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In a retrospective study two patient groups suffering from recurrent calcium oxalate lithiasis are compared before and after antirheumatic therapy using Diclofenac-Natrium alone or in combination with xanthine oxidase inhibitors and/or hydrochlorothiazides. The examination of concentration and excretion of lithogenic important parameters show a partly significant reduction of the concentration mean values of calcium, oxalic acid and uric acid. The influence of non-steroidal antiphlogistics (NSAP) on calculus recurrence rate in calcium oxalate lithiasis is recognized.

Excretion and concentration of glycose aminoglycans were measured in 19 patients with frequent relapses of calcium-oxalate lithiasis, prior to and two weeks after onset of Diclofenac-Na therapy. In most patients, markedly enhanced glycose aminoglycan concentration and excretion could be demonstrated. Elevation of the high-molecular inhibitor potential in the urine results in reduced risk of calcium-oxalate lithogenesis, which may explain the therapeutic success of nonsteroidal anti-inflammatory drugs in the treatment of therapy resistant calcium-oxalate lithiasis.

On the basis of 18 discriminance-analytically balanced urine parameters of patients with recidive calcium-oxalate nephrolithiasis and control subjects without urological complaints, it is shown in this article that the concentration of proteolytic activity, of enzyme inhibitors, of acid mucopolysaccharides and inhibition indices do not give better separation between the control group and recidive calcium-oxalate lithiasis patients than the usually measured urine parameters.

The values of 7 urinary parameters in divided urine collections were measured in 20 patients with calcium oxalate stones and ten normal persons. On this basis the thermodynamic stone formation risk was calculated for the different urine collections. Stone formation risk in the 0-6 a.m. urine fractions appeared to be the most important. The risk of stone formation is significantly increased in the time from midnight to 6 a.m. To detect the risk situation the determination of oxalic acid, calcium, potassium and inorganic sulfate in night urine is adequate.

We report on our experience with 9 cystine-lithiasis patients who were treated with large doses of ascorbic acid (5 g/day) for periods ranging from 6-27 months. We observed recidive lithogenesis in only 3 patients during this time. The influence of ascorbic acid on the excretion of cystine and oxalate in the urine is discussed. A lack of side effects and the significantly lower frequency of recidivation justify the further use of ascorbic as an alternative medication in cystine lithiasis.

Under defined stress conditions, a slight decrease in the calcium concentration in the urine of calcium oxalate stone patients on the first and second experimental days was observed. Taking simultaneously recorded calcium concentrations into consideration, Ca/Mg quotients, were calculated, which, at least in single cases, exceed the limiting range, thus signalling an increased risk of calculus formation.

36 operations of the renal pelvis or ureter were carried out in 35 patients. In all these cases a split stenosis or a tissue defect were covered by free peritoneal patches. Urographic controls of 30 patients showed 29 good or very good results. The following statements can be made: 1. In cases of a secondary scarred stenosis, of renal pelvic or ureteral wall defects, plastic operations of intrarenal pelvis of transsinus operations of staghorn calculi the splitting with splinting and covering by autologous tissue seems to represent a suitable operation. -- 2. As material the renal capsule, the venous wall and the peritoneum are suitable. -- 3. In cases of severe ureteral stenoses, which have to be resected, especially in cases of considerable differences of the ureteral lumen, the semicircular suture with covering should be preferred to the circular suture. -- 4. The covering of the defects by patches of autologous material reduces the time of the postoperative urinary diversion with all its dangers and the period of hospitalization. -- 5. In cases of a short covered stenoses (up to 4 cm) postoperative disturbance of the transport or urine was observed only once. The results of stenoses, longer than 4 cm, cannot yet be evaluated.

Until now almost exclusively clinicochemical urine parameters have been used to determine the risk of urinary stone formation. In part I of this study pelvic-calyceal systems of healthy persons and calcium oxalate stone formers are compared with regard to their morphology, whereas urine parameters will be briefly included in part II. Discriminant functions are given by means of which it is possible to calculate the risk and, e.g. to quantify a follow-up.

In the present work the influence of stress situations on the concentrations and excretions of lithogenous urinary substances (calcium, oxalic acid, uric acid) has been studied in defined urine portions of 10 calcium oxalate stone patients and 10 normal subjects and the results compared to those of 20 stone patients and 10 normal subjects without stress. Stress may be objectified in the given task. The increase of concentrations and excretions of lithogenous urinary substances indicates an enhanced risk of stone formation. Uric acid is discussed as an agent promoting the calcium oxalate crystallization. New insights on the calcium oxalate stone genesis are gained from the results.

