare, impotent men may find themselves receiving supplemental androgens. The authors evaluated the efficacy of oral testosterone 120mg daily in the treatment of erectile dysfunction in 23 hypogonadal men. Sexual function was assessed using a visual analogue scale and daily diaries. Serum gonadotrophin, testosterone, oestrogens, and sex hormone-binding protein were estimated before, during and after the study. There was no control group. Plasma testosterone was restored to normal levels in all patients but subjective improvement in sexual performance was observed in only 61% of subjects. No correlation was observed between conventional measures of gonadal function and clinical outcome.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Meretyk S, Gofrit ON, Gafni O, Pode D, Shapiro A, Verstandig A, Sasson T, Katz G and Landau EH.	Issue:	1997, 157: 780-786.

Title:

Complete staghorn calculi: random prospective comparison between extracorporeal shock wave lithotripsy monotherapy and combined with percutaneous nephrostolithotomy.

Abstract:
This prospective randomised study compared ESWL monotherapy using a Dornier HM3 lithotriptor with combined percutaneous lithotripsy and ESWL for the treatment of 50 staghorn calculi. Stone-free rate at 6 months was significantly higher in those patients receiving combined PCNL and ESWL (74% verses 22%). Therefore the number needed to treat is 2 to increase the stone-free rate for 6 months. Interestingly, morbidity was significantly higher in the ESWL group particularly with respect to sepsis. Unplanned ancillary procedure rate was higher in the ESWL monotherapy group though there was no significant difference in the number of procedures performed with anaesthesia. The authors conclude that PCNL with ESWL should be the treatment of choice for most patients with staghorn calculi.

Reviewer: Mark Feneley

Journal:	European Urology
Authors:	Bierkens AF, Hendrikx AJ, Ezz el Din KE, de la Rosette JJ, Horrevorts, A, Doesburg W, and Debruyne FM.	Issue:	1997, 31: 30-35.

Title:

The value of antibiotic prophylaxis during extracorporeal shock wave lithotripsy in the prevention of urinary tract infections in patients with urine proven sterile prior to treatment.

Abstract:
There is controversy over the need for antibiotic prophylaxis in patients with proven sterile urine about to undergo extracorporeal shock wave lithotripsy (ESWL). In this study, patients were randomised to receive placebo, 1 or 7 days of ciprofloxacin or cefuroxime 30 minutes before ESWL. After 2 or 6 weeks of ESWL, about 20% had signs of bacteriuria but proven urinary tract infection with symptoms were found in just 2-3% of patients. There was no proven benefit to antibiotics in prophylaxis in this group of patients.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Desgrandchamps F, Moulinier F, Daudon M, Teillac P and Le Duc A.	Issue:	1997, 79: 24-27.

Title:

An in vitro comparison of urease-induced encrustation of JJ stents in human urine

Abstract:
This Paris group compared the ability of four types of JJ stent to encrust in vitro after immersion in human urine for 24 hours. The polyurethane, silicone and purcuflex stents showed no crystal deposits. The C-flex and hydrogel-coated stents showed crystal deposition and the latter stent showed a significantly higher calcium and magnesium concentration. They conclude that care should be taken to follow-up patients in whom there is a hydrogel (= a wettable polymeric biomaterial) stent.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Langley SEM and Fry CH	Issue:	1997, 79: 8-14.

Title:

The influence of urinary pH on urinary ionised [Ca2+ ]: differences between urinary tract stone formers and normal subjects.

Abstract:
The authors have used an in vitro model to show that urinary ionised [Ca2+ ] decreased with increasing pH and that stone-formers have a critical urinary pH at which Ca-containing precipitates appeared (pHn) which is closer to their voided pH than normal subjects.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Kamihira O, Ono Y, Katoh N, Yamada S, Mizutani K, and Ohshima S.	Issue:	1996, 156: 1267-71.

Title:

Long-term stone recurrence rate after extracorporeal shockwave lithotripsy.

Abstract:
This 5 year study attempted to follow 903 patients who were stone free at three months following ESWL identifying recurrence rate and a number of prognostic factors. Mean follow up was 25 months (55 patients were followed to 5 years) with a recurrence rate of 20.3%. Recurrence was most common among those patients with multiple calculi. Most common site for recurrence was the lower pole calix.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Shoroff S, Watson GM, Parikh A, Thomas R, Soonawalla PF and Pope A	Issue:	1996, 78: 836-839.

Title:

The holmium: YAG laser for ureteric stones

Abstract:
The holmium: YAG laser is a multifunctional laser since it can cut and coagulate tissue such as prostate (trials are in progress) as well as drill holes in calculi with a pulse duration of 350ms. This makes it potentially interesting to the endourologist/healthcare provider from an economic point of view. This report from London describes its successful use in fragmenting 134 ureteric stones accessed using semi-rigid or flexible ureteroscopes. Total clearance was achieved in 87% cases (96% from the lower ureter), but 3 ureters were perforated during the treatment and these were treated by JJ stent insertion for 6 weeks.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Elashry O M, DiMeglio R B, Nakada S Y, McDougall E M and Clayman R V.	Issue:	1996, 156: 1581-1585.

