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Patients immune phenotype/genotype data may be useful to understand the molecular mechanisms involved in SARS-CoV-2 infection and can contribute to the identify the different levels of disease severity. The roles of chemokines have been reported in the coronavirus-related diseases SARS and MERS and they may likewise play a critical role in the development of the symptoms of COVID-19 disease. We analyzed the association of the MCP-1-A2518 G, SDF-1-3'A, CCR5-delta32, CCR5-A55029 G, CXCR4-C138T and CCR2-V64I gene polymorphisms with COVID-19 severity to further unveil the immunological pathways leading to disease severity and death. Polymerase chain reaction(PCR)/Sanger sequencing analysis was performed for detection of the variations in 60 asymptomatic and 119 severe COVID-19 patients. In our study, we found that the frequencies of MCP-1 of GA genotype and G allele carriers were significantly higher in severe COVID-19 patients than the asymptomatic COVID-19 patients (

Context Paediatric stone disease is an important clinically entity and management is often challenging. Although it is known that the condition is endemic in some geographic regions of the world, the global incidence is also increasing. Patient age and sex; the number, size, location, and composition of the stone; and the anatomy of the urinary tract are factors that need to be taken into consideration when choosing a treatment modality. Objective To provide a general insight into the evaluation and management of urolithiasis in the paediatric population in the era of minimally invasive surgery. Evidence acquisition A nonsystematic review of the literature on management of paediatric urolithiasis was conducted with the aim of presenting the most suitable treatment modality for different scenarios. Evidence synthesis Because of high recurrence rates, open surgical intervention is not the first option for paediatric stone disease, except for very young patients with very large stones in association with congenital abnormalities. Minimally invasive surgeries have become the first option with the availability of appropriately sized instruments and accumulating experience. Extracorporeal shockwave lithotripsy (SWL) is noninvasive and can be carried out as an outpatient procedure under sedation, and is the initial choice for management of smaller stones. However, for larger stones, SWL has lower stone-free rates and higher retreatment rates, so minimally invasive endourology procedures such as percutaneous nephrolithotomy and retrograde intrarenal surgery are preferred treatment options. Conclusions Contemporary surgical treatment for paediatric urolithiasis typically uses minimally invasive modalities. Open surgery is very rarely indicated. Patient summary Cases of urinary stones in children are increasing. Minimally invasive surgery can achieve high stone-free rates with low complication rates. After stone removal, metabolic evaluation is strongly recommended so that medical treatment for any underlying metabolic abnormality can be given. Regular follow-up with imaging such as ultrasound is required because of the high recurrence rates.

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.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.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.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.

In this study, we aimed to identify the glycemic profile of patients admitted to our emergency department during Ramadan. The charts of patients aged 18 years and over who had been fasting religiously and admitted to the Emergency Service with hyperglycemia or hypoglycemia during the month of Ramadan, were reviewed retrospectively. 169 patients (30 non-diabetic, 139 diabetic) were found to be admitted with hyperglycemia (161 cases, 95.3%) or hypoglycemia (8 cases, 4.7%). The blood glucose level ranged from 30 to 736, with an mean of 279±127 mg/dl. 163 cases (96.4%) were discharged from the hospital, 4 cases (2.4%) were referred to another hospital, and only 2 cases (1.2%) were hospitalized. After being informed about the metabolic disturbances that might occur during Ramadan and by meticulous follow-up of their symptoms, there is no harm in terms of urgent complications in the religious fasting of diabetes mellitus patients without complying any extra diet or medication protocol. Non-Diabetic patient scan undergo episodes of hypo or hyperglycemia during Ramadan. Such patients should be investigated for the presence of a prediabetic status or an underlying disease that can trigger a hyper or hypoglycemic episode., Bu çalışma ile Ramazan ayında acil servise başvuran diyabetik hastaların glisemik profilinin ortaya konulması amaçlandı. Acil servise hipo veya hiperglisemi ile başvuran ve oruç tuttuğunu ifade eden, 18 yaş üstü hastaların dosyaları geriye dönük olarak incelendi. Çalışmaya 161 (%95.3)’i hiperglisemi, 8 (%4.7)’i hipoglisemi nedeniyle başvuran toplam 169 (139 diyabetik, 30 diyabeti olmayan) hasta dahil edildi. Hastaların kan glukoz düzeyi 36 mg/dl ile 736 mg/dl arasında değişirken, ortalama 279±127 mg/dl olarak hesaplandı. 163 (%96.4) hastanın acil servisten taburcu edildiği, 4 (%2.4) vakanın sevk edildiği ve sadece 2 (%1.2) hastanın hastaneye yatırıldığı görüldü. Ramazan ayında ortaya çıkabilecek metabolik bozukluklar ve semptomlarının titiz takibi ile bilgilendirildikten sonra, diyabetik hastaların herhangi bir ekstra diyet ve ilaç protokolü izlemeden oruç tutabilecekleri görülmektedir. Diyabeti olmayan kişilerde de Ramazan ayında hipo veya hiperglisemi atağı görülebilir. Bu hastaların özellikle prediyabetik durum ve hipo veya hiperglisemiyi tetikleyebilecek altta yatan hastalıklar açısından tetkik edilmesi gereklidir.

