[The basquet in day hospital]. / I1 basket in Day Hospital.

We use the basket as the first choice method to treat the pelvic ureteral stones, according to the standard technique. In the last two years ('96, '97) the basket has been used in 49 cases (27 and 22 respectively) with pelvic ureteral stone; 4 of them were treated also by ESWL. So, 45 Pz have been treated only by basket and the success was obtained in 43 cases (95.5%). The 74% (32/43) of the cases were completed in a single step procedure and the 72% (23/32) of them have been discharged on the subsequent morning. Considering these results it is possible to perform the technique during a day hospital on condition that some parameters are respected: little size of the stone, seat near the bladder, easy insertion of the basket and female patient preferably. In any case we have to inform the patient about the possibility to proceed with a delayed extraction.

[T1G3 bladder tumors]. / I tumori vescicali T1G3.

Bladder tumors T1G3 are aggressive and difficult for their staging. Out of 176 p. with tumor pT1, 16 (9%) presented pT1G3. Among the latter 4 were submitted to TUR and chemioimmunotherapy; 5 to surgical partial resection and radiotherapy; 7 to radical cystectomy. After a mean interval of 21.6 months free of relapse, 5 p. had recurrent T1 tumor below G3: 1 out of 4 after TUR; 1 out of 5 after surgical resection; 1 out of 7 after cystectomy. Clinical T1G3 8 revealed a greater pathological staging: 7 (50%) had a relapse in spite of an aggressive therapy (2 TUR; 4 surgical resection; 8 cystectomy); 5 out of the 7 relapsed revealed a greater pathological staging than T1; 2 died by metastasis. The therapeutical choice should be demolitive from the beginning. Should conservative therapy be decided, the convenience of surgical bladder resection has to be considered because, besides being effective, has some advantages over TUR: easier and unfailing staging possibility of contemporary lymphadenectomy healing of bladder by first intention.

[Radical versus conservative therapy in prostatic adenoma. Open adenomectomy]. / Terapia demolitiva versus terapia conservativa nell' adenoma prostatico. Adenomectomia a cielo aperto.

Our technical procedure for surgical adenomectomy of prostate is the Hey-Delinotte one. Indications for this type of procedure are large adenomas with a volume, estimated by ultrasonography, more than 50 cc. and with significant obstruction and urinary retention. In our experience during the past 3 years, in patients without severe operating risk, it was utilized a little more frequently than transurethral resection. We hope that in the future the new procedures will be as useful and resolutive as traditional ones.

[Instrumental chemolysis of cystine calculi]. / La chemiolisi strumentale dei calcoli di cistina.

ESWL and PCN have modified the urinary stones therapy. Nevertheless these therapeutic procedures are not much effective in cystine stone because of its protein structure and frequent recurrences; these procedures need to be combined to achieve the best results. In cystine stones the lithochemolysis, performed following recent technique has shown excellent results, without complications and easy to apply.

[Treatment of symptomatic bone metastases of prostatic carcinoma using strontium chloride (Sr-89)]. / Trattamento delle metastasi ossee sintomatiche da carcinoma prostatico con Cloruro di Stronzio (Sr-89).

Until now, patients with a progressive prostatic cancer, in whom all therapies failed and the disease spread locally and distally, was considered "a lost patient"; because it did not exist an effective therapy easily to be used. The skeletal pain control is a serious problem and it is a great responsibility also for the Urologists especially if the patient has not a short survival time and the quality of life is very poor. Physicians feel the need for a systemic, well tolerated and effective therapy also for a long time, uniform and repeatable, able to be efficient for these patients. Strontium 89 chloride seems to offer all these possibilities and to be the best procedure for Urologist, Radiotherapists and Nuclear Specialists in order to satisfy the patients requirements. International research has shown Sr-849 Chloride is a powerful new therapy. Sr-89 Chloride is a radiopharmaceutical product for the treatment of painful metastases from prostatic cancer. It is a new treatment but its effectiveness is well documented and results are reported in the most important international literature. In our Department a clinical research has started and our purpose is to produce more data for a clinical and biological evaluation of the results, hoping that a similar research will extend as a multicenter study.

[Recurrence of lithiasis after extracorporeal lithotripsy, percutaneous surgery, and open surgery for calculi of the upper urinary tract]. / Récidives lithiasiques après lithotritie extracorporelle, chirurgie percutanée et chirurgie ouverte pour calculs du haut appareil urinaire.

The safety and short-term effectiveness of percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL) have already been well established. However, long-term follow-up studies are essential to prove that the recurrence rate after PCNL and/or ESWL is equal or even better than that of surgery. We reviewed 57 patients treated with ESWL monotherapy, 45 patients treated by PCNL (or by PCNL combined with ESWL for complete staghorn stones) and 59 patients treated by open surgery who all had at least three years of follow-up. The overall recurrence rate for ESWL was 37% for PCNL and for open surgery 39%. ESWL, PCNL and open surgery all showed a higher rate of recurrence and persistent bacteriuria when associated with residual stones. Therefore every effort should be made to remove residual fragments following stone treatment. We conclude that because of its efficacy and low morbidity ESWL should be the treatment of choice for most of renal calculi. Complete staghorn calculi are best treated with open surgery because the complete elimination of all calculous material and the eradication of infection are achieved at a higher rate than by PCNL and ESWL.

