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Aim We previously reported that some urodynamic parameters change with repetitive filling in children with neurogenic lower urinary tract dysfunction (LUTD). In this study, we aimed to search if three-times repeated filling cystometries (FC) and pressure-flow studies (PFS) would change the urodynamics parameters in children with non-neurogenic LUTD. Materials and Methods All children with three repeated FC and PFS between June 2017 and December 2018 were included in the study. Urodynamic reports and charts were evaluated retrospectively. The first sensation of bladder filling (FSBF), maximum cystometric capacity (MCC), detrusor pressure at the FSBF (P-det.first.sens), maximum detrusor pressure during filling (P-det.fill.max), presence of detrusor over activity, compliance, maximum urine flow (Qmax), detrusor pressure at the maximum urine flow (PdetQmax), residual urine and presence of detrusor sphincter dyssynergy (DSD) were compared among three-times repeated urodynamic studies. Results Forty children were included in the study. 27 (67.5%) were girls and 13 (32.5%) were boys. Median age was 9 (3.4-17) years. Indications were LUTD with low grade vesicoureteral reflux in 19 (47.5%), LUTD refractory to conservative management in 13 (32.5%), urinary tract infection with LUTD in 6 (15%) and secondary enuresis in 2 (5%). P-det.first.sens, presence of DO, MCC, Qmax, PdetQmax, residual urine, flow pattern, and presence of DSD were comparable in all three repeated tests. The third FC may show decreased filling detrusor pressures and increased compliance with no change on capacity. Conclusion In children with non-neurogenic LUTD, three-times repeated FC and PFS present comparable results except FSBF, P-det.fill.max,P- and compliance at the third test.

There are scanty data on the rate of abnormal Tc-99 m dimercaptosuccinic acid (DMSA) renal scintigraphy and associated factors in children older than 5 years with diagnosis of VUR. We do not have knowledge about which older children should undergo DMSA after VUR diagnosis. This study aims to assess the rate of abnormal DMSA findings and associated factors in children older than 5 years of age diagnosed with VUR. We retrospectively reviewed the medical records of 258 children with VUR diagnosed at or older than 5 year age. 179 children [42 (23.5%) males and 137 (76.5%) females] with complete data were included. 268 reflux units were compared according to gender, bilaterality, grade, reflux phase at voiding cystourethrography, febrile urinary tract infection (fUTI), lower urinary tract dysfunction (LUTD), and DMSA findings with uni- and multivariate analysis. The median age was 110 (60–216) months. VUR grades were I, II, and III in 197 (73.6%) units and IV–V in 71 (26.4%). 138 (51.5%) renal units had abnormal DMSA. VUR grade (p

Objective Biofeedback is an effective treatment in children with standard urotherapy-resistant dysfunctional voiding (DV). However, the duration of the session intervals is not standardized. We aimed to compare the effectiveness of daily and weekly sessions of biofeedback treatments. Methods The data of children who received biofeedback due to DV between March 2018 and May 2019 were retrospectively evaluated. The children were divided into two groups, one with daily and the other with weekly sessions. The voiding patterns in uroflowmetry (UF), maximum flow rate (Qmax), electromyography activity, postvoid residual volume (PVR), the ratio of voided volume to expected bladder capacity (EBC) (%), and Dysfunctional Voiding and Incontinence Scoring System (DVISS) were compared between the two groups. Results A total of 45 children (39 girls [86.6%] and 6 boys [13.3%]) were included in the study. The daily group consisted of 27 (60%) children and the weekly group of 18 (40%). Qmax, PVR, number of abnormal UF patterns, voiding volume/EBC, and DVISS scores were similar between the two groups before treatment. Voiding parameters improved statistically significantly in both groups following biofeedback, but there was no difference between the two groups. A statistical difference was found between the results of DVISS after treatment (P = .03). Conclusion Both types of biofeedback treatment (daily and weekly) are effective methods that improve voiding parameters and DVISS values in children with DV. Therefore, the duration between sessions can be determined according to the suitability of the patient and the biofeedback unit.