INTRODUCTION: The exact correlation of testicular microlithiasis (TM) with benign and malignant conditions remains unknown, especially in the paediatric population. The potential association of TM with testicular malignancy in adulthood has led to controversy regarding management and follow-up. OBJECTIVE: To determine the prognostic importance of TM in children in correlation to the risk of testicular malignancy or infertility and compare the differences between the paediatric and adult population. STUDY DESIGN: We performed a literature review of the Medline, Embase and Cochrane controlled trials databases until November 2020 according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) Statement. Twenty-six publications were included in the analysis. RESULTS: During the follow-up of 595 children with TM only one patient with TM developed a testicular malignancy during puberty. In the other 594 no testicular malignancy was found, even in the presence of risk factors. In the adult population, an increased risk for testicular malignancy in the presence of TM was found in patients with history of cryptorchidism (6% vs 0%), testicular malignancy (22% vs 2%) or sub/infertility (11-23% vs 1.7%) compared to TM-free. The difference between paediatric and adult population might be explained by the short duration of follow-up, varying between six months and three years. With an average age at inclusion of 10 years and testicular malignancies are expected to develop from puberty on, testicular malignancies might not yet have developed. CONCLUSION: TM is a common incidental finding that does not seem to be associated with testicular malignancy during childhood, but in the presence of risk factors is associated with testicular malignancy in the adult population. Routine monthly self-examination of the testes is recommended in children with contributing risk factors from puberty onwards. When TM is still present during transition to adulthood a more intensive follow-up could be considered. ispartof: JOURNAL OF PEDIATRIC UROLOGY vol:17 issue:6 pages:815-831 ispartof: location:England status: published

Objectives The systemic immune inflammation index (SII) is a novel biomarker based on platelet, neutrophil and lymphocyte counts. SII serum levels have diagnostic, prognostic degrees and correlations with various immune, inflammatory diseases. Celiac disease (CD) is an immune-mediated chronic enteropathy with inflammatory situations. Here we aimed to evaluate clinical significance of SII and to compare SII with other inflammatory markers in CD. Methods 161 pathologically confirmed CD and 75 dyspeptic patients were enrolled. Hemogram, biochemical markers, SII, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), mean platelet volume-to-platelet ratio (MPR) and monocyte-to-high density lipoprotein cholesterol ratio (MHR) were evaluated. Results There was a statistically significant difference between groups for SII (p560.0 was associated with CD with 64% specificity, 78% sensitivity (p Conclusions To the best of our knowledge, this is the first study analyzed the diagnostic value of SII in CD. SII may serve as a beneficial marker for the diagnosis of inflammatory state superior to that of hsCRP, PLR, NLR, MHR, MPR and WBC.

BACKGROUND: Testicular tumors in prepubertal boys account for 1-2% of all solid pediatric tumors. They have a lower incidence, a different histologic distribution and are more often benign compared to testicular tumors in the adolescent and adult group. This fundamental difference should also lead to a different approach and treatment.OBJECTIVE: To provide a guideline for diagnosis and treatment options in prepubertal boys with a testicular mass.METHOD: A structured literature search and review for testicular tumors in prepubertal boys was performed. All English abstracts up to the end of 2019 were screened, and relevant papers were obtained to create the guideline.RESULTS: A painless scrotal mass is the most common clinical presentation. For evaluation, high resolution ultrasound has a detection rate of almost 100%, alpha-fetoprotein is a tumor marker, however, is age dependent. Human chorionic gonadotropin (HCG) was not a tumor marker for testis tumors in prepubertal boys.CONCLUSION: Based on a summary of the literature on prepubertal testis tumors, the 2021 EAU guidelines on Pediatric Urology recommend a partial orchiectomy as the primary approach in tumors with a favorable preoperative ultrasound diagnosis.

In this work, we propose a computer-aided diagnosis system for automatic classification of adenomatous polyps from colonic histological images. The proposed method employs an ensemble of ConvNeXt variants, which is one of the most recent and prominent convolution based deep learning architectures. Comprehensive experiments show that classification performance of the proposed method outperforms the state-of-the-art Deep CNN models on our dataset, with a 95% accuracy. It achieves 91.1% and 90% classification accuracy respectively on EBHI and UniToPatho datasets, which shows that the model can generalize well for other datasets as well. Furthermore, we investigate the effect of stain normalization preprocessing on the classification accuracy. While the other methods are sensitive to the normalization, the proposed method retains its accuracy levels under the variations, which also indicates a high generalization ability. Lastly, we use the Grad-Cam method and show that the proposed model gives more attention to the regions where the cancer indicators potentially reside.

