Background: The previous epidemiological study of paediatric nephrolithiasis in Britain was conducted more than 30 years ago. Aims: To examine the presenting features, predisposing factors, and treatment strategies used in paediatric stones presenting to a British centre over the past five years. Methods: A total of 121 children presented with a urinary tract renal stone, to one adult and one paediatric centre, over a five year period (1997)(1998)(1999)(2000)(2001). All children were reviewed in a dedicated stone clinic and had a full infective and metabolic stone investigative work up. Treatment was assessed by retrospective hospital note review. Results: A metabolic abnormality was found in 44% of children, 30% were classified as infective, and 26% idiopathic. Bilateral stones on presentation occurred in 26% of the metabolic group compared to 12% in the infective/idiopathic group (odds ratio 2.7, 95% CI 1.03 to 7.02). Coexisting urinary tract infection was common (49%) in the metabolic group. Surgically, minimally invasive techniques (lithotripsy, percutaneous nephrolithotomy, and endoscopy) were used in 68% of patients. Conclusions: There has been a shift in the epidemiology of paediatric renal stone disease in the UK over the past 30 years. Underlying metabolic causes are now the most common but can be masked by coexisting urinary tract infection. Treatment has progressed, especially surgically, with sophisticated minimally invasive techniques now employed. All children with renal stones should have a metabolic screen.

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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