The handbook on lithiasis edited by Kurt Boshamer and originally brought out in 1961 was for more than two decades the standard work in this field for researchers and clinicians alike. However, our knowl edge of urolithiasis has been increased so enormously - by worldwide interdisciplinary research into the genesis of urinary calculi, by the new treatment possibilities opened up principally by advances in tech nology, and by the success achieved in prevention of recurrence - that it is almost impossible to take in all the relevant journal articles, books chapters, monographs, and proceedings. It was therefore our aim in this, the first of two independent vol umes, to provide a concise but comprehensive summary of current knowledge concerning the morphology and composition of calculi, epidemiology, pathogenesis, and diagnostic techniques. The most re cent developments are described, and nothing in the world literature is ignored. A second volume will cover medical therapy, operative, in strumental and noninvasive treatment, and prophylaxis. To have any chance of success, treatment and prophylaxis must be based on knowledge of calculus formation. Study of the composition of calculi has yielded important information regarding the conditions for formation, and this underlines once again the great value of analy sis of urinary concretions. Evaluation of epidemiological data has im portant consequences for the individual patient.

Urolithiasis: A Comprehensive History provides a historical sojourn into the varied manifestations of kidney stone disease. Utilizing historical sources and integrating classic material with new concepts, this new volume provides depth and details on stone disease not found in modern overviews on the topic. This volume serves as a very useful tool for physicians and researchers dealing with kidney stone disease. Written by a renowned expert in the field, Urolithiasis: A Comprehensive History is an in depth resource that heightens our medical understanding of this ancient disease and is of great value to urologists, nephrologists, endocrinologists interested in stone disease.

This volume comprises the proceedings of the sixth in a series of International Symposia devoted to basic and clinical aspects of urolithiasis. Previous symposia have been held at intervals of four years in Leeds, Madrid, Davos, Williamsburg, and Garmisch-Partenkirchen. The sixth symposium was held in Vancouver, British Columbia and was attended by over 250 participants from 26 countries around the world. As may be seen from the contents of this volume, the meeting covered many aspects of urolithiasis including the underlying physiology, crystal formation and the effects of inhibitors and promoters on crystallization, endocrinology and abnormalities of urinary composition, analyses, geography and epidemiology, and medical and surgical treatment with a special emphasis on extracorporeal lithotripsy. Internationally-recognized authorities gave invited talks in each of these areas, and from the submitted abstracts 30 were selected for oral presentation and the remainder were presented in either general or theme poster sessions. The nine theme-poster sessions provided a particularly valuable and successful feature of the meeting, giving an opportunity for a group of researchers working in related areas to present their posters and also to give a brief oral summary which was followed by discussion with the audience. Each of these poster sessions was chaired by two experts in the field who have provided an overview of each theme-poster session for this volume.

Urolithiasis: Basic Science and Clinical Practice is a comprehensive text that assists urologists in defining the best choice of treatment for each case through a balanced presentation of underlying science, diagnostic methods and practical tips, with additional discussions on educational issues, costs and management of resources. This user-friendly practical resource is replete with full-color illustrations and radiographs, covering all aspects of stone disease, and offering perspectives from Europe, the Americas, China, South Asia, Africa, and Australia. Topics include the biochemical and physiological basis of stone formation, treatment options, complications, assessment of techniques and technologies available, and guidelines on the prevention of stone recurrence. Urolithiasis: Basic Science and Clinical Practice is the definitive text on stone disease and is a must read for young consultants starting a new practice, and urologists in residence and training.

Urolithiasis, or stone disease occurs in 7% of women and 12% of men at some point, and these statistics are rising. Furthermore, for those who form a stone, the likelihood of a recurrence is nearly 50% within 5 years of initial diagnosis. Therefore, the need for effective, minimally invasive alternatives for stone eradication and prevention is crit

In 1968 Drs. B. E. C. Nordin and A. Hodgkinson organized the First International Symposium on Urolithiasis Research in Leeds, England. One hundred and five participants from continental Europe, Great Britain, and the United States met to review their work and exchange ideas regarding the formation of urinary calculi. This meeting achieved several important goals. It pulled together a nidus of workers in the many scientific disciplines that relate to urolithiasis. This nidus served as the seed for research growth in a complex, interdisciplinary field. It established a forum for con tinuing communication in urolithiasis research with subsequent sym posia being held every 4 years. The Williamsburg Symposium was the fourth in the Leeds-Madrid Davos series involving 186 participants from throughout the world. A stated emphasis was on clinical research under way in the field. There were no invited speakers and for the first time the 41 papers that were presented orally at the meeting were selected from 184 submitted abstracts. A total of 134 papers were presented in the poster sessions in the afternoons where informal exchange between interested participants and investigators could occur without the restrictions of a plenary session. Virtually all areas of urolithi asis research from the most fundamental physical chemistry to clinical patterns of disease and specific modes of treatment were presented, reviewed and discussed during the meeting.