Bosnia and Herzegovina is located in the South-Eastern Europe, characterized by numerous historical influences, massive migration processes and complex population structure. For that reason, the aim of this study is to provide an accurate and precise update of the population genetics data of allele frequencies on 23 Y-STR loci in Bosnia and Herzegovina using larger sample size. For this purpose, 480 adult male individuals from the general population have been genotyped over 23 Y-STR loci contained in the PowerPlex Y23 system. Population genetics parameters have been calculated, namely allele and haplotype frequencies, gene and haplotype diversity, as well as Rst and P values for the assessment of interpopulation differences. The obtained results are in close agreement with previously published data for Bosnian-Herzegovinian population, as well as for local subpopulations. This study offers significantly increased resolution and information content, with 454 unique haplotypes. Population comparison reveals no statistically significant differences between the study population and 12 European populations used for comparison, as visualized through an MDS plot and neighbour-joining phylogenetic tree. This study offers representative data for local Y chromosomes that can be used for forensic applications, paternity and kinship testing, as well as for genealogical studies.

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

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 co-polymer (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.

INTRODUCTION: Dorsal inlay graft urethroplasty (DIGU) has been described as an effective method for hypospadias repair with the proposed advantage of reducing the risk of complications. We aimed to systematically assess whether DIGU has any additional advantages over standard tubularized incised plate urethroplasty (TIPU) repair in children with primary hypospadias.MATERIALS AND METHODS: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The a priori protocol is available at the PROSPERO database (CRD42020168305). A literature search was conducted for relevant publications from 1946 until January 10, 2020 in seven different databases. Randomized controlled trials (RCTs), comparative studies (TIPU vs DIGU) and single arm case series (>20 cases) of DIGU were eligible for inclusion. Secondary hypospadias, two-stage repairs, disorders of sex development, significant curvature of >30°, and a mean or median follow-up of less than 12 months were excluded.DISCUSSION: A total of 499 articles were screened and 14 studies (3 RCTs, 5 non-randomized studies (NRSs), and 6 case series) with a total of 1753 children (distal: 1334 (76%) and proximal: 419 (24%)) were found eligible. Mean follow-up of the studies was between 16 and 77 months. DIGU was found superior to TIPU in decreasing meatal/neourethral stenosis (p = 0.02, 95% CI 0.02-0.78). All other parameters were found comparable including overall complications, fistula and glans dehiscence rates. Success rates were similar among the groups ranging between 48% and 96% for DIGU and 43-96% in the TIPU group. The lack of standardization in the definition of complications and success was the major limitation of this study.CONCLUSIONS: Using an inlay graft during primary hypospadias repair decreases the risk of meatal/neourethral stenosis. However, current evidence does not demonstrate superiority of DIGU over TIPU in terms of treatment success and overall complication rates.

Bitkisel ürün adı altında satılan birçok gıda takviyesi ürünün günümüzde kullanım sıklığı artmıştır.Televizyon, radyo ve özellikle internetgibi araçlar ile tüm topluma rahat erişim sağlanması sonucunda denetimsiz ve hekim kontrolü dışında satılan bu tarz birçok ürün ciddi sağlık problemlerine neden olabilmektedir. Olgumuz baş ağrısı ve sol kolda uyuşukluk şikayeti ile acil servise başvuran 65 yaşında erkek hastayı bildirmektedir. Alınan ayrıntılı anamnezde cinsel gücü artırmak amacıyla hekim önerisi ve kontrolü olmadan bitkisel bir ürün alıp kullandığı öğrenildi. Bilinen herhangi bir hastalığının, operasyonunun ve hekim kontrolünde kullandığı bir ilacının olmadığı öğrenildi. Bu tarz bitkisel ürünlerin ciddi nörolojik hadiselere neden olduğu bilinmektedir. Özellikle akut nörolojik şikayetler ile acil servise başvuran ve özgeçmişinde belirgin hastalık olmayan hastalarda bu ürünlerin kullanımı mutlaka sorgulanmalıdır., The frequency of use of many food supplements sold under the name of herbal products has increased today. As a result of easy access to the whole society with tools such as television, radio and especially the internet, many such products sold uncontrolled and outside the control of physicians can cause serious health problems. Our case reports a 65-year-old male patient who was admitted to the emergency service with a headache and left arm numbness. In the detailed history taken, it was learned that he used a herbal product without the recommendation and control of the physician in order to increase sexual power. It was learned that he did not have any known disease, operation, and medicine used under the control of a physician. It is known that such herbal products cause serious neurological events. The use of these products should be questioned, especially in patients who are admitted to the emergency department with acute neurological complaints and have no apparent medical history.