Title:

Intracorporeal electrohydraulic lithotripsy of ureteral and renal calculi using small calibre (1.9F) electrohydraulic lithotripsy probes

Abstract:
This paper reviews the use of 1.9F or small electrohydraulic lithotripsy probes in conjunction with rigid or flexible ureteroscopes in the treatment of 45 patients (57 with renal and 32 ureteral calculi). Fragmentation (fragments 2mm or smaller) was achieved in 98% of patients with no significant morbidity. Overall stone free rate was 92% , with a stone free rate of 87% for patients with lower pole calculi at 8.7 months.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Chow G K and Streem S B.	Issue:	1996, 156: 1576-1578.

Title:

Medical treatment of cystinuria: Results of contemporary clinical practice

Abstract:
This paper is a retrospective review of 16 patients (aged 1.5 - 49 years) of whom 12 were stone free at study entry. All patients received standard therapy (forced hydration therapy and urinary alkalisation). Failure of standard therapy to prevent new stones or stone growth was followed by the introduction of thiols ( D-penicillamine 1-2mg daily, or alpha-mercaptopropionylglycine 800-1200mg daily). Captopril 50mg tds was added for failure or intolerance to thiols. Highest rates of stone events were observed in those patients receiving standard therapy alone (1.6 per patient year). Treatment with standard therapy and thiols significantly reduced the rate of stone events (0.52 per patient year) as did treatment with captopril (0.72 per patient year) though the reduction was not as great. No benefit was seen from addition of captopril to standard therapy with thiols in terms of rate of stone events. The incidence of side effects with either thiols or captopril is not reported.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Chen R N and Steem S B.	Issue:	1996, 156: 1572-1575.

Title:

Extracorporeal shock wave lithotripsy for lower pole calculi: Long-term radiographic and clinical outcome

Abstract:
The efficacy of ESWL as a primary treatment for lower pole calculi is reported to range from 25 to 80%. Overall stone free rate determined by meta-analysis has been reported as 59.2%. This finding has lead to suggestions that patient with lower pole calculi may be better managed by a percutaneous approach rather than ESWL. This paper reports the outcome of ESWL in 206 patients with a stone burden of 4 to 625 mm2 (mean 88) treated on an unmodified Dornier HM3. Eight patients received more than 1 treatment for fragments larger than 4mm after a single treatment. Ninety nine patients (48%) were rendered stone free by 1 month after ESWL. Among patients with residual stone 13 patients (6.3%) had decreased stone burden, 71 (34%) were stable, and 10 (4.8%) increased in size at a mean follow-up of 14.5 months. One hundred and eighty patients remained asymptomatic during the follow-up period (1 - 99 months), while 26 patients (12.6%) became symptomatic requiring medical attention, and 19 went on to require intervention. The authors conclude that ESWL is the treatment of choice for stone less than 20 ml as the stone free rate for these stones was comparable to that for stones at other sites, although the data presented does not support this.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Sun B Y -C, Lee Y -H, Jiaan B -P, Chen K -K, Chang L S and Chen K -T	Issue:	1996, 156: 903-906.

Title:

Recurrence rate and risk factors for urinary calculi after extracorporeal shockwave lithotripsy.

Abstract:
This is a retrospective review of 841 patients who underwent extracorporeal shock wave lithotripsy (ESWL) attempting to identify risk factors for recurrent stone formation. Recurrence was rather loosely defined as new stones confirmed by plain abdominal film after being free of stone within three months of ESWL, physician diagnosis, spontaneous passage of stones, renal colic, or patient self-report of recurrence more than 1 year after ESWL. Follow-up was by questionnaire and ranged from 6 to 9 years. 47 patients had radiological evidence of a new stone and 27 reported the passage of a stone. The risk or recurrence was increased by male gender, diseases predisposing to urinary calculi, multiple stones, residual stones after ESWL and raised serum uric acid.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Hosking DH, Bard RJ	Issue:	1996, 156: 899-902.

Title:

Ureteroscopy with intravenous sedation for the treatment of distal ureteral calculi: a safe and effective alternative to shock wave lithotripsy.

Abstract:
In this retrospective cohort study, the authors review their experience with ureteroscopy under sedo-analgesia in 68 patients. 66 stones (97%) were successfully removed without complications. Tolerance of the procedure was reported as good in 81% of patients. No information is given about the stone size, but only one patient required fragmentation of the stone prior to basket removal. While the authors advocate this technique, comparison with shock wave lithotripsy and relative cost-effectiveness are not addressed. Insertion of a double pigtail ureteral stent for the prevention of urological complications

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Martins MC, Meyers AM, Whalley NA, Margolius LP, Buys ME.	Issue:	1996, 78: 176-180.

Title:

Indapamide (Natrilix): the agent of choice in the treatment of recurrent renal calculi associated with idiopathic hypercalciuria.

Abstract:
About 16% of recurrent stone formers will have renal hypercalciuria. Thiazide diuretics (e.g. 50 mg hydrochlorthiazide [HCT] daily) have been recommended to treat this condition, but these drugs have many side-effects associated with their long-term use. Indapamide is a related drug which at a daily dose of 2.5 mg daily has none of these side-effects except hypokalaemia. This South African study recruited 12 patients to a prospective randomised double-blind crossover trial using both agents for 3 months each, separated by 3 week washout periods. Both resulted in a mean reduction in urinary calcium excretion of about 33% and a similar reduction of serum potassium (none requiring K+ supplementation). On HCT, patients were observed to show significant increase in serum urate and decrease in urinary citrate. The conclusion is stated in the title.

Reviewer: Mark Feneley