[Treatment of symptomatic bone metastases of prostatic carcinoma with strontium (Sr-89) chloride: initial experience]. / Trattamento delle metastasi ossee sintomatiche da carcinoma prostatico con Cloruro di Stronzio (Sr-89), esperienza iniziale.

Until now, patients with a progressive prostatic cancer, in whom all therapies failed and the disease spread locally and distally, was considered "a lost patient"; because it did not exist an effective therapy easily to be used. The skeletal pain control is a serious problem and it is a great responsibility also for the Urologists especially if the patient has not a short survival time and the quality of life very poor. Physicians feel the need for a systemic, well tolerated and effective therapy also for a long time, uniform and repeatable, able to be efficient for these patients. Strontium 89 chloride seems to offer all those possibilities and to be the best procedure for Urologist, Radiotherapists and Nuclear Specialists in order to satisfy the patients requirements. International research has shown Sr-89 Chloride is a powerful new therapy. Sr-90 Chloride is a radiopharmaceutical product for the treatment of painful metastases from prostatic cancer. It is a new treatment but its effectiveness is well documented and results are reported in the most important international literature. In our Department a clinical research has started and our purpose is to produce more data for a clinical and biological evaluation of the results hoping that a similar research will extend as a multicenter study.

Urinary excretion of citrate, glycosaminoglycans, magnesium and zinc in relation to age and sex in normal subjects and in patients who form calcium stones.

One hundred and ninety-seven healthy subjects and 104 patients with idiopathic calcium stone disease had their urinary excretion of citrate, glycosaminoglycans, magnesium, and zinc measured and the results correlated with sex and age. In normal subjects the daily excretion of citrate, magnesium, and zinc increased with age to a maximum during the fifth decade and remained relatively constant until the eighth decade when they decreased. The daily excretion of magnesium and zinc were higher in men than in women, which was attributed to the higher body weights of the men. The urinary excretion of citrate, magnesium, and zinc related to creatinine remained relatively constant with age in adult life; analyses of magnesium and zinc excretion rates divided by urine creatinine did not distinguish men from women. There was no significant difference between men and women for citrate excretion in 24 hour urine, but the citrate:creatinine ratio was significantly higher in women than men. The higher citrate excretion in women may explain the lower incidence of calcium stones in women. The highest glycosaminoglycan excretion rates were seen during the first two decades which is why children and teenagers are less prone to develop calcium stones in spite of high urinary calcium concentrations. Urinary citrate and magnesium excretion were lower, and glycosaminoglycan and zinc excretion were higher, in stone formers than in controls. It seems that a decreased excretion of citrate and magnesium together with an increased excretion of calcium, may contribute to the formation of calcium stones. The role of urinary glycosaminoglycans and zinc in the formation of calcium stones remains uncertain.

The influence of diet on urinary risk factors for stones in healthy subjects and idiopathic renal calcium stone formers.

The daily intake of 103 recurrent idiopathic calcium stone formers and 146 controls was assessed by means of a computer-assisted 24-h dietary record. Timed 24-h urine samples were collected over the same period to assess the relationship between dietary intake of nutrients and urinary risk factors for calcium stones. After standardisation for sex, age and social status a total of 128 subjects underwent final statistical analysis; 64 renal stone formers and 64 controls. Significant increases in the consumption of animal and vegetable protein and purine were identified as the nutritional factors that distinguished renal stone formers from controls. As expected, the daily urinary excretion of calcium and oxalate was higher and the daily urinary excretion of citrate was lower in stone formers than in controls. No difference with respect to daily urinary uric acid excretion was recorded. Daily urinary excretion of calcium was correlated to dietary protein intake while daily urinary oxalate was correlated to dietary vitamin C intake. It was concluded that renal stone formers could be predisposed to stones because of their dietary patterns. A link between the protein content of the diet and urinary calcium was confirmed, but dietary animal protein had a minimal effect on oxalate excretion.

Familial aggregation of renal calcium stone disease.

The question of a familial predisposition towards stone formation in primary nephrolithiasis has not been explored completely. In a sample of 214 calcium stone patients, and 428 age and sex-matched controls we observed a higher frequency of stones among the first degree relatives of stone patients compared to the relatives of controls. A family history of renal stones was more common among the female (45 per cent) than among the male patients (31 per cent). There was no relationship between family history of renal stones, and abnormal calcium and oxalate excretion rates. A significant association between a family history and a higher urinary pH was observed among the female calcium stone patients. A genetic defect in urinary acidification with variable expressivity might be associated with a high frequency of stone formation. Moreover, uric acid excretion was higher in male stone patients with a family history of stones. Finally, the parents and siblings of the renal stone patients were affected more by calculi than were the corresponding relatives of their spouses.