Objectives Our goal was to determine the short-term effects of donor nephrectomy on the cardiovascular system and to gain a better understanding of the recently recognized long-term increased risk of end-stage renal disease and cardiovascular mortality. Materials and methods Living kidney donors who underwent donor nephrectomy between January 2010 and January 2015 at the Hacettepe University Transplantation Unit were retrospectively screened. Echocardiographic parameters, kidney volumes, and renal functions before nephrectomy were compared with measurements after nephrectomy. Flow-mediated dilatation values of living kidney donors were compared with healthy individuals. Results The study included 73 female and 31 male living kidney donors with a mean age of 46.1 ± 10.8 years. In the comparative analysis of donors versus 35 healthy individuals, the changes in flow-mediated dilatation were 12.3 ± 5.7% and 15.4 ± 6.3%, respectively (P = .016). In the comparative analysis of preoperative versus the last visit transthoracic echocardiographic results, left ventricular end-systolic and end-diastolic diameters decreased and left ventricular posterior wall thickness and septum thickness increased (P = .025, P = .002, P = .026, and P = .019, respectively). Conclusions Nephrectomy may cause several hemodynamic changes in living kidney donors, which may exacerbate cardiovascular risks in this population.

Background: The human angiotensin I converting enzyme 1 (ACE1) gene insertion/deletion (I/D) polymorphism is classified based on the presence or absence of a 287 bp Alu sequence. The ACE1 D allele is associated with higher ACE1 concentrations in tissues. Previous research has shown that susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is primarily determined by the affinity between the viral receptor-binding domain and the host human receptor angiotensin-converting enzyme 2 (hACE2) receptor. In the human genome, ACE2 is identified as a homolog to ACE1. Objective: The purpose of this study was to characterize the ACE1 D allele distribution in Bosnia and Herzegovina (B&H), so as to compare it to population data from other European countries and to investigate the potential correlation between D allele frequencies and coronavirus disease 2019 (COVID-19) epidemiological findings in selected European populations. Methods: The ACE1 D allele frequencies in 18 selected European populations were analyzed and compared with COVID-19 prevalence, mortality, and severity using multivariate linear regression analysis. Results and Discussion: The ACE1 D allele distribution within the B&H population was similar to its distribution in other European populations. Regression analysis showed no significant correlation between the D allele frequency and the incidence of infections between the examined populations, nor with the rates of fatality and severe cases. Conclusion: There is no clear statistical evidence that the ACE1 D allele is associated with increased or decreased COVID-19 incidence, mortality, and case severity within the investigated populations.

Introduction A large number of genes and environmental factors, like dietary habits, play a role in the development of hypercalciuria in children. In this study, we aimed to determine the effects of the presence and grade of vesicoureteral reflux (VUR) on hypercalciuria status in children. Materials and Methods Data for 165 patients who admitted to the Pediatric Urology Department were retrospectively analyzed. The patients were composed of following four different groups: (1) urinary stone patients, (2) VUR patients under follow-up, (3) corrected VUR patients, and (4) control. The demographic features, clinical data, and laboratory tests for the groups were compared. Results The mean age of the patients was 100.6 ± 54.69 months and the female/male ratio was 79:86. The mean urinary calcium/creatinine (UCa/Cr) excretion and the frequency of high UCa/Cr ratios in the corrected VUR group were similar to those in the control group (p = 0.375 and 0.965, respectively). In contrast, the mean UCa/Cr excretion and frequency of high UCa/Cr ratios in the urinary stone and follow-up VUR groups were significantly higher than those in the corrected VUR group (p Conclusion Both the mean UCa/Cr ratio and the rate of hypercalciuria in the corrected reflux group were significantly lower than the corresponding values in the follow-up VUR and urinary stone groups. Further, the follow-up VUR patients had similar urinary calcium excretion levels as the stone patients. VUR treatment is associated with a decrease in urinary calcium excretion to the normal population level. A positive correlation between reflux degree and calcium excretion was observed.

AIMS To assess the efficacy of transcutaneous posterior tibial nerve stimulation (TPTNS) on functional voiding disorder (FVD) and investigate the utility of urine biomarkers (UBs: nerve growth factor, transforming growth factor-beta 1, and tissue inhibitor of metalloproteinases 2) in diagnosis and follow-up. METHODS A total of 44 children were included to this randomized controlled trial prospectively. After randomization, 20 of 30 children with storage phase dysfunction those were unresponsive or noncompliant to medical treatment received TPTNS treatment (test group) and 10 children underwent TPTNS with no current (sham group) for 12 weeks. Fourteen healthy children constituted the nonsymptomatic group. UB levels, dysfunctional voiding and incontinence scoring system (DVISS), voiding diary, and quality of life (QoL) scores were assessed before and after treatment in the treatment groups. RESULTS QoL scores, overall and day-time DVISS scores were significantly decreased in both sham and test groups (p

Objective: To determine the factors affecting the outcomes of percutaneous nephrolithotomy (PCNL) in patients in infantile/toddler and preschool age group. Materials and Methods: The data of 186 re...

