[Our experience in the conservative surgical treatment of megaureter in the adult]

Surgical treatment of the megaureter in adults is only indicated when important symptoms and/or complications occur. The Authors report their experience with eight adult patients affected by megaureter, undergone to conservative surgery. The average age of the patients was 36 years (range 21-52). The disease was unilateral in five cases (four on the right side and one on the left), bilateral in three. In five patients megaureter was primary (obstructed in four, refluxing in one). A case of megaureter with ectopic orifice in the prostatic urethra was observed. The remaining two cases, already operated in other hospitals, were a segmentary megaureter associated with vesico-ureteral reflux secondary to endoscopic incision of an ureterocele and a bilateral refluxing megaureter in a patient undergone to bilateral ureterocystoneostomy because of primary megaureter in his childhood. All patients underwent ureterocystoneostomy, performed with Politano-Leadbetter antireflux technique in six cases and with direct non-antireflux technique in two. A reductive Hendren ureteroplasty was also performed in 7 cases. The average length of follow-up is actually of 82 months (range 5-231). Satisfactory results were obtained in three primary obstructed megaureters, in the megaureter with ectopic orifice and in the segmentary megaureter associated with reflux. In two patients with refluxing megaureter surgery was unsuccessful and a new operation was necessary. Finally, one patient with primary obstructed megaureter underwent endoscopic dilatation of the strictured vesico-ureteral anastomosis two months after the ureterocystoneostomy.

Aspetti epidemiologici e demografici dell'invecchiamento della popolazione: Epidemiological and demographic aspects of an ageing population

An ageing population is mainly due to the reduction of births and the increase in life expectation. In Italy the percentage of people aged at least 65 years increased from 11.3% in 1971 to 15.3% in 1991. This increase mostly involved those aged 75 years and over. In the last four decades the average life span has extended by more than 11 years (from 65.5 to 76.9 years). The average life span in women is currently 80.2 years, almost 7 years longer than that of men. As age increases so does the incidence of various urological diseases requiring surgery, such as prostatic diseases (hyperplasia and carcinoma), urological tumours, urinary infections and incontinence. At the same time the probability of associated pathologies increases and consequently the risk of peri-operative complications, thus negatively influencing the prognosis. Surgery is only indicated in the elderly when it may increase life expectancy and/or improve the quality of life. A careful pre-operative evaluation of all the factors that may influence both life expectancy and quality of life is therefore indispensable, with particular reference to the actual disease and co-morbidity.

L'eziopatogenesi della fibrosi retroperitoneale: Etiopathogenesis of retroperitoneal fibrosis

The etiopathogenesis of retroperitoneal fibrosis is still obscure and probably multifactorial. Among the secondary forms due to demonstrable causes, the one caused by aorto-iliac atherosclerosis has recently been recognised. Its pathogenesis is linked to the low density oxidised lipoproteins of the atheromatous plaque, which are responsible for a local immunologic reaction. The most common form is still idiopathic or primitive, hypothetically related to genetic, environmental, vascular and/or immunologic factors. Idiopathic retroperitoneal fibrosis is sometimes associated with other sclerosing syndromes and/or systemic diseases. In such cases a common pathogenesis, probably immunologic may be postulated. After having illustrated the different categories of retroperitoneal fibrosis, the authors report their experience with 25 patients of whom 14 had idiopathic fibrosis and 11 secondary fibrosis. In the former group 11 patients (78.5%) smoked more than 10 cigarettes a day, while there was a history of prolonged professional exposure to asbestos in one case. The following associated pathologies were observed: hypertension in 7 cases (50%), ischemic cardiopathy in 2 (14.3%), diabetes mellitus in 2 (14.3%), multiple myeloma in 1 (7.1%) and juvenile rheumatoid arthritis in 1 (7.1%). The disease was also associated with other sclerosing pathologies in 3 cases: sclerosing cholangitis in 2 and Dupuytren's contracture in 1. The location of the fibrosis was typically periaortic in 13 cases (92.8%), as shown by CT. Lastly, 10 patients underwent immunosuppressive therapy with a favourable response, suggesting the probable immunologic pathogenesis of the disease.

Acute scrotum: Analysis on 333 cases

Treatment of acute scrotum is becoming increasingly more common in urological surgery. The aim of this work was to analyse all the cases of acute scrotum subjected to surgical exploration in the last 20 years. Funicular torsion was found in 51% of patients, appendicular testis torsion in 26%, alterations compatible with previous funicular torsion in 15%, while findings were negative in 7%. Surgery to relieve funicular torsion and eversion of the vaginal was performed in 82% of cases, while the testis was fixed in 12% and in 11 cases orchiectomy was necessary. The contralateral testis was never fixed. No recurrence of funicular torsion has been found during follow-up, but in 9% of patients contralateral funicular torsion occurred at a later date.