No abstract

About 10% of the people is the subject of an episode of kidney stones during their lifetime, about 70% of these people undergoes relapses. About 80% of the urinary stones contains calcium, of wich 80% is formed of calcium oxalate, in pure form or associated with calcium phosphate. Therefore we can saythat in most cases (about 65%) the urinary stones are composedof calcium oxalate. Use of supplements of potassium citrate and magnesium citrate can help in the prevention of kidney stones of calcium oxalate, but mostly they can be used in the days before a shockwaves lithotripsy treatment to make the stones more fragile to the effect of the shock waves. A case of successful treatment with magnesium potassium citrate of a SWL resistant ureteral stone is presented. KEY WORDS:Calcium oxalate stones prophylaxis. SummaryNo conflict of interest declared.-family history of kidney stones: is the case for example of cystine stones, due to a congenital defect of the kidney which cause high concentration of a poorly soluble amino acid in the urine (cystine) which precipitates forming crystals; -chronic urinary tract infections; -abuse of certain drugs or saline and vitamin supplements; -hyperthyroidism (catabolic effect on bone) and hyperparathyroidism (increased blood calcium); -incongruous diet; -ethnicity: increased incidence of kidney stones in white and Asian race; -climate (during the hot summer period the increased of evaporation, if not supplemented by appropriate fluid intake, increases urine concentration and the formation of stones). CASE REPORTA man of 28 years was diagnosed with a 15 mm radiopaque stones located in the first tract of the left lumbar ureter (Figure 1). The patient was subjected to a shockwaves litothripsy (SWL) (2) treatment that did not achieve fragmentation of the stone (3). After that, he underwent left ureterolithotripsy with limited fragmentation of the stone and migration of the frag-

Uric acid calculi can also be treated without surgery, with simple medical lytic therapy. After appropriate dietary adjustments and add of mineral water, the needed amount of alkali supplementation can increase pH values of the urine in order to dissolve the stones. Treatment should be prolonged to prevent stone recurrence. A case of bilateral renal uric acid stones that were successfully treated by alakalizing treatment was presented.

– Fournier's disease is an acute pathologic process of cellulitis and necrotising fascitis involving the male genitals with a mortality of 30–50%. The main causes are periurethral and perirectal infections, immuno-depressive syndromes, diabetes mellitus and traumas. Mixed types of infections involve aerobic and anaerobic germs, the latter being responsible for the necrosis of the subcutaneous tissue. Therapy is synergic and multi-disciplinary, antibiotic with radical and reconstructive surgery.

Leiomyomas are an uncommon form of benign tumour composed exclusively or mostly of smooth muscle. They may involve any part of the genito-urinary apparatus, but are found most frequently in the renal capsule. The authors report the case of a leiomuscular type prostatic tumour with atypia making it impossible to define a malignant state with any certainty. It is emphasised that only the histological examination can decide since observation and instrumental examinations are not sufficient for diagnosis.

Renal ultrasound is not a functional type of examination, which means it cannot be used to determine the degree of obstruction of the upper urinary tract, for which more or less invasive exams such as Whitaker's test, renogram and/or urography must be perfomed. Dynamic ultrasound with furosemide test gives information on the morphology and also the degree of obstruction and is extremely useful in the pre and post-operative assessment of patients with upper urinary tract pathologies. A total of 72 renoureteral units in 39 patients were studied. Patients with a normal “dynamic” ultrasound picture were excluded, while the others were also studied with renogram and/or urography. Data analysis shows dynamics ultrasound reliability is on a par with that of the above-mentioned invasive methods (88–95%). Given the simplicity of use and its availability in all hospital structures, it is therefore considered that dynamic ultrasound should be used immediately in studying obstructions of the upper urinary tracts.

– An inflammatory pseudoneoplasm of the bladder is an uncommon benign lesion. The case described involves a 46-year-old man with macrohematuria. Diagnosis from the ultrasound image tended towards urothelioma, while endoscopy showed a lesion with indefinite characteristics. The histological exam finally allowed correct diagnosis, showing the benign nature of the disease.

The authors report their experience in treating benign prostatic hypertrophy with transurethral incision of the prostate (TUIP) as an alternative to resection (TURP).