Sixty patients with idiopathic retroperitoneal fibrosis presenting between 1965 and 1984 are reviewed. Their mean age at presentation was 56 years and the male:female ratio was 3:1. The commonest presenting symptoms were flank and abdominal pain, weight loss, nausea and polyuria. Physical examination was usually normal, expect for the presence of hypertension. Anaemia and elevation of erythrocyte sedimentation rate were usually present. Proteinuria was found in less than a third of patients at presentation and significant bacteriuria was uncommon. The correct diagnosis was made or suspected in very few patients before referral. The cumulative actuarial survival rate was 86% at 1 year and 78% at 2 years. Seventeen patients died; they were significantly older and more uraemic at the time of referral than those who survived. A few patients did well with either corticosteroid therapy or ureterolysis alone. In the majority, both operation and steroid treatment were necessary. In bilateral obstruction with residual function in both kidneys, bilateral ureterolysis proved superior to unilateral operation (each followed by steroid therapy) in conserving renal function. Operation alone or steroid therapy alone should be considered in cases where steroids or surgery respectively present particular hazards. The less traumatic unilateral operation should be considered in poor risk patients and in those whose renal function is absent on one side. In many survivors, disease activity has persisted for many years. Life-long follow-up is recommended.

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Upper tract pressure flow studies in four clinically unobstructed ureters with double J stents in situ indicated that urinary flow occurred mainly around the stent and that there was significant vesicorenal pressure transmission. This study examined the dynamics of ureteric urinary flow and morphological effects consequent upon stenting a ureter in vivo. In a porcine model, ureteric intubation caused a rise in intrapelvic pressures, hydroureter, vesicorenal reflux and generalised thickening of the ureteric wall with characteristic histological changes in the urothelium. These findings suggest that double J stents may compromise urinary drainage when ureteric obstruction is not present, urging caution in their use in the damaged, unobstructed upper urinary tract.

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Objective To determine the optimum duration for the 25 min. The patients' discomfort was recorded using a 4-point descriptive pain scale and a 100 mm nonretention of 2% lignocaine gel intraurethrally as an anaesthetic for flexible cystoscopy in men.graphical visual analogue scale. Results In the first study, those patients receiving lignoPatients and methods A prospective, randomized, double-blind, placebo-controlled trial was conducted caine gel for 25 min experienced significantly less pain than the other three groups. In the second, lignocaine in two parts. Initially, the importance of duration was determined, i.e. whether pain relief was significantly gel in the urethra for 15 min provided the same level of pain relief as lignocaine for 25 min. improved when lignocaine gel was instilled for longer than is currently practised. As pain relief was improved Conclusion Pain during flexible cystoscopy can be significantly reduced when 20 mL of 2% lignocaine gel by retaining the lignocaine gel for longer, the optimum time was determined in a second trial. Initially, 90 is left in the urethra for 15 min; lignocaine gel would be more eÂective when left for longer than is currently patients were divided into four groups receiving 20 mL of 2% lignocaine gel or plain lubricating gel for 5 or practised. Keywords Local anaesthesia, flexible cystoscopy, topical 25 min. Subsequently, 60 men were divided into two groups receiving 20 ml of 2% lignocaine gel for 15 or lignocaine gel, urethra whether pain relief was significantly improved when