Aim:The C-reactive protein (CRP)/albumin ratio is a new inflammation-based prognostic score that correlates with inflammation severity.Objective:The present study investigated the diagnostic value of the CRP/albumin ratio to distinguish between patients with simple and complicated acute appendicitis. This retrospective study was conducted at the University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, Department of Emergency Medicine, after approval from the ethics committee.Materials and Methods:A total of 188 patients with acute appendicitis were included. Biochemical parameters, CRP/albumin ratio, ultrasonography (USG) and computed tomography (CT) results, operation findings and length of hospital-stay were compared between patients with simple and complicated appendicitis.Results:There was no statistically significant difference in terms of leukocyte count, albumin value and diameter of the appendicitis between both USG and CT. The CRP/albumin ratio could specifically differentiate the complicated appendicitis group. The cut-off point of the CRP/ albumin ratio for the diagnosis of complicated appendicitis was 4.4.Conclusion:The CRP/albumin ratio may be used as a valuable biomarker in the clinical diagnostic process and in treatment planning, particularly to differentiate patients with acute complicated appendicitis from those with non-complicated acute appendicitis.

Amac: Kisinin bilincli olarak ve isteyerek yasamina son vermesine intihar denir. Intihar ile ilgili en cok arastirilan konulardan biri de zihinsel bozukluklardir. Son yillarda bircok kronik hastaligin tedavisinde D vitamininin onemli bir rol oynadigi bildirilmistir. Artan kanitlarda gunes isiginin veya D vitaminin, noropsikiyatrik hastaliklarin etiyolojisinde onemli bir cevresel faktor oldugu bildirilmektedir. Bu calismanin amaci acil servisimize intihar girisimi nedeniyle basvuran D vitamini duzeylerini arastirmak ve sonuclara gore klinik uygulamalarin tedavisine katkida bulunmakti. Yontemler: Calismaya intihar girisimi olan 59 kisi ve kontrol grubu olan 42 kisi dahil edildi. Sosyodemografik Bilgi Formu (SBF) Hastalarin cinsiyeti, yasi, egitim duzeyi, medeni durumu ve ekonomik durumu, daha once psikiyatrik tedavi almis veya intihar girisiminde bulunmus olmasi her hasta icin ayri bir forma kaydedildi. Kategorik (nominal veya sirali) ve ikili degiskenlere dayali istatistiksel degerlendirmeler icin Mann Whitney U testleri kullanildi. Bulgular: Calisma grubunun laboratuvar D vitamini duzeyleri minimum 4,4 ng/ml maksimum 33 ng/ml degerleri bulundu. Intihar girisiminde bulunanlarin D vitamin ortalamasi 9,6 ng/ml, kontrol grubunun D vitamin ortalamasi 13,8 ng/ml idi. D vitamini duzeyleri ile psikiyatrik hastalik varligi arasindaki iliski istatistiksel olarak anlamli bulundu (P

Zusammenfassung Hintergrund und Zielsetzung Die radikale Zystektomie (RCX) ist die kurative Standardbehandlung für muskelinvasive Harnblasenkarzinome. Aufgrund des operativen Ausmaßes und der damit verbundenen komplexen stationären Betreuung ist die RCX mit hoher Morbidität und Mortalität verbunden. Ziel war es, Daten aus dem klinischen Alltag zur gegenwärtigen Praxis des perioperativen Managements zu erfassen. Methoden Mitglieder der DGU und der German Society of Residents in Urology beantworteten anonym einen 24 Fragen umfassenden Online-Fragebogen. Gegenstand waren sowohl klinisch relevante Aspekte der gegenwärtigen EAU/DGU-Leitlinien als auch kontrovers diskutierte klinische Fragen. Ergebnisse Durch die Teilnehmer konnten mindestens 19 % aller infrage kommenden deutschen Zentren erfasst werden. Mehrheitlich wird das präoperative Staging mittels CT-Urografie und CT-Thorax durchgeführt. Die meistgenutzte Antibiotikaprophylaxe umfasst ein Drittgenerations-Cephalosporin plus Metronidazol (46 %), welche im Median für 5 Tage verabreicht werden. Harnleiterschienen (HS) werden im Mittel beim Ileumconduit am 11. und bei der Neoblase am 12. Tag nach RCX entfernt. Gemessen an Surrogatparametern wie oraler Darmvorbereitung, Beginn des Kostaufbaus und Einsatz einer Magensonde sind aktuelle Fast-Track-Konzepte noch nicht allgemein verbreitet ( Schlussfolgerungen Die meisten Aspekte des perioperativen Managements werden leitliniengerecht durchgeführt, so z. B. Staging-Untersuchungen, Einsatz von Antibiotika und Entfernung der HS. Andere klinische Fragestellungen wie Durchführung einer Bildgebung vor Entfernung der HS und Fast-Track-Konzepte werden unterschiedlich gehandhabt, obwohl zunehmende Evidenz in diesen Bereichen existiert. Leitlinienadhärenz war nicht mit Zentrumsgröße oder Anzahl der Eingriffe assoziiert.

