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Summary Introduction Lower urinary tract dysfunction (LUTD) is a situation that often disrupts the quality of life (QoL) of both the child and the family with daytime and nighttime incontinence. Although the first-line treatment option for children with LUTD is standard urotherapy, biofeedback therapy can be performed in children in which standard urotherapy failed. Objective We studied the biofeedback success in children with LUTD according to parents' expressions. Methods We retrospectively analyzed our hospital records of children who were diagnosed with LUTD between 2005 and 2017. In total, 281 patients, refractory to standard urotherapy were included into the study and directed to biofeedback treatment. Their parents completed the dysfunctional voiding symptom scores (DVSS) before and after biofeedback therapy. Results At the end of the six-month follow-up period, all voiding disorders and voiding patterns were evaluated. According to DVSS, QoL tools before biofeedback treatment 48 (17%) parents appraised that LUTD caused no effect in their children's daily life, 104 (37.8%) expressed little effect, 89 (31%) moderate effect, and 40 (14.2%) serious effect. And, 120 (43%) parents expressed no effect, 95 (34%) little effect, 51 (18%) moderate effect, and 15 (5%) serious effect (P = 0.001) after biofeedback therapy. Biofeedback therapy affected positively the daily life of LUTD's family. The less serious the effect of LUTD on these children's family, the more success rate of biofeedback therapy. The effect of biofeedback therapy was less successful in moderated and serious affected families. Conclusions Biofeedback treatment is a non-invasive and effective treatment modality for improving the QoL for LUTD families who were less suffered from LUTD. Summary Table . Quality of life results before and after biofeedback therapy (%). Before biofeedback n = 281 After biofeedback n = 281 No effect 48 (17%) 120 (43%) Little effect 104 (37%) 95 (34%) Moderated effect 89 (31%) 51 (18%) Serious effect 40 (14%) 15 (5%)

Objective Our goals were to assess long-term outcome for patients with posterior urethral valves (PUV) and determine the impact of the timing of diagnosis. Patients and methods We reviewed the hospital records for patients with PUV treated in 1994–2008. Only those patients diagnosed, treated surgically, and followed clinically at our center were included. Results There were 52 patients with PUV. Thirty-nine were diagnosed by 1 year of age (early diagnosis cohort), while 13 were diagnosed after 1 year (late diagnosis cohort). Mean follow up after valve operation was 7.2 years (range 15 months–14 years). Chronic renal failure rates were not statistically different between the early and late diagnosis groups after surgical intervention: 48% (14/29) vs 25% (3/12), P = 0.30. Among the early diagnosis cases, 10% (3/29) eventually required renal transplant, while no child in the late diagnosis group has developed end-stage renal disease to date ( P = 0.55). Conclusions Gestational age at diagnosis is an important predictor of postnatal renal outcome. Our results suggest that diagnosis after 1 year of age is associated with a lower risk of developing renal insufficiency on long-term follow up.

Objective To assess parental satisfaction with e-mail consultations and fetal outcomes after consultation for offspring with 45,X/46,XY mosaicism. Patients and methods A chart review was performed of prenatal and postnatal e-mail consultations concerning 45,X/46,XY mosaicism at our institution. Prenatally, mosaicism was detected by amniocentesis; postnatally by phenotype and subsequent genotyping. Parents e-mailed us for a second opinion after internet searches. Follow-up parental satisfaction was evaluated by e-mail. Results E-mail consultation occurred in six prenatal and eight postnatal cases. One of the eight postnatal cases had a prenatal diagnosis but without our second opinion. In 7/8 postnatal cases, abnormal neonatal phenotype was evaluated by genotyping. Termination of pregnancy was a consideration in all six prenatal consultations, although not discussed by us. One fetus was stillborn. Postnatal karyotype was mosaic in 11/13 surviving neonates. Phenotypes in surviving fetuses were normal male (2/13), hypospadias and an undescended testis or streak gonad (9/13), female with mild clitoral hypertrophy (1/13), and normal female (1/13). The stillborn fetus was noted only to have a penis. Conclusion All parents reported in follow up that e-mail consultations provided them with enhanced clinical information, allowing them to make better informed clinical decisions.

We reviewed our initial results with complete primary repair of exstrophy in regard to continence status and the need for subsequent continence procedures.We performed a retrospective review of our surgical records from 1996 to 2008 to identify all patients with bladder exstrophy managed at our center.Sixteen children were closed successfully. Six patients (37.5%) experienced complications: umbilical hernias in two, transient penopubic fistula in three, and subcoronal fistula due to meatal stenosis in one. Of the 12 males, seven (58.3%) were left with a hypospadias at the time of primary closure. Two (22.2%) children required a formal bladder neck reconstruction to achieve continence. Bladder augmentation and continent catheterizable stoma was performed in four cases (44.4%), and bladder neck injection in one case (11.1%). Bladder neck closure was also performed in another child following primary closure. Three of these children are continent and void spontaneously (33.3%). The remaining six require clean intermittent catheterization four to six times a day, resulting in four (44.4%) being continent. The number of continence procedures and mean number per patient were 15 and 1.66, respectively.Our early experience with this technique has been encouraging, with few major complications, a highly successful closure rate and a cosmetically normal result.

