In the January - February 2001 issue of the Brazilian Journal of Urology, the editor would like to highlight some important papers.
     Doctors Murphy and Streem from Cleveland Clinic, Cleveland, USA, present on page 3 a comprehensive article on the most important aspects of management of lower pole renal calculi, an area of ongoing controversy. The authors address the roles of shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), ureteroscopy (URS), open surgery and laparoscopy, for treatment of such pathology. In short, the authors concluded that lower pole stones that are symptomatic, locally obstructing, infection related, or increasing in size require intervention. For most stones smaller than 1 cm, SWL is the treatment of choice while for stones greater than 2 cm, percutaneous management is generally indicated. The stones of 1 - 2 cm represent important controversy, and in such cases, the intrarenal anatomy and the stone fragility should be considered for choosing the appropriate therapeutic intervention.
     Doctors Shekarriz and Stoller from University of California, San Francisco, California, USA, provide on page 10 and article on the urological aspects of metabolic evaluation of stone disease. The authors briefly review the pathophysiology of stone formation, and present a thorough discussion of the current recommendations for metabolic evaluation. Also, the medical management based on the results of metabolic evaluation is presented.
     The role of varicocele treatment in the present era of high technology assisted reproduction is outlined on their urological aspects by Doctors Fisher and Sandlow, from the University of Iowa, Iowa City, Iowa, USA (page 19). Nowadays, it is well established that varicocele is associated with decreased testicular volume, impaired sperm quality and decline of Leydig cell secretion. However, the exact pathophysiologic mechanisms involved in testicular dysfunction in men with varicocele remain theoretical. After an extensive review of the recent literature concerning male factor infertility, the authors concluded that varicocele repair can fulfill the goals of therapy, that is, to improve semen parameters, improve testicular function, and improve pregnancy rates. Also, varicocelectomy is associated with low morbidity, and is a more cost-effective therapy when compared to high technology assisted reproductive techniques. When male-factor infertility associated with varicocele is present, it is clearly that varicocele should be corrected. Even today, intra-cytoplasmic sperm injection is not justifiable as the first line of treatment in varicocele–associated male infertility in the face of economic, morbidity, and treatment outcomes.
     A stereological analysis of histologic components in transition zone of normal and hyperplastic human prostates is presented by Doctor Chagas and colleagues from State University of Rio de Janeiro, RJ, Brazil (page 26). The authors determined the volumetric density of the stromal components (connective tissue and smooth muscle cells) in normal and hyperplastic prostate samples. It was found a statistically significant increase of 29% in smooth muscle fibers and 34% in connective tissue in hyperplastic prostates when compared to transitional zones of controls.
     Doctor Alexsandro da Silva, from Rio de Janeiro, Brazil, provided our authors with an interesting historical article on page 76. After an extensive research on historical documents, the author shows how the history of Brazilian Republic was almost changed by a bladder stone.
     An investigative paper on the effects of L-arginine and L-name in the renal ischemia-reperfusion in rats is presented on page 48 by Doctors Rhoden and co-workers from Federal School of Medicine, Porto Alegre, RS, Brazil. The authors found that nitric oxide have a protective effect in the renal ischemia-reperfusion induced-injury in rats.oc

Dr. Francisco J. B. Sampaio
Editor-in-Chief