Urolithiasis is not only one of the most frequently encountered diseases at uro logical clinics; it is also the disorder whose treatment has shown the most rapid progress in the past decade. In that period, medicine has experienced a real revolution, characterized by minimally invasive treatments, improvement of the quality of life, and cost-effectiveness in treatment outcomes. In urology, the revolution started with the development of endoscopic retrograde treatment of urolithiasis in the upper urinary tract, which led to development of the percuta neous antegrade maneuver in the latter half of the 1970s. The most remarkable event occurred in 1982, when clinical use of extracorporeal shock wave lithotripsy was introduced by the Munich group, represented by Dr. Christian Chaussy, at the 18th Congress of the International Society of Urology in San Francisco. With the advent of these new strategies, open surgery for urolithiasis has all but dis appeared. Today, with the availability of new technology and equipment, guide lines for the treatment of urolithiasis have changed in all developed countries. It is quite timely that the Meeting of International Consultation on Urolithiasis will be held in Paris in June 2001 to establish international guidelines for urolithiasis. Looking through this textbook for urolithiasis, I was greatly impressed to learn that we have already drawn up some guidelines. The book includes all the updated advances of urolithiasis presented by the most prominent and experi enced urologists from all around the world.

"People . . . see you sweat in agony, turn pale, turn red, trem ble, vomit your very blood, suffer strange contractions and con vulsions, sometimes shed great tears from your eyes, discharge thick, black and frightful urine, or have it stopped up by some sharp rough stone that cruelly pricks and flays the neck of your penis. " * These 16th century frustrations of Michel de Montaigne which most graphically reflect his experience with renal colic still plague approximately 1 per 1000 individuals in the United States annually. Since as many as 75% of clinically. apparent episodes of renal colic represent single nonrecurring events, physicians not in frequently approach the differential diagnosis of nephrolithiasis in a less than adequate fashion and assume that the incident may prob ably never recur after the single attack. However, the ureteral or bladder stone actually represents one form of abnormal crystalline precipitation; parenchymal nephrocalcinosis, silently progressive azotemia, and asymptomatic renal pelvic calculi may also stem from the same pathological process(es) which conditioned the for mation of the ureteral or bladder stone. In this regard it is worth emphasizing that the postmortem incidence of renal calculi is some tenfold greater than that presumed from surveys wherein a clinical attack of nephrolithiasis is the sole determinant. *In Familiar Medical Quotations. M. B. Strauss, Ed. Little Brown, Boston, 1968, p. 646. v vi FOREWORD The last decade has witnessed the birth of new knowledge in urolithiasis research.

In recent years, a growing interest has prompted increasing numbers of research publications and scientific conferences on the subject of urolithiasis. The aims of this symposium were three: a) to review and inte grate recent progress in major subject areas, b) to discuss current research developments and c) to stimulate interchange between investigators in Europe and in America. In a series of morning lectures, invited, recognized experts presented comprehensive reviews of major fields of urolithiasis research such as the physical chemistry of crystal formation, the metabolism of stone forming substances, and modes of therapy. A special emphasis was given to general renal physiology and the renal excretion of Ca++, Pi, Mg, oxalate and urate. Despite its obvious importance, renal function has been relatively neglected in uro lithiasis research. New research results were presented by the mechanism of after noon poster sessions. This procedure permitted informal lengthy discussions between those participants especially interested and the responsible investigator himself. In addition, informal group discussions were organized during the evenings on an ad hoc basis. In this volume, both the review lectures and brief summaries of the poster presentations have been collected. Interchange between European and American investigators was achieved by the direct participation of a large delegation from North America. This large attendance was made possible by the generous support of the National Institute for Arthritis, Metabolism and Digestive Disease U.S. N.I.H.

Urolithiasis is a common disorder which is recognised in most parts of the world and occurs in both man and animals. The multifactorial nature of the problem requires an interdisciplinary approach which has always been a feature of this series of International Symposia which started in Leeds in 1968 and has progressed at four-yearly intervals through Madrid, Davos and Williamsburg. The latest Meeting, at Garmisch-Partenkirchen in April 1984, involved 302 participants from all five continents. The major emphasis of the Meeting was to blend the basic and clinical research on urolithiasis. Comprehensive reviews of the major areas of current research were presented by invited speakers, all internationally recognized experts in their fields. From more than 250 submitted abstracts, 18 were selected for oral presentation and the remainder presented at three afternoon poster sessions which provided an opportunity for informal and more lengthy discussions of the work on display. The Meeting also included three ad hoc Evening Discussions on how to approach various unsolved questions in the clinical and laboratory evaluation of stone patients and four Round Table Discussions involving specialists in the field who debated the theoretical aspects of stone formation in the urinary tract, the measurement of inhibitory activity of urine, the treatment of idiopathic stones with drugs, and the nature and treatment of stones arising from urinary tract infection.