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Objective: To evaluate pediatric patients with lower urinary tract dysfunction (LUTD) who received bladder or external sphincter botulinum toxin A (BTX) injection in terms of effectiveness and permanence. Materials and Methods: We analyzed 80 patients treated with intradetrusor (n=48) n or intrasphincteric (n=32) BTx injection between May 2007 and December 2019. We divided the patients into 2 groups: Neurogenic bladder (NB) and LUTD. Clinical assessment of results was mainly done with Dysfunctional Voiding and Incontinence Symptoms Score (DVISS) and quality of life questionnaires and dryness status. Uroflowmetry with electromyography and video-urodynamic study was performed postoperatively. Results: Mean age and follow-up time were 123.0±48.3 and 30.1±5.8 months. For bladder BTx (NB: 18 patients; LUTD: 30 patients), the response rate was 79.1% (n=38). NB patients' response duration was shorter (32 vs 87 weeks) and required subsequent multiple injections more (55% vs 23%) than the LUTD group. For sphincter BTx (NB: 13 patients; LUTD: 19 patients) clinical improvement was found in 75% (n=24) n of the patients. There was no significant difference between the NB and LUTD groups. DVISS and quality of life questionnaires showed substantial decrease in the LUTD groups after bladder (p<0.001) and sphincter (p<0.05) BTx injection. NB patients showed significant dryness status in both BTx-B (pre: 3.2%, post: 82.1%, p<0.05, chi-square test) and BTx-S (pre: 0%, post: 100%, p<0.05, chi-square test) patients postoperatively. Conclusion: This study demonstrated that BTx injection is an effective and safe treatment in pediatric patients with NB and LUTD. With its benefits, this endoscopic treatment should be kept in mind before major constructive surgeries. [ABSTRACT FROM AUTHOR]

Objective: To define and discuss the new concept which using loop cutaneous ureterostomy (LCU) in patients with obstructing megaureter and solitary kidney. Materials and Methods: Two patients with solitary kidney with obstructive pattern were included. Both patients underwent LCU within the 1st month to reduce the obstruction and to relieve the pelvicaliceal system. Thereafter, parents were taught to dilate the ureter and irrigate the bladder with sterile saline by a disposable 6F catheter via antegrade fashion through the distal ureter. Initially, 10 cc saline was used once a day, then it was increased to 20 cc once a day after 2 months. When the bladder capacity was sufficient (50 mL capacity at the 6th month or by cystoscopic evaluation intraoperatively), we performed undiversion with ureteroneocystostomy and Double-J-stent placement. Results: Ureterorenal dilatations were followed-up by ultrasonography and renal function tests. No bladder dysfunction and renal insufficiency were observed during follow-up. At the postoperative controls, patients' renal function tests were compatible with their ages and they had no voiding dysfunction. Conclusion: Patients with solitary kidney and obstructing megaureter require urgent diversion. After diversion, bladder cycling is required to prevent bladder dysfunction by protecting and developing bladder capacity. Using this concept, the kidney can be protected from further damage and treatment can be finalized around 6 months of age with minimum morbidity. [ABSTRACT FROM AUTHOR]

Objective: This study determines the publication rates and publication times of studies presented at the first four Meetings of the Society of Urological Surgery in Turkey (MSUST). Materials and Methods: The first four books of abstracts published by MSUST were examined, and an analysis of the abstracts of authors published between January 1, 2012 and January 1, 2021 identified from the PubMed, Web of Science, Scopus and Google Scholar databases were analyzed. The publication time refers to the interval between the date of the congress and the date on which the publication was made available on a journal website. Results: A total of 1,436 abstracts were reviewed, and the publication rates for the first four MSUST were 50.7%, 33.4%, 28.2%, and 26.9%, respectively, with a mean publication rate of 33.4%. In an assessment of the publications made within 2 years of a meeting, the publication rates were found to be 27.6%, 25.8%, 24.2% and 26.9%, respectively. The mean publication rate within a 2-year period was determined to be 26%. The median time of publication when calculated prospectively, was 22 (-2-88), 12 (-2-60), 10 (-2-39) and 7 (-2-24) months. The ratios of articles from the first three MSUST, published within 2 years to total publication were found to be 54.3%, 77.3%, and 85.5%, prospectively. Conclusion: The ratio of studies presented at MSUST congresses that are subsequently published is increasing, and more than half of these publications occur within the first 2 years following the congress, which can serve as an indicator of the legitimacy of a scientific meeting. [ABSTRACT FROM AUTHOR]