The authors aimed to evaluate the factors affecting clinical outcomes of cystine stone disease in children and to understand the change in disease management over time. Between January 1991 and September 2017, the demographic and clinical data of pediatric patients with documented cystine stone disease were retrospectively analyzed. Patients with at least 12-month follow-up were included. Disease management and clinical outcomes were compared between the first and second 35 patients managed during the study's time frame. A total of 70 patients were included. The female to male ratio was 30/40. The mean age and follow-up period was 29.8 ± 40.1 months and 106.5 ± 56 months, respectively. The mean initial procedure number to treat the first stone episode was 2.4 ± 1.6. Single stone and single affected site were significant predictors for stone clearance. Overall, patients underwent a mean of 5.5 procedure during their follow-up. Recurrence was detected in 71.4% (50/70) of patients. Residual fragments and non-compliance to medical treatment after the initial intervention were significant predictors for recurrence within shorter interval period. 31.4% (22/70) of patients had renal atrophy during follow-up. They were older at the initial diagnosis and had average urine pH lower than 7.5. The first 35 patients had more open procedures. Still, they had more recurrence rate and tend to have more renal atrophy. As a conclusion, cystine stone disease has a recurrent course in children. Stone and fragments entirely removed (SaFER) concept with all minimally invasive methods available and strict follow-up should be the basis for any management plan.

The purpose of the study was to assess the outcomes of salvage procedures after failed pediatric pyeloplasty. Recurrent ureteropelvic junction obstruction treatment is a difficult course. The salvage surgery is more challenging in the pediatric population. We aimed to assess the outcomes of salvage procedures after failed pediatric pyeloplasty to determine the most efficient surgical intervention. 40 children with 41 renal units who have been treated for recurrent ureteropelvic junction obstruction after pyeloplasty were analyzed retrospectively. The outcomes of all initial and sequent interventions were assessed including redo pyeloplasty, endopyelotomy and balloon dilatation. Children’s mean age at initial intervention for failed pyeloplasty was 45.9 (± 46.4) months. Our mean follow-up time after the initial intervention was 46.9 (± 46.6) months. The success rate of our initial treatment methods was 48.7% (20/41). Although redo pyeloplasty was the most successful intervention (83.3%) than DJS placement (45.5%), endopyelotomy (50%) and balloon dilatation (30.8%), the statistical difference was not significant in the initial operations. The overall success rates of redo pyeloplasty, double-J stent placement, endopyelotomy and balloon dilatation were 78.9%, 46.1%, 38.8% and 29.4%, respectively (p

Aim: Through advances in technology and medicine, life expectancy is longer than before. The area covered by elderly people in the population pyramid has been changing over the years. Emergency departments are often used by elderly patients. It increases the density and fullness in already-crowded departments. In this study, we aimed to examine characteristics of the admissions of old-old people through the EDs and we wanted to discuss the precautions and regulations that might be taken in order to improve the quality of care and management. Methodology: This study was carried out cross-sectionally and retrospectively in the one-year period between 01.01.2017-31.12.2017 in a department of emergency medicine. Patients' age, gender, the hours of admissions to the emergency department, the month of admissions, reasons for admissions, diagnoses, consultations, final status, the place of hospitalization, the name of the hospitalization department and the number of readmissions in a one-year period were recorded in the study form. The study data were analyzed with SPSS for Windows 22.0. P < 0.05 was considered statistically significant. Results: 4331 of these patients were included in the study. The mean age of the patients was 85.25 ± 3.90 and 60.5% of them were female. According to the months, the first three of the admission months were December, November and October (9.7%, 9.6%, 9.2% respectively). The most common admission was in the 08: 00-15: 59 time zone with 47%, followed by 41.8% with the 16: 00-23: 59 time zone.4331 patients included in the study admitted to the emergency department 12.988 times during the study period. 46.2% of the patients admitted to the department once, 53.8% of them admitted 2 times and more. The discharge rate of patients who were admitted only once was 84.2% and the rate was 88.4% for twice and more admissions. Conclusion: The existence and increasing number of this population should not be forgotten in changes to be made in emergency departments and other parts of the health system. Efforts should be made to improve the quality of care and to train staff to manage these patients more quickly and safely.

