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The ureteral double pigtail stents are versatile and valued for proper urinary drainage in the setting of trauma, fistula formation, after extra-corporeal shock wave lithotripsy (ESWL) and surgical manipulations of the upper urinary tract. Also they are used for prolonged urinary drainage in patients with chronic tumor-induced ureteral obstruction, and present an exceptional patient tolerance. The authors' experience is based upon 54 patients treated for ureteral obstruction of malignant origin between January 1989 and October 1995. Complications of this method as well as the quality of life of these patients are analysed and the results compared with those of the literature. The patient tolerance was excellent. Mean survival time after ureter catheterisation was 18 months. Complete urine diversion was achieved and hydronephrosis disappeared soon after stent placement in 42 patients (80%). In addition hydronephrosis persisted in 12 cases (20%), despite orthotopic positioning of the catheter and numerous stent changes for larger caliber stents. The palliative use of the double pigtail stent when no other treatment is possible for malignant ureteral obstruction, precludes the need for ureterostomy and offers the patient a comfortable quality of life. Bladder disease is a contraindication to the use of these catheters, although their insertion is rarely impossible. In case of acute obstruction, it is better to prepare the pathway with a standard ureteral catheter, which is easier to manage. It is always possible to insert the pigtail stent after some time has elapsed.

Surgical injury to the ureter is an important problem that confronts the urologist, the gynecologist and the general surgeon. The authors report 20 cases of iatrogenic pelvic ureteral injuries (22 ureters) observed after gynecological surgery between January 1985 and January 1995. The ureter was injured during ligation of the lumbo-ovarian vascular pedicle because it was inadequately protected during the operation. Open surgery and double pigtail stent insertion using retrograde route were used for treatment. The iatrogenic ureteral injury was in 18 patients unilateral and in the remaining 2 patients both ureters were damaged. As regards treatment, the authors recommend immediate repair, whenever the lesion is noticed at operation. In the post-operative period, ureteral stent or double pigtail stent insertion using balloon dilatation or ureteroscope, may be a successful conservative treatment. If the damage is only diagnosed subsequently, they recommend a ureterovesical implantation, using the psoas hitch bladder procedure or the Boari-Cassati-Küss procedure if the lesion is in the lower ureter or a transuretero-ureterostomy if it is in the upper ureter.

The results observed in a series of 40 patients treated for urethral stricture by endoscopic resection of the callus after internal endoscopic urethrotomy (Guillemin's technique) are presented. The mean age of the patients was 57 years, with a follow-up of five years. The authors obtained 80% (32 patients) of very good results for urethral strictures less than 1 cm long. The success rate of the technique was 10% (4 patients) when the callus was between 1 and 2 cm long. The recurrence rate was high for strictures longer than 2 cm (4 patients) (10%). Complications consisted of 2 cases of acute epididymitis, 2 cases of urethral perforation, 2 cases of urethral haemorrhage, 2 cases of perineal haematoma and 3 cases of meatal stenosis. The indications of this original technique therefore depend more on the length of the urethral stricture than on its topography or its aetiology.

From 1987 to 1990, 719 subjects (385 males and 334 females) were screened, by means of urocystin-kit, for cystinuria and cystine lithiasis, in Epirus district (North-West Greece). The positive results were confirmed by chromatographic analysis of urine amino acids and laboratory tests. Forty patients, belonging to six cystinuric families, were identified. These patients were excreting 3.1 +/- 1.7 mmol/24 h of cystine in urine. All patients were treated by per os administration of alpha-MPG in daily doses of 400-1,200 mg/24 h). We therefore report the results of a 4 +/- 2 year follow-up of these patients. We conclude that treatment with alpha-MPG is very effective with minimal side effects in patients suffering from cystinuria or cystine urinary calculi.

Seventy patients with urethral strictures underwent endoscopic urethrotomy in the Department of Urology of the Ionnina University Hospital since 1983. The mean age of the patients was 58 years and they were treated for single (53 cases) or multiple (17 cases) urethral strictures. The cause of stricture was traumatic, post-infections, iatrogenic (post-TURP or open adenomectomy) or unknown in 6, 21, 28 and 15 patients respectively. Good results were obtained after the first endoscopic urethrotomy in 36% of cases (25 patients), at 5 year follow-up. The success rate of repeated internal urethrotomies was satisfactory in 54% of cases (38 patients). Finally, 4 patients (6%) had 5 or 6 internal urethrotomies and many urethral dilatations and were then treated by urethrectomy followed by termino-terminal urethrraphy.

The authors report a rare case of sub-peritoneal malignant schwannoma developing 5 years after excision of a schwannoma of the sigmoid. The non-excised tumour compressed the bladder and one ureter. This type of tumour, extremely rare, accounts for less than 2% of tumours. Arising in the cells of the Schwann sheath, and as a general rule developing in the central nervous system, peripheral nerves of the neck, mediastinum, flexor surfaces of the extremities or nerves of the digestive tract, they may be benign tumours do not recur. The example reported here showed that this distinction is in no way absolute.