The natural history of post-extracorporeal shock wave lithotripsy residual stone fragments (clearance, growth and aggregation) is incompletely known, even though they are believed to constitute a risk in terms of new stone formation and persistent infection of the urinary tract. We addressed this issue and the hypothesis that alkaline citrate therapy improves residual stone fragment clearance in a 12-month followup study. There were 40 sterile calcium and 30 struvite stone patients with residual fragments after extracorporeal shock wave lithotripsy (diameter less than 5 mm.) consecutively enrolled and randomly assigned to a citrate therapy (6 to 8 gm. per day) or control (hygienic measures only) group. Infection stone patients also received adequate antibiotic therapy throughout the study. Among the patients in the untreated sterile group 21% and 32% were stone-free at 6 and 12 months, respectively. In the infection group these figures were 27% and 40%, respectively. Among the untreated sterile calcium stone patients in whom clearance was not achieved a high percentage experienced residual fragment growth or reaggregation. Citrate therapy significantly improved the stone clearance rate in the sterile (at 6 and 12 months 65% and 74% were stone-free, respectively) and infection (71% and 86%, respectively) stone patients, and prevented residual fragment growth or reaggregation in subjects in whom clearance was not achieved. The data show that growth and persistence are common in the natural history of residual stone fragments. Citrate ameliorated the outcome of these residual fragments by reducing the growth or agglomeration, and by increasing the clearance rate in calcium oxalate and in infection stone patients.

Injury to the external male genitalia is considered, with attention focused on accidental fracture of the corpora cavernosa (by coitus or masturbation). Such injuries are often complicated by urethral lesions. We present 13 patients with either simple or complicated fracture of the penis, all of whom were operated on between 2 h and 8 days following injury, with excellent functional results. The need for immediate surgery is emphasised, in order to avoid erectile failure and curvature, which are typical complications of conservative treatment. Surgery consists of complete evacuation of haematoma, curettage and repair of the albuginea. If the fracture is associated with urethral disruption, the latter is also repaired.

In our experience, even if on a limited number of patients, the application of ICG with NIR fluorescence during RARP is helpful to identify the benchmark artery of neurovascular bundle.

Clinically insignificant residual fragments (CIRFs) are small fragments (less than 5 mm) that are present in upper urinary tract at the time of regular post-SWL followup. The term is controversial because they may remain silent and asymptomatic or become a risk factor for stone growth and recurrence, leading to symptomatic events, and need further urologic treatment. Although a stone-free state is the desired outcome of surgical treatment of urolithiasis, the authors believe that the presence of noninfected, nonobstructive, asymptomatic residual fragments can be managed metabolically in order to prevent stone growth and recurrence. Further urologic intervention is warranted if clinical indications for stone removal are present.

Obiectives: To report our experience of diagnosis and multimodal management of urolithiasis in renal transplantation. Patients and Methods: From January 1995 to December 2012, 953 patients underwent renal transplantation in the Kidney Transplant Unit of Treviso General Hospital. Ten (10%) of them developed urinary calculi and were referred at our institution. Their mode of presentation, investigation and treatment were recorded. Results: Seven had renal and 3 ureteral calculi. Urolithiasis was incidentally discovered on routine ultrasound in 6 patients, 1 presented with oliguria, 1 with anuria and acute renal failure and in 2 urolithiasis was found at removal of the ureteral stent. Nephrostomy tube was placed in 5 patients. Hypercalcemia with hyperparathyroidism (HPT) was present in 5 patients and hyperuricemia in 3. Two patients were primary treated by shock wave lithotripsy (SWL) and one of them was stone-free after two sessions. Two patients, one with multiple pielocaliceal calculi and the other with staghorn calculus in the lower calyx, were treated with percutaneous nephrolitothotomy (PCNL). Three patients were treated by ureteroscopy (URS) and in one of them two treatments were carried out. One patient had calculus impacted in the uretero-vesical anastomosis and surgical ureterolithotomy with re-do ureterocystoneostomy was performed after failure of URS. Two patients with calculi discovered at removal of the ureteral stent were treated by URS. Conclusions: The incidence of urolithiasis in renal transplantation is uncommon. In the most of patients the condition occurs without pain. Metabolic anomalies and medical treatment after renal transplantation may cause stone formation. Advancements in endourology and interventional radiology have influenced the management of urolithiasis that can be actually treated with a minimal incidence of risk for the renal allograft.KEY WORDS: Urolithiasis management, Renal transplantation. In the most of cases stone formation appears to form "de novo" after renal transplantation, although some studies suggest that the calculi are more often transplanted with the graft to the recipient (1, 5, 6). Theremore, metabolic anomalies causing stone formation could be present in allograft rather than native kidneys (7). Urolithiasis is often asymptomatic and the clinicians are not able to diagnose urinary calculi in renal transplant at an earlier stage. Neverthless, the prompt diagnosis and the subsequently stone removal is necessary to prevent adverse effects on a solitary kidney whose renal function is often borderline. Today the development of endourological tecniques for calculi management and interventional radiology for the emergency management of acute obstruction have minimized the potential risk for renal graft. However, such minimally invasive procedures could be performed only in centers that are well equipped and have expertise to offer the appropriate treatment. We evaluated our experience of renal transplant patients with urolithiasis, regarding the risk factors associate...