Aims: Acute pancreatitis is a severe inflammation of the pancreas presenting sudden onset with high morbidity and mortality. Simple, accessible, cost-efficient and feasible laboratory tests are still needed to demonstrate the prognosis of the patients. The aim of the present study was to search the efficiency of CRP/Alb ratio as a biochemical marker on mortality and clinical progress in the patients diagnosed with acute pancreatitis in correlation with APACHE-2. Methodology: This prospective case-control study was conducted with the patients diagnosed with acute pancreatitis through Atlanta criteria and healthy volunteers as a control group in the emergency department. Demographic characteristics, vital signs, ultrasound reports, clinical outcomes, neutrophil, lymphocyte, neutrophil/lymphocyte ratio (NLR), CRP, albumin and CRP/Alb ratio, APACHE-2 score within control and patient groups were recorded. Logistic regression analysis was performed to distinguish healthy volunteers from acute pancreatitis cases. Results: There was a statistically significant difference between CRP/Albumin and NLR measurements according to the groups and we found that the measurements of the patient group were significantly higher than the control group. The cut-off point for CRP/Albumin and NLR was found to be respectively 1.08, 4.04 and above. (Respectively; sen: 76.64%, 78.50%; spe: 97.20%, 97.20%; PPV: 96.47%, 96.55%; NPV: 80.62%, 81.89%; the accuracy: 86.92%, 87.85%). APACHE-2 scores ranged from 0 to 16, with a mean of 5.80±3.92. The probability of acute pancreatitis was significantly higher in patients with high CRP/Albumin and NLR. Conclusion: This study showed that CRP/Alb ratio and NLR were positively correlated with APACHE-2 scores that designed for prognosis in patients with acute pancreatitis.

Objectives:To compare the resolution of reflux after surgery and follow-up and to determine what the appropriate treatment is in patients with vesicoureteral reflux (VUR) who were diagnosed less than 2 years of age.Materials and Methods:Data from 250 patients who were diagnosed with VUR below 2 years of age between 2000 and 2016 were examined retrospectively. Patients with low risk and moderate risks according to the EAU/ESPU guidelines were evaluated. Patients who underwent surgery and followed up were compared regarding the age at diagnosis, VCUG findings, gender, presence of scar in DMSA, BTI, postoperative UTI, follow-up period and resolution rates.Results:Of the patients, 207 patients underwent surgery while 43 did not. Mean age was 9.62 (0-24) months. Follow-up patients were followed up for an average of 55.4 months. Of the followed-up patients, 60.5% (26) had complete resolution of VUR at the average of 25.8 months (6-64). When we compared the data of surgically treated and followed-up patients, we detected that frequency of male gender, renal scar, high-grade reflux and moderate risk were significantly more, the resolution rate was higher and follow-up period was shorter in operated group.Conclusion:Spontaneous resolution rate of VUR less than 2 years of age is high and it is important to determine which patients should undergo early surgery in this patient group in terms of preventing complications. Surgical options with satisfactory success rates should be discussed with the family. Besides, the possible costs and comorbidities should also be regarded.

Background/Aims: Altered anatomy is a challenge in endoscopic retrograde cholangiopancreatography (ERCP) for patients with Billroth II anastomosis. In this study, we investigated the overall success and role of endoscopist experience. Methods: Data of patients who underwent ERCP between 2014 and 2018 after a previous Billroth II operation were retrieved retrospectively from 2 tertiary FRCP centers. The procedures were performed by 2 endoscopists with different levels of experience. Clinical success was defined as extraction of the stone, placement of a stent through a malignant stricture, and clinical and laboratory improvements in patients. Results: Seventy-five patients were included. The technical success rate was 83% for the experienced endoscopist and 75% for the inexperienced endoscopist (p=0.46). The mean (istandard deviation) procedure tune was 23.8 +/- 5.7 min for the experienced endoscopist and 40.684:6.07 min for the inexperienced endoscopist (p

