Analgesic abuse, ureteric obstruction, and retroperitoneal fibrosis.

We report two cases of unusual ureteric obstruction in patients with an excessive consumption of analgesics. In a retrospective survey of seven cases of non-malignant retroperitoneal fibrosis seen in the last 15 years it was found that four had taken excessive amounts of analgesics. A careful drug history should be taken in all patients with restroperitoneal fibrosis and ureteric obstruction.

The natural history of renal and ureteric calculi.

In a prolonged follow-up of a series of 416 patients at The London Hospital Stone Clinic it was found that recurrence could still occur even as long as 10 years after the first stone, though this risk decrease slowly year by year. Recurrence is seldom related to hypercalciuria or urinary infection except when infection is caused by or associated with B. proteus in women. Claims for the value of any form of therapy for stone disease must be evaluated against the background of the natural history of lithiasis.

The place of partial nephrectomy in the management of renal calyceal calculi.

In 416 patients with renal and ureteric calculi other than large staghorns we found that when it was possible to identify the calyx of origin of the stones, the lower poles were involved in 36-6% of males and 40-4% of females. In the follow up of the 115 lower poles originally containing stones the recurrence rate was 17% in those who were merely observed, 56% in those treated by pyelo- or nephrolithotomy, and zero in those treated by partial neprectomy. But when these cases were looked at more closely it was found that recurrences were virtually confined to lower poles which had originally harboured more than one stone, while in those with single stones to start with, the recurrence rate was not significantly different in either of these three groups. Partial nephrectomy should therefore be reserved for selected cases where the stones are originally multiple, or where the lower pole has been severely damaged. It is not necessary for small and single calyceal calculi.

Price of prostatectomy.

Three different urological units found that transurethral prostatectomy required a hospital stay at least one week shorter than open Millin or transvesical prostatectomy. By making transurethral resection more widely available there could be a substantial financial saving; but more surgeons would have to specialize in urology.