Aim: Congenital anomalies of the kidney and urinary tract (CAKUT) in children include structural and functional malformations. These anomalies are the most common malformations in the prenatal period and constitute the leading cause of end-stage renal disease in children worldwide. In this study, the clinical, demographic, and treatment characteristics of the children with CAKUT were evaluated. Material and Methods: We retrospectively reviewed the medical records of the children with CAKUT who were admitted to our outpatient clinic during the two years period at Erzurum Regional Education and Research Hospital. Age, gender, family history, imaging studies and treatments were recorded. Results: The study included 378 patients. 179(47.4%) children were female, 199(52.6%) children were males. The mean age was 38 months(min 1 month-max 212 months). In our study, ureteropelvic junction obstruction was detected in 132(35%) patients, primary vesicoureteral reflux was detected in 128(33.9%) patients, renal agenesis was detected in 34(9%) patients, and ectopic kidney was detected in 19(5.1%) patients, double collecting system was detected in 19(5.1%) patients, horseshoe kidney was detected in 16(4.2%) patients, renal hypoplasia was detected in 15(3.8%) patients, polycystic kidney disease was detected in 14(3.8%) patients, multicystic dysplastic kidney was detected in 13(3.4%) patients, uretero-vesical junction obstruction was detected in 11(2.9%) patients, ureterocele was detected in 10(2.7%) patients, posterior urethral valve was detected in 9(2.4%) patients and urethral hypoplasia was detected in one (0.3%) patient. Eighty-seven (22.9%) patients had renal scar and 13(3.4%) patients had chronic kidney disease. Forty-three patients had multiple CAKUT forms. Twenty- nine(7.7%) of the patients had a history of CAKUT in the family.. Conclusion: CAKUT may cause serious morbidity throughout life. Careful and regular monitoring of children from the antenatal period is important. Although early diagnosis reduces the risk of permanent renal damage in cases requiring treatment, it still plays an important role in CKD in our country.

Aim: We aimed to evaluate the demographic characteristics, metabolic etiology, and response to treatment of children who admitted to our hospital with an urinary stone disease (USD) in our study. Patients and Method: The medical records of 259 patients who had been diagnosed with USD, between 01/04/2017-31/03/2018 were reviewed retrospectively. Results: The most common presenting symptoms of the patients were USD detected by ultrasonography performed for other reasons (n: 100, 38.6%). 52 of the patients (20.1%) had pyuria and urine culture positivity. Hematuria was detected in 31 (11.2%) patients. Hypocitraturia (38/82) 46.3%, hypomagnesuria (22/116) 13.2%, hypercalciuria (28/225) 12.4%, hyperuricosuria (17/219) 7.7%, hyperoxaluria (4/76) 5.2% was found in cases. Serum vitamin D levels were high in 5.8% of cases (15/259). The most common localization of stone was lower kidney pole (38.2%). Medical treatment was given to 92 (35.5%) patients while extracorporeal shock wave lithotripsy (ESWL) was performed in 34 (13.12%) patients and other surgical procedures were performed in 9 (3.74%) cases. Concurrent medical and surgical treatment was performed in 17 patients. The median follow-up period of 199 cases under followed-up was 3 months (1-12 months). In the last follow-up, 142 (71.35%) of the patients showed improvement, while 36 (18.05%) had no change in stone size, and 21 (10.6%) had an increase in stone size. Conclusion: Currently, USD is not rare in children with increasing in diagnostic methods. We believe that the detection and treatment of metabolic causes, reduce the stone recurrence, the requirement for surgical procedures, and ESRD in affected children., Amaç: Çalışmamızda hastanemize üriner sistem taş hastalığı (ÜSTH) saptanarak başvuran çocukların demografik özellikleri, metabolik etyolojileri ve tedaviye yanıt-larının değerlendirilmesi amaçlanmıştır. Hastalar ve Yöntem: 01/04/2017-31/03/2018 arası Çocuk Nefroloji-Üroloji kliniklerine başvuran ÜSTH tanısı konulmuş 259 hastanın kayıtları retrospektif olarak incelenmiştir. Bulgular: Olguların en fazla başvuru şikayeti, başka nedenlerle yapılan ultrasonografide saptanan ÜSTH (n:100, %38.6) idi. Olguların 52’sinde (%20.1) piyüri ve idrar kültüründe üreme vardı. Hematüri 31 (%11.2) olguda saptandı. Hipositratüri (38/82) %46.3, hipomagnezüri (22/116) %13.2, hiperkalsiüri (28/225) %12.4, hiperürikozüri (17/219) %7.7, hiperokzalüri (4/76) %5.2 olguda tespit edildi. Serum vitamin D düzeyi olguların (15/259) %5.8’inde yüksekti. Taş yerleşimi en sık böbrek alt polünde (%38.2) saptandı. Medikal tedavi verilen olgu 92 (%35.5), vücut dışı şok dalga litotripsi (ESWL) yapılan 34 olgu (%13.12), diğer cerrahi girişimlerin yapıldığı olgular ise 9 (%3.74) idi. 17 olguya eş zamanlı medikal ve cerrahi tedavi uygulandı. Takibe devam eden 199 olgunun ortanca takip süresi 3 ay (en kısa 1 ay en uzun 12 ay) idi. Son takiplerinde hastaların 142’sinde (%71.35) iyileşme görülürken, 36’sında (%18.05) taş boyutunda değişiklik saptanmadı, 21’inde (%10.6) ise taş boyutunda artış mevcuttu. Sonuç: Günümüzde tanısal yöntemlerin artması ile çocuklarda ÜSTH’nın nadir olmadığı görülmektedir. Metabolik nedenin saptanması ve tedavisi; taş tekrarını, cerrahi işlem gereksinimini ve etkilenmiş çocuklarda SDBY azalttığı kanaatindeyiz.