The objective is to review the literature related to lower urinary tract (LUT) conditions in children to conceptualize general practice guidelines for the general practitioner, pediatrician, pediatric urologist, and urologist. PubMed was searched for the last 15-year literature by the committee. All articles in peer-review journal-related LUT conditions (343) have been retrieved and 76 have been reviewed extensively. Prospective trials were few and the level of evidence was low. Most of the recommendations have been done by committee consensus after extensive discussion of literature reports. History taking is an integral part of evaluation assessing day- and nighttime urine and bowel control, urgency, and frequency symptoms. Exclusion of any neurogenic and organic cause is essential. Uroflowmetry and residual urine determination are recommended in all patients to evaluate bladder emptying. Urodynamic studies are reserved for refractory or complicated cases. Urotherapy that aims to educate the child and family about bladder and bowel function and guides them to achieve normal voiding and bowel habits should initially be employed in all cases except those who have urinary tract infections (UTI) and constipation. Specific medical treatment is added in the case of refractory overactive bladder symptoms and recurrent UTIs.Conclusion: Producing recommendations for managing LUTS in children based on high-quality studies is not possible. LUTS in children should be evaluated in a multimodal way by minimal invasive diagnostic procedures. Urotherapy is the mainstay of treatment and specific medical treatment is added in refractory cases.What is Known:• Symptoms of the lower urinary tract may have significant social consequences and sometimes clinical morbidities like urinary tract infections and vesicoureteral reflux. In many children, however, there is no such obvious cause for the incontinence, and they are referred to as having functional bladder problems.What is New:• This review aims to construct a practical recommendation strategy for the general practitioner, pediatrician, pediatric urologist, and urologist for LUTS in children. Producing recommendations for managing LUTS in children based on high-quality studies is not possible. LUTS in children should be evaluated in a multimodal way by minimal invasive diagnostic procedures. Urotherapy is the mainstay of treatment and specific medical treatment is added in refractory cases.

Background and aims The objective of this update of the EAU-ESPU guidelines recommendations for nocturnal enuresis was to review the recent published literature of studies, reviews, guidelines regarding the etiology, diagnosis and treatment options of nocturnal enuresis and transform the information into a practical recommendation strategy for the general practitioner, pediatrician, pediatric urologist and urologist. Material and methods Since 2012 a monthly literature search using Scopus® was performed and the relevant literature was reviewed and prospectively registered on the European Urology bedwetting enuresis resource center (http://bedwetting.europeanurology.com/). In addition, guideline papers and statements of the European Society for Paediatric Urology (ESPU), the European Association of Urology (EAU), the National Institute for Health and Care Excellence (NICE) and the International Children Continence Society (ICCS) were used to update the knowledge and evidence resulting in this practical recommendation strategy. Recommendations have been discussed and agreed within the working group of the EAU-ESPU guidelines committee members. Results The recommendations focus to place the child and his family in a control position. Pragmatic analysis is made of the bedwetting problem by collecting voiding and drinking habits during the day, measuring nighttime urine production and identification of possible risk factors such as high-volume evening drinking, nighttime overactive bladder, behavioral or psychological problems or sleep disordered breathing. A questionnaire will help to identify those risk factors. Conclusion Motivation of the child is important for success. Continuous involvement of the child and the family in the treatment will improve treatment compliance, success and patient satisfaction.

BACKGROUND: In childhood, the most common reason for a neurogenic bladder is related to spinal dysraphism, mostly myelodysplasia.AIMS: Herein, we present the EAU/ESPU guidelines in respect to the diagnostics, timetable for investigations and conservative management including clean intermittent catheterization (CIC).MATERIAL AND METHODS: After a systematic literature review covering the period 2000 to 2017, the ESPU/EUAU guideline for neurogenic bladder underwent an update.RESULTS: The EAU/ESPU guideline panel advocates a proactive approach. In newborns with spina bifida, CIC should be started as soon as possible after birth. In those with intrauterine closure of the defect, urodynamic studies are recommended be performed before the patient leaves the hospital. In those with closure after birth urodynamics should be done within the next 3 months. Anticholinergic medication (oxybutynin is the only well-investigated drug in this age group-dosage 0.2-0.4 mg/kg weight per day) should be applied, if the urodynamic study confirmed detrusor overactivity. Close follow-up including ultrasound, bladder diary, urinalysis, and urodynamics are necessary within the first 6 years and after that the time intervals can be prolonged, depending on the individual risk and clinical course. In all other children with the suspicion of a neurogenic bladder due to various reasons as tethered cord, inflammation, tumors, trauma, or other reasons as well as those with anorectal malformations, urodynamics-preferable video-urodynamics, should be carried out as soon as there is a suspicion of a neurogenic bladder and conservative treatment should be started soon after confirmation of the diagnosis of neurogenic bladder. With conservative treatment the upper urinary tract is preserved in up to 90%, urinary tract infections are common, but not severe, complications of CIC are quite rare and continence can be achieved at adolescence in up to 80% without further treatment.DISCUSSION AND CONCLUSIONS: The transition into adulthood is a complicated time for both patients, their caregivers and doctors, as the patient wants to become independent from caregivers and treatment compliance is reduced. Also, transition to adult clinics for patients with neurogenic bladders is often not well-established.