Objective: To compare the histological responses of 3 bulking agents, which are used in the endoscopic treatment of vesicoureteral reflux, on rats’ urinary bladder and subcutaneous tissue. Materials and Methods: Thirty rats were divided into 3 groups according to the injection materials; Dextranomer Hyaluronic acid- Deflux® (DxHADf), Dextranomer Hyaluronic acid- Deal® (DxHA-Dx) and Polyacrilate Polialcohol Copolymer-Vantris® (PPC). In each group, material was injected both into the submucosa of the rats’ urinary bladder dome and the subcutaneous tissue at their names. In each group, 5 rats were scarified at the 2nd and 6th months after injection. The histopathologic compartment was performed by scoring inflammation, neutrophil, eosinophil, macrophage, mast cell and giant cell reactions around the injected material. Results: All materials maintained their bulky effect. Despite the large amount of degradation with dextranomer materials, there was minimal degradation with PPC. The materials had the same amount of capsule formation around the injection site, which was not related to the degradation properties of the material. There was no statistically significant result for bladder injections. For subcutaneous injections mast cell scores around the injection (DxHA-Df, DxHA-Dx, PPC: 1.4, 1.2, 0 respectively, p=0.024) were significantly different at 2nd month. Mast cell scores around the injection (DxHA-Df, DxHA-Dx, PPC: 1.0, 1.75, 0 respectively, p=0.007) were significantly different at 6th month also. The inflammation around PPC was higher at the 6th month (DxHA-Df, DxHA-Dx, PPC: 1, 1, 3.5 respectively, p<0.05). Conclusion: Both dextranomer agents were degradable with good capsule formation and minimal inflammation in the adjacent tissue. PPC degraded minimally and caused significant inflammation at adjacent tissue. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the pre-voiding bladder and post-voiding residual [BV, post-void residual (PVR)] volumes measured by the portable ultrasonic scanner (PUS) in standing and supine positions. Materials and Methods: This study included 436 children. Two groups were composed (group-1: PUS vs. volume by catheter and group-2: PUS vs. infused volume during the urodynamic study) to evaluate the agreement of PUS measurements with true bladder volume. Additionally, the third group (group-3) was created to analyze the correlation between PUS measurements in different positions. In groups 1 and 2, PUS measurement agreements were evaluated using the paired sample T or Wilcoxon signed-rank tests. Following the agreement, correlations were analyzed using Pearson's or Spearman's coefficients depending on whether variables were distributed normally or not, respectively. Coefficients were interpreted as 0.90-1.00 (very high correlation) and 0.70-0.90 (high correlation). Results: The catheter and PUS measurements were similar in group-1 (Wilcoxon signed-rank test, p=0.976) and were highly correlated (r=0.873). The measurements of volumes infused by urodynamic device and PUS were similar in group-2 that revealed the agreement of PUS measurements on different volumes and highly correlated at the 25th and very highly correlated at the 50th, 75th, and 100th percentiles of the estimated bladder capacity related to age. The BV and PVR measurements by PUS in standing and supine positions in group-3 were highly correlated, revealing that PUS can be used in both positions. Conclusion: Measurements of BV before uroflowmetry or PVR volume by PUS in standing position gave similar results with those in the supine position. [ABSTRACT FROM AUTHOR]