The International Children's Continence Society recommends urodynamics repeated at least twice for the optimal result. We aimed to search if 3 times repeat filling urodynamics in the same session would change the urodynamics parameters in children with neurogenic lower urinary tract dysfunction due to myelodysplasia.We investigated urodynamic reports and charts of 80 consecutive children with neurogenic lower urinary tract dysfunction due to myelodysplasia who underwent 3 repeat, same session filling cystometry studies between June 2017 and December 2018. Maximum detrusor pressure, maximum cystometric capacity, detrusor leak point pressure, compliance, residual urine volume and maximum cystometric capacity/estimated bladder capacity for age ratio were compared among all 3 filling cystometries.The median age was 4.3 years (IQR 5.8). Of the patients 39 (48.75%) were girls and 41 (51.25%) were boys. Primary pathological finding was myelomeningocele in 69 patients (86.3%). Maximum cystometric capacity, compliance, residual urine and maximum cystometric capacity/estimated bladder capacity for age were found comparable in 3 repeat cystometries. However, maximum detrusor pressure at first filling was higher compared to others (second, p=0.015, and third, p=0.002). Detrusor leak point pressure at the first filling was also higher compared to the third (p0.001). Detrusor overactivity was persistent in all 3 fillings in 85% of patients (68 of 80). Of the patients 68 (85%) remained in the same risk group according to detrusor leak point pressure (cutoff 40 cmHMaximum cystometric capacity and detrusor overactivity are comparable in 3 repeat cystometries but detrusor pressures significantly decrease in the repeat fillings. In our practice we plan our management according to the most worrisome urodynamics parameters for a safer proactive approach.

Objective To evaluate and compare the effectiveness of biofeedback therapy (BF) in children with treatment refractory overactive bladder (OAB) and dysfunctional voiding (DV). Methods This study was performed between April 2012 and March 2014. Patients with treatment refractory OAB and DV were included. All patients had 3 months of BF. Patients' urologic system symptoms and uroflow parameters before BF and 3 months after BF and response rates were compared. Results Forty-five patients completed the study. Significant improvement was seen in urinary tract infections, urge incontinence, fractionated voiding, constipation, voided volume, maximum flow rate (Qmax), average flow rate (Qave), and postvoiding residue for patients with DV and in urinary tract infection, frequency, urge incontinence, Qmax, Qave, voiding time, and postvoiding residue for patients with OAB. Overall, better results were observed in patients with DV. Conclusion BF is an effective treatment modality in children with treatment refractory OAB and DV; however, patients with DV show better improvement.

