grade, concomitant upper tract carcinoma in situ (CIS), and size were all analysed. Univariate and multivariate analyses were done using the Kaplan-Meier Method, with the log-rank test, and the Cox proportional hazards regression model, respectively. RESULTSThe median follow-up was 71 months, during which bladder tumours were detected in 42 patients (54%). On univariate analyses, tumour stage ≥ pT2 ( P = 0.015), concomitant upper tract CIS ( P = 0.001), high-grade tumour G3 ( P = 0.027) and tumour size > 4 cm ( P = 0.011) were statistically significant predictors of intravesical recurrence. After multivariate analyses, concomitant CIS ( P = 0.005, hazard ratio 2.9, 95% confidence interval 1.4-5.8) and tumour size > 4 cm ( P = 0.042; 1.9, 1-3.7) were significantly related to bladder tumour recurrence.

The aim of this paper is to study the variations in the percentage of the different types of renal stones with age and sex. Renal calculi were classified according to their composition and structure. Stone formers were divided according to age and sex, and the percentage of each kind of calculi in the different considered age periods for men and women were determined. It was found that calcium oxalate dihydrate calculi decreased with age, but only in men. These calculi were also clearly predominant in men. Hydroxyapatite calculi decreased with age in both men and women, but they were predominant in women. Uric acid calculi increased with age in both men and women, but were predominant in men. Finally, it was found that calcium oxalate monohydrate unattached calculi increased with age in both men and women. As a main novelty, the study here presented demonstrates the importance of distinguishing between calcium oxalate monohydrate papillary stones and calcium oxalate monohydrate unattached stones, since the etiologic factors responsible for their origin must be clearly different.

Calcium oxalate monohydrate (COM) papillary calculi can be initiated by subepithelial calcification of the renal papillae. Hydroxyapatite disruption of the papillary epithelial layer can become the nidus of a COM papillary calculus. This study evaluated the causes of papillary tissue calcifications in 60 patients with calcium oxalate lithiasis, 30 with COM papillary and 30 with calcium oxalate dihydrate (COD) calculi. Urinary redox potential was higher in the COM than the COD group, suggesting that the former is more deficient in antioxidants due to increased oxidative stress. Urinary calcium was significantly higher in the COD group, whereas urinary oxalate was significantly higher in the COM group, suggesting a greater degree of oxidative injury of renal cells. Evaluations of their diets showed that both groups consumed low amounts of phytate-rich products. Of chronic diseases possibly associated with urolithiasis, only the prevalence of gastroduodenal ulcer differed significantly, being higher in the COM group and suggesting that epithelial lesions are common to gastroduodenal ulcers and COM papillary renal stones. Occupational exposure to cytotoxic products occurred in 47 % of the COM and 27 % of the COD group, but this difference was not statistically significant. These findings indicate that oxidative stress is associated with injury to papillary tissue and that this is the origin of intrapapillary calcifications. The continuation of this process is due to modulators and/or deficiencies in inhibitors of crystallization. Identifying and eliminating the causes of injury may prevent recurrent episodes in patients with papillary COM calculi.

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Calcium oxalate monohydrate (COM) renal calculi can be classified into two groups: papillary and nonpapillary. In this paper, a comparative study between etiologic factors of COM papillary and nonpapillary calculi is performed. The study included 40 patients with COM renal calculi. The urine of these individuals was analyzed. Case history, lifestyle, and dietetic habits were obtained.No significant differences between urinary biochemical data of both groups were observed; 50% of COM papillary stone formers and 40% of COM nonpapillary stone formers had urolithiasis family history. A low consumption of phytate-rich products was observed for both groups. A relationship between profession with occupational exposure to cytotoxic products and COM papillary renal lithiasis was detected.The results suggest that COM papillary calculi would be associated to papillary epithelium alterations together with a crystallization inhibitors deficit, whereas COM nonpapillary calculi would be associated to the presence of heterogeneous nucleants and a crystallization inhibitors deficit.