Objective: Estrogen-secreting adrenocortical tumors (ACTs) are quite rare with feminizing adrenocortical tumors (FATs) accounting for 0.37-2% of all ACTs. The aim was to evaluate clinical and hormonal characteristics of FATS as well as treatment options and follow-up in the pediatric age group. Methods: Medical records of children with ACTs presenting to a single center in the last two decades were reviewed. Literature review within Pubmed revealed 34 pediatric patients (22 boys) with FAT among 192 articles. Results: Among the 25 children presenting with ACTs in the last two decades, two new pediatric cases of FAT were identified, one benign and the other malignant, in two genders with different clinical presentations. Literature review showed that FATs are extremely rare tumors that are most commonly seen in men and boys presenting with gynecomastia. FATs are more common in children ≤8 years of age, with a median age at diagnosis of six years. While boys present with contrasexual pseudopuberty signs, girls present with isosexual pseudopuberty. A high estrogen level strongly supports diagnosis, while elevations in other adrenal hormones may be seen. FATs are usually malignant in adults and prognosis is generally very poor. However, in children approximately half are benign although assessment of malignant potential depends on clinical behavior of the tumor. FATs are very unpredictable so even after surgery long-term follow-up is required. FATs presenting in childhood may have a better prognosis than adult presentation tumors as most FATs in children are followed without recurrence of tumor. Conclusion: FATs are more common in children ≤8 years of age, with a median age at diagnosis of six years. FATs in childhood may have a better prognosis than in adult males. [ABSTRACT FROM AUTHOR]

Objective: Factors that may influence the efficiency and reliability of shock wave lithotripsy have been examined in the treatment of stone disease in patients aged 0-2. Materials and Methods: The data of 149 patients treated with shock wave lithotripsy in our clinic between the ages of 0 and 2 years were evaluated retrospectively. Factors for predicting success in terms of overall stone-free rate were analyzed using univariate and multivariate analyses. Results: The mean age of the group was 14.39±4.56 months. The stone-free status was achieved in 102 (70.5%) patients in the first session, 15 (65.2%) of 23 patients in the second session, and 2 (50%) of 4 patients in the third session. Thus, 122 (81.9%) of the children were stone-free after shock wave lithotripsy at an average of 10.01±11.34 months of follow-up. The mean stone size was 8.66±3.47 mm. Moreover, smaller stone size and single stones were found to be significant predictors of treatment success (p=0.007 and p=0.001, respectively). Additionally, it was determined that the single number of stones had a positive effect on treatment success in multivariable analysis (area under the curve=0.683, p=0.002). There were no major complications observed. Conclusion: Our study has shown that shock wave lithotripsy can be used with high success and low morbidity in the treatment of urinary system stone disease in children aged 0-2, especially in the presence of a single stone. [ABSTRACT FROM AUTHOR]

