Retroperitoneoscopy can be the technique of choice for accessing and carrying out all the surgery of the upper urinary tract respecting the principles of oncological surgery. After experience with 600 cases during the last 10 years the technique has become safe, simplified, reproducible and effective although not easy. Most complications are minor and easily managed.

Purpose: Extracorporeal shockwave lithotripsy (SWL) is a noninvasive but painful procedure. The aim of this study was to identify predictive risk factors for pain during SWL. Patients and Methods: Two hundred twenty-two SWL treatments with the Lithostar lithotripter (Siemens) were included in a monocentric study. Patient and stone characteristics were prospectively collected in a database, and a standardized pain control protocol was administered 1 hour before treatment: paracetamol, nefopam, ketoprofen, and alprazolam. Subjective pain level was assessed with visual analog scale (VAS, 0-10). If VAS was !3, tramadol was added. If VAS was still !3, shockwave intensity was decreased or treatment was interrupted. The efficacy on stone fragmentation was evaluated 1 month after treatment. The need for adjuvant analgesia was compared with patient and stone characteristics to find out predictive risk factors for pain. Results: The average subjective pain was 3.1. The need for supplementary analgesia was more frequent in women (p ¼ 0.035), younger patients (p < 0.001), anxious and depressed patients (p ¼ 0.018), in patients with previous SWL (p ¼ 0.0185), in patients with a rib projected stone (p < 0.001), in patients with renal stones (p ¼ 0.0535), and finally in patients with homogeneous stones (p ¼ 0.02). Multivariate analysis revealed two independent risk factors for pain: young age (odds ratio ¼ 5; p < 0.001) and rib projected stone (odds ratio ¼ 5.23; p < 0.001). Stone fragmentation was worse in patients with an adjuvant analgesia requirement (p ¼ 0.0311). Conclusion: Predictive risk factors for pain during SWL treatments were found: young age, rib projected stones, anxious and depressed patients, previous SWL treatment, and homogeneous stones. A higher analgesic requirement is necessary for these preselected patients to perform SWL and optimize its efficacy.

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Purpose of reviewTo provide a comprehensive review of the nonsurgical management of acute urinary retention (AUR). Recent findingsA recent meta-analysis confirmed that a-blockers are associated with higher rates of successful trial without catheter (TWOC) compared with placebo, while combination therapies do not significantly reduce the rate of recatheterization. Compared with standard TWOC, bladder perfusion with physiological serum prior to catheter removal is a simple and cost-effective method to increase TWOC success rates (odds ratio 2.41, 95% confidence interval 1.53-3.8), and to reduce time-to-discharge (À89.68 min, 95% confidence interval À160.55, À18.88). Clean intermittent catheterization (CIC) is increasingly used for urinary retention in patients with benign prostatic hyperplasia as existing data suggest that it may decrease the risk of urinary tract infections, accelerate spontaneous voiding recovery and might be more cost-effective compared with indwelling urethral catheterization. Ongoing trials are examining whether office-placed prostate stent may be a promising solution in patients with AUR.