WOS: 000447379800010, PubMed ID: 30325125, To evaluate the value of Positional Installation of Contrast (PIC) and Redo-PIC cystography in patients with febrile recurrent urinary tract infection (f-UTI) where voiding cystourethrogram (VCUG) was negative. Patients with recurrent f-UTI with no reflux on VCUG referred to the outpatient clinic of Pediatric Urology, between June 2011 and June 2016 were included in the study. A PIC cystography was performed in all patients. When reflux was found, subureteric injection was performed. Urinary cultures were used for follow-up. Patients that continued having f-UTI, received redo-PIC cystography. PIC cystography was performed on 42 patients. The average age of patients was 8.0 +/- 3.6 years. Vesicoureteral reflux (VUR) was detected in 41 patients. Average follow-up time after PIC cystography was 44.6 months. Thirty-three patients (80.5%) were free of f-UTI after PIC cystography and concurrent subureteric injection. Eight patients continued to have recurrent f-UTI. Six of these patients underwent redo-PIC cystography and PIC-VUR was demonstrated in all patients. After an average follow up of 30.9 months, no f-UTI was seen in these patients. The success rate of 80.5% (33/41) after 1st PIC cystography and subureteric injection increased to 95.1% (39/41) after redo-PIC cystography in six patients. Patients with recurrent f-UTIs without VUR on VCUG are an important challenge. PIC cystography is an important tool in demonstrating occult VUR in these patients. We advise that PIC cystography is performed in all patients with recurrent f-UTI with negative VCUG and redo-PIC cystography in patients who continue to have f-UTI after 1st PIC cystography and subureteric injection.

Summary Objective While there are many options for children with treatment refractory urinary incontinence, there is no single accepted method. This study's aim was to prospectively evaluate the effect of transcutaneous electrical nerve stimulation in children with urinary incontinence resistant to standard medical, urological therapy and/or biofeedback. Patients & methods This study was performed at a university hospital. For inclusion, patients >5 years of age first underwent evaluation with urinary ultrasonography, uroflow-electromyogram and voiding diaries. Treatment with biofeedback, alpha adrenergic blockers, anticholinergics and/or urotherapy was commenced according to uroflow-EMG and voiding diary findings. Patients with partial or no response to this standard therapy were then included in this study, performed between April 2012 and February 2014. Patients with anatomical or neurological causes for urinary incontinence were excluded. TENS was performed on S3 dermatome, every day for 3 months. Each session lasted 20 min with a frequency of 10 Hz and generated pulse of 350 μs. Intensity was determined by the child's sensitivity threshold. Medical treatment and urological therapy was continued during TENS. Uroflow parameters (voiding volume as percentage of expected bladder capacity, Qmax, Qave, flow and voiding time, postvoiding residual urine) and urinary system symptoms (presence of urinary tract infection, frequency, urge incontinence, fractionated voiding and constipation) were compared immediately before commencement and immediately after the completion of 3 months of TENS. Results Twenty-seven patients were included in this study (4 males, 23 females). Patients' average age was 7.2 years, 11 had overactive bladder and 16 had dysfunctional voiding. Comparison of urinary system symptoms and uroflow parameters before and after TENS are shown in Table. After 3 months of TENS; a statistically significant decrease was observed in the number of patients with frequency, urge incontinence, urinary tract infections and constipation. There was a decrease in the number of patients with fractionated voiding, although this change was not statistically significant. Similarly, for uroflow-EMG parameters; bladder capacity, Qmax, Qave and flow time increased while voiding time and PVR decreased. Changes seen in bladder capacity, Qmax and PVR were statically significant, while other changes were not. Patients' response rates after 3 months of TENS were; complete response in 70.4%, partial response in 22.2% and no response in 7.4%. Table . Urinary system symptoms and uroflow parameters before and after TENS. EBV: Expected bladder volume. Before TENS After TENS Observed change P Urinary Tract Infection (n) 18 4 −77.8% 0.0005 Frequency (n) 17 3 −82.4% 0.0455 Urge Incontinence (n) 16 3 −81.3% 0.0009 Fractionated Voiding (n) 14 5 −64.3% 0.0736 Constipation (n) 12 4 −66.7% 0.0412 % of EBV (%) 77.0% 106.2% 37.9% 0.03846 Qmax (ml/s) 20.1 24.4 21.4% 0.02382 Qave (ml/s) 9.1 9.5 4.4% 0.37886 Flow Time (sec) 25.6 30.2 18.0% 0.06148 Voiding Time (sec) 38.3 37.6 −1.8% 0.96012 Postvoiding Residual Urine (ml) 27.6 16.1 −41.7% 0.04338 Conclusion This study has shown that transcutaneous electrical nerve stimulation is a promising treatment option for standard-treatment refractory children with urinary incontinence.