Overactive bladder syndrome (OAB) and dysfunctional voiding (DV) are subgroups of lower urinary tract dysfunction (LUTD). Standard urotherapy is the first-line treatment option of OAB in children.The aim was to investigate the use of biofeedback as a first-line treatment option in OAB refractory to standard urotherapy, and determine the factors affecting efficacy.Between 2005 and 2015, we retrospectively analyzed a total of 136 hospital records of children with OAB who had not previously used any anticholinergics and were refractory to standard urotherapy. Patients with urgency and/or urge incontinence and/or making holding maneuvers to suppress urgency were defined as having OAB symptoms, and resolution of these complaints was defined as successful biofeedback therapy.Seventy-three of 136 OAB patients' urgency recovered by biofeedback therapy with the success rate of 53% (p0.001). Sixty-two of 101 patients with holding maneuvers (success rate 61%) (p0.001), 70 of 101 patients with urgency incontinence (success rate 69%) (p0.001), 76 of 114 patients with daytime incontinence (success rate 66%) (p = 0.023), 87 of 97 patients with enuresis (success rate 89%) (p = 0.009), and 27 of 39 patients with dysuria (success rate 69%) (p = 0.007) recovered from their symptoms significantly. The mean lower urinary tract symptom score (LUTSS) was 16.38 and 8.18 before and after biofeedback therapies, respectively (p0.001) (Table). Patients without holding maneuvers (p = 0.045), daytime incontinence (p = 0.030), and enuresis (p = 0.045) had better recovery compared to the opposites.Biofeedback can be thought of as the first-line treatment option when standard urotherapy fails in children with OAB.

Summary Introduction Dysfunctional voiding (DV) occurs in neurologically normal children who are not able to establish brain control on detrusor muscle contractions (DMCs). It is also reported to be the result of incorrect voiding habits during toilet training. Children contract pelvic floor muscles (PFMs) to suppress DMC and DV begins. Urinary nerve growth factor (uNGF) is necessary for the synthesis and regulation of neurotransmitters, development of dorsal root ganglia (sensory neurons), and development of sympathetic cells during embryonic and post-natal life. uNGF has also a role in the intracellular signal transduction in nerve cells towards the target organ. To our knowledge, no study has investigated the association between uNGF, biofeedback treatment and DV in children. Objectives The aim was to examine the potential effect of uNGF in the assessment of the effectiveness of biofeedback success in children with lower urinary tract disorders. Study design Fifty-two children with the suspicion of DV and 48 children from a primary school reporting no urinary complaints were enrolled in this study from October 2010 to April 2013 in the Urology Department. uNGF levels were compared. Results The mean uNGF/creatinine (Cr) level was 0.23 ± 0.26 in the control group and 0.96 ± 0.88 in the DV group (p Discussion To our knowledge this study is the first to show the correlations between uNGF levels and biofeedback therapy in children with DV. Tissue NGF in 12 patients with overactive bladder (OAB)/detrusor overactivity and 15 healthy women was previously compared and it was suggested that there was no correlation between bladder tissue NGF and OAB. uNGF levels in the bladder in patients with interstitial cystitis and idiopathic sensorial urgency were evaluated previously, and uNGF levels reported. Similar to these reports, most of the previous studies handled uNGF in patients with diseases such as interstitial cystitis, OAB, urinary tract infections, urolithiasis, spinal cord injury, and prostate cancer, and found significantly higher uNGF levels. These studies were generally in adults. A previous study about uNGF comprised 40 children with OAB, in contrast to other studies. According to this study, 40 children diagnosed with OAB were administered anti-muscarinic therapy (oxybutynin 0.3–0.5 mg/kg/day). It was reported that uNGF/Cr levels of the OAB group were higher than control group. In the current study, we evaluated the uNGF difference in DV and the effect of biofeedback treatment on uNGF levels. Conclusions uNGF levels were higher in children with DV and decreased after biofeedback therapy. uNGF levels could be used for the diagnosis and the assessment of biofeedback success in these children. Download : Download high-res image (105KB) Download : Download full-size image Figure . The mean uNGF/Cr levels in the DV group at the baseline, at the end of biofeedback therapy (6 and 12 months).