In a prospective study, the influence of sole Diclofenac-Na therapy (3 X 25 mg Rewodina, Voltaren) on the calculus recurrence rate of eight frequently relapsing and therapy resistant calcium-oxalate stone patients is analysed. During a period of one year's treatment, the recurrence rate could be reduced by 73.2%, from 123 to 33 calculi. Serious side effects, changes in blood serological parameters and various urine components were not observed. The course of passages of calculi was improved by reduced pain and rapid passage. The paper summarizes all results of calcium-oxalate stone treatments with nonsteroidal antiphlogistics known so far. In the opinion of the authors, the present successful Diclofenac-Na treatment offers a novel possibility of influencing therapy resistant stone-formers over long periods.

29 patients suffering from recurrent struvite stones and/or persistent urinary tract infection were analyzed retrospectively with a follow-up time of 10 +/- 6 years. A sanitation of the urease-positive urinary tract infection was possible in 12 patients (41%). After 10 out of 53 operations (19%) rest stones were found. An unilateral nephrectomy was done in 3 cases. Despite rest calculi and persistent urinary tract infection no further calculus growth or deterioration of renal function was found in most patients.

The influence of magnesium chloride on various blood and urine parameters in calcium oxalate stone patients is studied. High dose magnesium therapy was found to increase urinary magnesium concentrations, whereas the oxalic acid concentration is reduced. The experiments support the statements on the role of magnesium in endogenous oxalic acid depression and the inhibition of the intestinal resorption. For urolith prevention it will be necessary to apply high magnesium doses of easily absorbable and well-tolerated medicaments.

Concentrations and excretion of ten urine parameters were recorded in defined urine portions of 20 calcium oxalate stone patients and 10 normal subjects; some of these urine constituents show a day-night rhythm thus indicating a daily risk variation. From the analysis of questionnaires on physical strain and psychonervous stress, correlations between stress and urine substances can be established. In this connection, oxalic acid concentration and excretion seem to be of special importance. The obtained results provide the basis for further complex-chemical calculations.

By the use of simple quotients consisting of the lithogenic variables in the numerator and the litholytic ones in the denominator as well as of complex chemical and discriminant analytical computational use of urine parameters, it is possible to distinguish significantly between groups of control persons and recurrent calcium oxalate stone formers and to obtain a relative prediction concerning the risk of stone formation. In discriminant analytical computation, in our opinion, it is most convincing to make use of variables which have been checked multivariately concerning their separating properties with regard to their mutual correlations and their measure of indispensability.

The present study describes a modified method of the semiquantitative determination of cystine in the urine which is based on the decomposition of cystine by dithionite ions and formation of a mixed nickel/cystein/sulfide-complex. The method is suitable as rapid and search test, it guarantees an acceptable reproducibility as well as the exactness of the values and is simply to be performed in every clinical-chemical laboratory. The criteria of analytic applicability are confirmed in comparisons of methods. It must be urged to treat fresh urines.

In this paper a method of semiquantitative cysteine determination is presented, which is based on the formation of a red cysteine-Na-nitroprusside salt. The method is a suitable rapid test for checking the process of ascorbic acid therapy in cystinuria and cystine urolithiasis patients. It guarantees acceptable reproducibility of values and can be easily carried out in every clinicochemical laboratory. With the K2CO3/nitroprusside test described and an additional cystine rapid test (Ni2+/S2O4(2-) tablet reagency) a separate semiquantitative differentiation of cysteine and cystine in fresh (!) urine is possible.

Until now almost exclusively clinicochemical urine parameters have been used to determine the risk of urinary stone formation. In part I of this study, pelvic-calyceal systems of healthy persons and calcium oxalate stone formers are compared with regard to their morphology, whereas urine parameters will be briefly included in part II. Discriminant functions are given by means of which it is possible to calculate the risk and, e.g. to quantify a follow-up.