Objective: To investigate factors affecting the success rate of endoscopic subureteral injection (ESI) in patients with vesicoureteral reflux (VUR) and to evaluate the changes in years. Materials and Methods: A total of 439 patients with primary VUR who underwent ESI were included. We used dextranomer hyaluronic acid copolymer (Dx-HA) as bulking agent. Statistical analyzes were performed by SPSS 20.0 programme. Results: Overall patient-based and renal unit-based success rates of ESI were 75.6% and 78.2%, respectively. Operational age of 82 months and lower grades of VUR were found to be the factors increasing success rate (p=0.023, p=0.005). Success rates were as 83.6%, 77.9% and 64.5% for grades of reflux 1-2, 3 and 4-5, respectively (p=0.002). When patients were seperated into four equal chronological groups, we observed that the ratio of patients who had previous failed ESI, high-grade reflux and renal scarring and volume of injected material has increased over the years. Conclusion: ESI has higher success rates in older children and lower grades (grades 1-3) of VUR. It is performed also in high-grade patients with acceptable success rates which tended to increase over the years. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the feasibility, efficacy and complications of cutaneous ureterostomy (CU) in different indications. Materials and Methods: Data from 83 patients who underwent CU between 1991 and 2019 were reviewed retrospectively. Patients with neurogenic bladder, posterior urethral valves, solitary kidney and bilateral kidney involvement were excluded. A total of 53 patients aged <2 years were included in the analysis. Indications to perform CU were ureterovesical junction obstruction (UVJO) and high-grade vesicoureteral reflux (VUR) with dilatation. Ureteroureterostomy or ureteroneocystostomy methods were preferred for undiversion according to the dilatation status of the ureter. Results: The mean patient age was 4.47±3.6 months, 40 (75.5%) were male and 13 (24.5%) were female. The mean follow-up time was 57.4±41.4 (6-150) months. Loop and end CU were performed in 18 (34%) and 35 (66%) patients, respectively. The indications for CU were UVJO in 26 (49%) and high-grade VUR in 27 patients. Two (3.7%) patients needed dilatation because of stenosis that occurred after CU. Within the follow-up time, 39 patients underwent undiversion. The clinical improvement rate was 94.3%. Conclusion: CU is a simple method with satisfactory results when performed in patients with megaureter and massive dilatation. Despite the less frequent use, it is still an important alternative to the increasingly used conservative methods. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Ankara University Faculty of Medicine / Ankara Üniversitesi Tip Fakültesi Mecmuasi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Urological Surgery is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To investigate the factors that predict the success and complication rates of semi-rigid ureteroscopy (URS) in pediatric population. Materials and Methods: This is a retrospective analysis of the database including 182 patients who underwent URS between 2001 and 2016. The possible factors that might affect the outcome were age, gender, stone laterality, largest stone size, number of stones, stone location, orifice dilatation status, and caliber of ureteroscope. Results: The mean age was 68.1 (7–204) months, and male-to-female ratio was 94:88. Operative side was left for 97, right for 82, and bilateral for 3 patients. One hundred and forty-four patients had a single stone, and 38 patients had multiple stones. The median largest stone size was 7 (2–20) mm. Postoperative ureteral stenting was performed in 150 (86.2%) patients. The overall success rate was 84.6%, while 81.6% and 85.4% in 8F URS and 4.5F URS groups, respectively (p = 0.560). Stone-free rate was higher among patients who were older than 36 months, distal ureteral stones and single stones (p = 0.012, 0.002, and 0.009, respectively). Complication rate was higher for proximally located stones (p = 0.029). The mean follow-up was 23.9 ± 32.5 months. Conclusion: URS is a safe procedure with acceptable success rates in the pediatric population. Younger age, multiple stones, and proximal location are the predisposing factors for failure, whereas proximal location was the only factor for complication occurrence. Therefore, semi-rigid ureteroscopy should not be the first choice in the treatment of proximal ureteral stones, and alternative methods should be preferred, if available. [ABSTRACT FROM AUTHOR]

To draw attention to the disregarded malignancy risk after ileocystoplasty, we present two cases of adenocarcinoma. The first case was metastatic at initial diagnosis. Despite chemotherapy, the condition progressed and the patient died at the 9th month. The second patient has received cystectomy followed by chemotherapy and radiotherapy. Although the second patient was an immunosuppressed renal transplant, she was disease-free at the 27th month. As the malignancy risk after bladder augmentation is a proven fact, until the discovery of a proper diagnostic method, we recommend doing routine annual cystoscopic biopsy starting after the 10th year of ileocystoplasty. [ABSTRACT FROM AUTHOR]

This study was performed to evaluate the role of postnatal ultrasonography (US) in predicting the final diagnosis and need of surgery of antenatal hydronephrosis patients. One hundred and twenty six renal units (RUs) of 76 patients with diagnosis of antenatal hydronephrosis (ANH) were studied. An early postnatal US no later than the first week of life was requested. Voiding cystourethrography (VCUG) and/or diuretic renogram (MAG3) was performed in children who had persistent or worsening hydronephrosis to make a certain diagnose of etiology. US findings of different etiologies, and operated/nonoperated groups are compared. Regarding the renal pelvic anteroposterior diameter in the first week postnatal US; mild, moderate, severe, and no HN was detected in 48 (38.1%), 31 (24.6%), 24 (19.0%), and 23 (18.3%) RUs respectively. Eight RUs with a normal first postnatal US were found to have renal anomaly during follow up and 63% of these were vesicoureteral reflux (VUR). Kidneys with mild or moderate HN were likely to have transient dilatation while severe HN was likely to have obstruction. Postpartum follow-up of AHN is a dynamic process. Follow-up must be planned with optimum period of intervals according to clinic and US findings, to select the right patient for surgery or close follow-up. [ABSTRACT FROM AUTHOR]