Purpose Anterior urethral valves (AUV) are rare entities generally described in case reports. They are an uncommon cause of lower urinary tract obstruction in children and can be difficult to diagnose. In the present study, we present our experience in four children with AUV along with a literature review. Materials and methods We retrospectively identified four children with AUV presented between 1998 and 2005 at age 4–9 years. Results Hematuria, urinary tract infection and weak voiding stream were the most common symptoms. Voiding cystourethrography (VCUG) confirmed the diagnosis of AUV. On cystourethroscopy, cusp-like valves in the anterior urethra were seen in all children. Transurethral endoscopic resection of the valves was carried out in three children using a pediatric resectoscope. In one child with a massive anterior urethral diverticulum, open resection of the valve, diverticulectomy and urethroplasty were performed. All patients were cured, none had complications as a result of surgery, and all reported a normal urinary stream at follow-up. Conclusions Children with poor stream and recurrent infections should be evaluated carefully and anterior urethral valves should be considered in differential diagnosis of obstructive lesions.

Purpose To evaluate the effect of biofeedback therapy on the residual urine volume in children with dysfunctional voiding. Material and Methods This prospective study was conducted in children with dysfunctional voiding associated with abnormal postvoid residual urine (PVR) from June 2002 to 2007. The children were divided randomly into 2 groups. Group 1 was treated with standard urotherapy combined with biofeedback therapy and group 2 was treated with only standard urotherapy. The outcomes of uroflowelectromyography pattern, urinary tract infection (UTI), and PVR were recorded before and at the end of sixth month of treatment. Results A total of 94 patients were enrolled in this study. Groups 1 and 2 consisted of 62 and 32 patients, respectively. The voiding pattern became normal in 80.6% (50/62) and 56.2% (18/32) of patients in groups 1 and 2, respectively. The PVR resolved in 40 of 62 (64.5%) patients in group 1 and in 11 of 32 (34.4%) children in group 2. Before the treatment, UTI was noted in 22.5% of patients (14/62) in group 1 and 21.8% of patients (7/32) in group 2. After the treatment, UTI was observed in 3.2% of patients (2/62) and in 9.3% (3/32) of patients in groups 1 and 2, respectively. Although both treatment modalities changed the voiding pattern, rate of febrile UTI, and PVR positively, these outcomes were better in a combination group. Conclusions The combination of standard urotherapy with the biofeedback therapy improved the results significantly.

Purpose Diagnostic laparoscopic is the most appropriate method to approach children with bilateral non-palpable testes as imaging studies are not considered to be effective any more. However, some authors advocate endocrinological evaluation beforehand since laparoscopy is an invasive method. The serum basal antimullerian hormone(AMH) and human chorionic gonadotropin stimulation test are the most commonly used two endocrinological methods. We performed bilateral orchiectomy to simulate anorchia in new born rats and compared inhibin B and AMH levels of them with those of the bilateral cryptorchid and normal rats. Material and Methods Totally 108 Sprague-Dawley rats(3 groups of 36 each) were included in this study. Bilateral testis were placed and fixed to the intraabdominal region after birth in the first group. Bilateral orchiectomy was performed after birth in the second group. Third group was the control group. All rats were sacrified in 1, 3, 7, 14, 21 and 35th day and serum samples were collected with intracardiac aspiration.Serum inhibin B and AMH levels were measured. Results Mean serum inhibin B and AMH levels were 113,6 pg/ml and 3,38 ng/ml, respectively in the first group and 129,1 pg/ml and 3,4 ng/ml, respectively in the third group. On the 3rd day of orchiectomy, both inhibin B and AMH decreased to unmeasurable levels (mean inhibin B 0,887 pg/ml and AMH 0,64 pg/ml) in the second group. There was no significant difference between those two hormone levels in terms of sensitivity and specifity (p Conclusions Testicular tissue existence could be determined with the measurement of serum basal inhibin B and AMH levels.

Purpose Dysfunctional voiding makes the 40% of the patients who admitted pediatric urologists. Voiding dysfunction symptom score (VDSS) is a noninvasive test and has been used for detection or monitoring of these patients. Here in we attempted to find predictive value of VDSS to find the response time to the treatment. Material and Methods Between April 2004–July 2007, 214 patients who admitted to pediatric urology clinic with LUTD was reviewed. VDSS of 9 and upper were pointed. VDSS performed to the patients before and after treatment of 1, 3 and 6 months. Results 22(%64.7) of 34 patients having 10 and lower scores showed improvement at first month of the treatment. 11(%32.4) and remaining 1(%2.9) showed improvement after treatment 3, 6 months. Of the 54 patients with symptom scores 11–15, 35(%64.8) showed improvement at the first month and 18(%33.3) at the 3 rd month. 1 (%1.9) patient showed no improvement. Of the 63 patients with symptom scores 16-20, 2(%3.2) showed improvement at the first month, 44(%69.8) at 3 rd month and 7(%11.1) at 6 th month of treatment. 10(%15.9) patients showed no improvement. 8(%12.7) of 63 patients with scores of 20 and more showed improvement after treatment 3 months. 24(%38.1) showed improvement at 6 th month of treatment and 31(%49.2) patient no improvement. Conclusions This study has been shown that, VDSS is a predictive test to find the response time to the treatment. The higher scores of VDSS show long treatment period and late onset of response to the treatment.