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Aim: The treatment of vesicoureteral reflux (VUR) in infants is controversial. Subureteric injection is considered by some to be a popular alternative to long-term antibiotic prophylaxis. In this study, we reviewed our experience in endoscopic subureteric injection to correct high-grade reflux in infants with documented indications for antireflux surgery. Materials and Methods: The hospital records of patients with grade 4-S VUR and breakthrough urinary tract infections who had undergone endoscopic subureteric injection in the first year of life between 2009 and 2016 were reviewed retrospectively. Radiologic success was defined as complete resolution of reflux determined via voiding cystourethrogram obtained at least three months after the injection, and clinical success was defined as the downgrading of reflux grade to below three and the absence of urinary infection. Results: A total of 23 patients (5 girls, 18 boys) with 34 high-grade refluxing units were included in this study. The mean age at first injection was 6.3 +/- 1.8 months (1-11 months). The radiologic success rate with initial injection was 61.7%, and it was 85.2% after repeated injections. The overall clinical success rate after first injection was 70.6% and 97.1% after repeated injections. The mean injected material volume was 0.34 +/- 0.27 (0.1-1) mL per ureter. Conclusion: The management of high-grade infantile reflux is still controversial with insufficient data. Published studies comparing endoscopic treatment and antibiotic prophylaxis have inconclusive results due to their wide range of success rates. Although it needs to be supported by prospective studies, endoscopic treatment is a successful alternative in high-grade VUR infants with breakthrough infection.

Aim: In 2016, the Centers for Disease Control and Prevention published a management algorithm for Spina Bifida (SB) cases from birth and started collecting data prospectively. They designated risk factors from urodynamic studies as end filling pressure or detrusor leak point pressure (DLPP) >= 40 cm H2O or neurogenic detrusor overactivity (NDO) with detrusor sphincter dyssynergia (DSD), and categorized this type of bladder dysfunction as hostile bladder (HB). They recommended the immediate start of clean intermittent catheterization and anticholinergics in these patients. Having similar concerns regarding this patient population, we designed a retrospective study to identify and reveal the long-term outcomes of SB patients with HB. Materials and Methods: All urodynamic studies and hospital records of SB patients admitted and followed between 1994-2014 were reviewed retrospectively. The demographic data, the presence of DLPP, DSD and NDO in the first urodynamic examination, bladder compliance, first and last radiologic and scintigraphic imagings, and surgical interventions were evaluated. Upper tract damage was defined as new scars in dimercaptosuccinic acid scans. Results: A total of 58 patients were included in this study. The mean follow-up was 12.17 +/- 5.17 years. The presence of a scar in the first scintigraphy (p=0.01) and the presence of hydronephrosis in the first and last ultrasonography (p=0.03) were found to be independent risk factors for new scar development. When DLPP values were evaluated with receiver operating characteristic curve analysis, 50 cm H2O was observed as a significant threshold value with 73% sensitivity and 60% specificity. Conclusion: Our study confirmed the detrimental effects of high pressure and detrusor-sphincter dyssynergia; however, HB parameters were not sufficient to distinguish high-risk group patients. The presence of scars in the first scintigraphic evaluation, DLPP above 50 cm H2O, and the presence of hydronephrosis in the first ultrasound were found to be risk factors for renal deterioration. More frequent monitoring and detailed evaluation may be necessary for patients with these risk factors.

Enurezis nokturna cocukluk ca¤›nda idrar kac›rman›n en s›k sebebidir ve iflemenin fizyolojik olmas›, kendili¤inden duzelmesi ile karakterizedir. ‹drar kac›rma ile baflvuran cocuklar›n co¤unda altta yatan yap›sal ya da norolojik herhangi patoloji bulunmamas›na ra¤men, bu cocuklarda do¤ru tan› koymak cok onemlidir. Ayr›nt›l› ve iyi yap›land›r›lm›fl bir oyku inkontinensi buyuk oranda tan›mlamaya yetece¤inden ek incelemeler yaln›zca k›s›tl› say›da hastada gerekmektedir. Hekim iflemeyle ilgili neyin kusurlu oldu¤unu anlar ve semptomu de¤il altta yatan sebebi tedavi ederse hem idrar kac›rman›n cocu¤un sosyal geliflimi uzerine olumsuz etkilerini azaltacak hem de ust uriner sistemin olas› hasar›ndan koruyacakt›r. Bu sebeple bu yaz› daha cok uriner inkontinens sebeplerinin ay›r›c› tan›s›na odaklanm›flt›r. (Turk Arch Ped 2010; 45 Suppl: 90-3) Anahtar kelimeler: Enurezis, idrar kac›rma, uriner inkontinans