In a prospective study the efficacy and actual outcome of non-medicamentous preventive measures with metabolically unremarkable calcium-oxalate urolithiasis were investigated in 49 idiopathic calcium-oxalate stone formers. Overnight urine excretion was not increased. The mean concentration and excretion of essential parameters in terms of lithogenesis were hardly influenced. The obvious reduction of the pelvi-calyceal area in both lithogenous and non-lithogenous kidneys after one year of calculus prophylaxis was striking. By means of a discriminant function including morphological parameters and high-molecular urine components some developments may be verified in the discriminant space suggesting a good prophylactic result in many patients.

The circumcaval course of the ureter can no more be regarded as a urological rarity. Primarily a disturbance of the development of veins in the 6th to 8th fetal week is present. A division in 2 forms of the course of the retrocaval ureter is possible. In addition to the pathologic course the type 1 still shows a disease of the precaval segment. The two forms are demonstrated with the help of own observations. According to the opinion of the authors the two types must be differentiated before operation and must be removed by different operation techniques. Associated malformations must be taken into consideration.

Disturbances in purine metabolism with hyperuricaemia and/or hyperuricosuria are a risk factor in uric acid and Ca oxalate stone formation. By way of a competitive xanthine oxidase inhibition, the formation of uric acid is reduced by allopurinol. In investigations on two groups of patients, Milurit could be demonstrated to decrease the uric acid levels in serum and urine. No differences could be seen in the dosages of 3 x 100 mg or 1 x 300 mg Milurit. Therefore, in stone recurrence prevention, the administration of Milurit 300 is recommended.

In profile urines from oxalate stone patients and normal persons the progress of concentration and excretion of 10 urine parameters was investigated. For the majority of lithogenic and litholytic urine substances, especially for oxalic acid, a day-and-night rhythm was proven. This may be transferred to a principle of zonary structure of weddellite crystals, explaining the periodically recurring change of weddellite layers of different dissolution resistances arising from different growth rates due to different concentrations of supersaturated urine.

The results of interposition plastic operations of the small intestine are presented which were performed in 8 patients. The control period comprises 4 to 23 years. The relatively complicationless postoperative course confirms an efficient technique, by means of which the functionless ureter may be bridged over. The function of the kidneys remains compensated and this the technique fulfils the main criterion of an operative technique conserving the organ.

Distinct sinus-like variations in the production of urine - with regard to diurnal as well as seasonal rhythms - result in an increased risk of stone formation in the months of May, June, September and November (concerning seasonal rhythm) and between midnight and 6 a.m. (concerning diurnal rhythm). Other data of importance influencing urinary excretion are sex, age and supply of fluid.

Long-lasting success was obtained in the treatment of 8 therapy-resistant, frequently relapsing calcium-stone formers with non-steroidal anti-inflammatory drugs (NSAIDs). Over the period of treatment the rate of stone formation decreased markedly in these patients. Until now 3 test persons have exhibited only partial success with NSAID treatment. Diclofenac-Na as single-drug therapy or in combination with thiazide preparations or indomethacin is presented as a novel therapeutic possibility, the influence of NSAID on pathomechanism of calcium-stone formation is discussed.

17 cystine stone patients were treated with high doses of ascorbic acid (5 g p. d.). During the observation period, a total of only two natural passages of cystine stones could be observed. For five patients the therapeutic strategy was altered because the recurrence rate did not change and the cystine concentration in the urine was enhanced. One mixed calcium-oxalate/cystine stone had to be resected. In this case as well as on the occasion of further medical check-ups of other patients, an increased risk of calcium-oxalate stone formation was signalled by an enhanced oxalic-acid concentration in the 24-hour urine. Changes in blood serum and impairment in hepatic and renal functions were not observed. With three patients, the therapy had to be interrupted because of gastritis symptoms. The use of high-dose ascorbic acid therapy is recommended and is continued. In special cases, an additive of low do ses of alpha-mercaptopropionyl-glycine is recommended.

This study is intended to elucidate the process of urinary transport through the pelvi-calyceal system (PCS). PCS-motility of a total of 28 PCS was qualitatively and quantitatively determined in 9 stone patients and 14 control persons by examination of contrast medium excretion. From X-ray videograms recorded by means of Siemens urography, four different urinary transport types could be distinguished as well as the duration of the contraction periods and the intervals between the PCS-contractions. In stone patients physiological types of urinary transport are less common (33%) than in control subjects (81.25%). In stone patients the PCS is often characterized by reduced or even absent motility. Calyceal reflux is usually found in the systolic phase of PCS-contractions, which may apparently be regarded as a physiological process.