Sixteen years of experience with stone management in horseshoe kidneys.

INTRODUCTION: Horseshoe kidney is the commonest congenital renal fusion anomaly, and is often complicated by urolithiasis. We focus on our 16 years of experience with stone management in horseshoe kidneys. MATERIALS AND METHODS: We reviewed the progress of 44 patients treated between 1987 and 2002. Shock wave lithotripsy (SWL) was used in 25 patients; the average stone surface area was 91 (range 10-1,600) mm2 and average follow-up was 36.5 (range 1-91) months. 19 patients underwent percutaneous nephrolithotomy (PCNL); the average stone surface area was 197 (range 6-2,400) mm2. Follow-up data are available for 8 patients and the average follow-up was 42.3 (range 3-144) months. RESULTS: In the SWL group the 3-month stone-free rate (SFR) was only 31%. In the PCNL group the SFR was 75% on the postoperative day-1 KUB. Complications occurred in 9 patients. CONCLUSIONS: Stone management in horseshoe kidneys is challenging: PCNL produces a higher SFR with minimal major complications and failed access. PCNL thus appears to be the preferred management option in patients with urolithiasis in horseshoe kidneys.

Lignocaine gel: does it cause urethral pain rather than prevent it?

OBJECTIVES: To test the hypothesis that the chemical content of lignocaine gel is the cause of urethral pain during its instillation into the urethra. METHODS: A prospective, double blind study was designed to test whether plain aqueous gel caused less delivery discomfort in the male urethra than 2% lignocaine hydrochloride gel (Instillagel). 100 consecutive, consenting male patients attending for flexible cystoscopy were recruited and randomised to receive 11 ml of 2% lignocaine hydrochloride gel or 11 ml of plain aqueous gel. Upon receiving the gel into the urethra, the patient was asked to score any associated discomfort by using a horizontal, 100mm, non-graphical, visual analogue scale. Statistical comparison between the groups was made using the non-parametric Mann-Whitney U-test. RESULTS: Statistical analysis by Mann-Whitney U-test showed a significant reduction in urethral delivery discomfort in those patients receiving plain gel compared to those receiving 2% lignocaine hydrochloride gel (p=0.039). CONCLUSIONS: This current study has shown that plain aqueous gel causes significantly less delivery discomfort in the male urethra than 2% lignocaine hydrochloride gel (Instillagel).