Introduction Neurogenic bladder with anorectal malformations (ARM) is a well-known yet understudied topic. Diffusion tensor imaging (DTI) is a special usage of MRI that can evaluate peripheric nerves. The aim of this study is to evaluate the lumbosacral plexuses of patients with ARM using DTI. Patients and methods Patients with ARM willing to participate were included. Patient files were reviewed, a questionnaire was made, and DTI was performed. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were computed for the right and left lumbosacral plexuses. Results There were 18 patients and 12 controls. Groups were similar in terms of sex (p = 0.232) and age (p = 0.853). There was a significant difference only for ADC of the left plexus. There was visible asymmetry in tractographies and DTI parameters of two patients with severely deformed pelvises (image 1) but also in another patient with a normal sacrum. In addition, despite asymmetry, FA and ADC were similar to controls also in these patients. Conclusion This is the first study presenting quantitative data about the lumbosacral plexus in ARM. We think the most interesting finding of this study was observing the normal values even in the patients with severely malformed sacrum which is yet to be validated with further studies., Aliye Uster Foundation (Izmir, Turkey) research scholarship; research activities in Ege University, This work was supported by Aliye Uster Foundation (Izmir, Turkey) research scholarship. This is an independent organization funding educational and research activities in Ege University. The authors have no conflict of interest regarding the study.

Takotsubo cardiomyopathy (TC) is a significant cause of acute heart failure in adults. However, triggering factors, ECG and echocardiographic findings, and prognosis of TC have not been well studied in children. Therefore, this study aimed to evaluate the demographic characteristics, signs and symptoms, laboratory findings, and prognosis of children with TC. We analyzed demographic characteristics of childhood TC cases (aged < 18 years) treated at our university hospital from 2014 to 2019. The triggering factors of TC; outcomes of the disease; and laboratory, ECG, and echocardiographic findings at presentation were also examined. A total of 17 patients (mean age 9.71 ± 5.03 years, 52.9% female) were included in the study. Chest pain, palpitation, and dyspnea were the most common presenting symptoms. The most common triggering factor was emotional stress (47%) in our study population. Ten patients (58.8%) had a classical form of TC, with apical left ventricular wall motion abnormalities. None of the patients died, and 15 (88.2%) had complete recovery of left ventricular systolic function. Only two patients (11.8%) had a left ventricular ejection fraction < 50% at the end of follow-up.Conclusion: This is the first retrospective data on childhood TC. The majority of patients with TC experienced an emotional stress as a trigger of the disease, and nearly 90% of the patients completely recovered.What is Known? • The occurrence of acute heart failure following an emotional or physical stress is called Takotsubo cardiomyopathy (TC). • Takotsubo cardiomyopathy is rarely reported in childrenWhat is New? • The present study is the first case series of children with TC. • In contrast to the female predominance in adult population, TC was almost equally distributed between boys and girls in the pediatric age group.

SARS-COV-2 is associated with unexpected symptoms. Several studies in adults reported urinary frequency with COVID-19. The aim of this study is to reveal lower urinary tract symptoms associated with COVID-19 (CALUTS) in children.All children diagnosed with COVID-19 and associated multisystem inflammatory syndrome in children (MIS-C) between November 2020-June 2021 in our hospital were reviewed and asked for urinary symptoms at the time of or following their disease. The ones reporting symptoms were invited for further evaluation. Parents were inquired for their child's former bladder and bowel function, their symptoms after the diagnosis of COVID-19 or MIS-C, onset and duration of the symptoms, and their current state. They were questioned for the frequency of voiding as well as dysuria, odor, and the presence of incontinence as well as other symptoms of COVID-19. The patients who reported symptoms at the time of inquiry were followed for cessation of symptoms. The parameters age, sex, need for hospitalization and admission to ICU were also compared to the whole group to evaluate the main characteristics of patients with lower urinary tract symptoms.In total 20 patients (18/216 with acute disease and 2/36 with MIS-C) reported CALUTS (figure). Age and sex distribution were not significantly different from the patients without urinary symptoms (p = 0.777 and p = 0.141 respectively). All were otherwise healthy children with no concomitant chronic diseases other than overactive bladder in two. There were 13 girls and 7 boys. Mean age was 11 years (±5 years). Thirteen of the patients were older than 10 years; however, there were also 3 children under 5 years of age. All parents described a sudden onset of extremely increased urinary frequency and urgency lasting for weeks which disappeared gradually. Median bladder and bowel dysfunction questionnaire (BBDQ) score before COVID-19 was 2.5 (1-18) which increased to a median of 22 (15-29) at the time of the symptoms (p 0.001). The timing of onset and duration of symptoms were variable and not associated with symptom severity (p = 0.306 and p = 0.450 respectively). Eight patients (40%) reported diarrhea. The duration of diarrhea was limited to less than one week in all.Our study revealed that SARS-COV-2 can be associated with lower urinary tract symptoms also in children both during the acute phase and MIS-C. Further studies are necessary to understand the etiopathogenesis and prevalence of this unexpected aspect of COVID-19.

Objective: We aimed to conduct a survey to see how the patient management of pediatric urologists has changed during the COVID-19 pandemic in daily practice and its compliance with the guidelines that aim to minimize the harm to the patient and healthcare professionals. Material and methods: A questionnaire was prepared to be asked to physicians via Microsoft Forms dealing with pediatric urology for this purpose, and a link was shared in social media groups of doctors managing pediatric urology patients. Results: A total of 58 (46 males and 12 females) doctors participated in the survey. Participants stated that they made a very high rate of change in their clinical routine;the most preferred approach for the prevention in the operating room was reducing the number of the working staff, and the second most frequent was performing a preoperative COVID-19 screening. Elective surgeries (ie, inguinoscrotal pathologies) were delayed by the majority. However, the majority of the surgeons did not delay surgeries for ureteropelvic junction obstruction or urinary stones. Ninety-five percent of the participants stated that the number of patients was decreased in the outpatient clinics, which was mainly due to the hospital and government policies. The most used method to communicate with patients during the pandemic was phone calls, and there was a 52% increase in the WhatsApp messenger application before the pandemic. Conclusion: Our survey provided us with an opinion about how our colleagues' lives changed during the pandemic and showed us the importance of a well-established telemedicine system. [ABSTRACT FROM AUTHOR] Copyright of Turkish Journal of Urology is the property of Turkish Association of Urology 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.)

*Gül, Murat ( Aksaray, Yazar ), The objective of our study was to investigate the possible relationship between poor perinatal outcome and foetal cardiac functions in pregnant women with reduced foetal movements (RFM). This cross-sectional study included 126 pregnant women with normal foetal movements (Group 1, Controls) and 42 pregnant women over 32 weeks gestation with RFM (Group 2). Group 2 was further divided into two subgroups according to their perinatal outcome: normal perinatal outcome (Group 2a) and poor perinatal outcome (Group 2b). Cardiotocography, the E/A ratio in both atrioventricular valves, myocardial performance index (MPI) and foetal tricuspid annular plane systolic excursion (f-TAPSE) were evaluated. Foetuses with poor perinatal outcome had a higher MPI (p =.003), higher tricuspid and mitral E/A (p

BACKGROUND: The Corona virus still has a big impact on medical work. All medical specialties have been called to confront this unexpected event, even pediatric surgery. The objective of this study is to highlight the effect of pandemic on daily work of young pediatric surgeons during the Covid-19 first wave. METHODS: An online survey was sent via email by the Scientific Committee of YPUC in April 2020. The impact of Covid-19 was invested, by analyzing the results of answers received. The difference between young consultants and trainees (C and T) were examined to assess the effect of pandemic in 2 different categories. RESULTS: A total of 88 participants filled out the questionnaire. Guidelines around surgeries were well arranged: clear for 98% concerning triage with no difference between T and C; clear for 84% concerning pre-operative screening and for 81% concerning surgical dressing with a significance difference between T and C in understanding (p=0.07 and p=0.06). Forty-two respondents (48%) tested all surgical patients and the 20% operated patients positive for COVID-19. Thirteen (15%) were relocated to work in other divisions on different tasks, 12 were C. 86% of T did not participate in surgeries as much as before. CONCLUSIONS: The impact of the pandemic has been very significant for pediatric urologists and the difference between C and T confirm that the training could be impacted. After the first wave we should be careful on PPE, on pre-operative screening of surgical patients and we should protect the trainee learning curve.

Introduction The management of neurogenic bladder mostly relies on urodynamic studies; however, several studies have shown low interobserver reproducibility. The aim of this study was to evaluate if a new objective cystometric parameter was superior to other cystometric measures. Patients and methods A new parameter (pressure adjusted area under curve ratio, PAUC) was formulated from the ratio of area under the cystometry curve to a DLPP-adjusted total area (A(T)). A(T) was figured from a rectangle designed on the cystometrogram curve with a fixed height of 200 cmH(2)O and a width defined by the filling phase (figure). Two different estimated pressure measures derived from this (upper mean static pressure, UMSP and theoretical end filling pressure TEFP) were then calculated. Medical records of myelomeningocele patients with ultrasonography and renal scintigraphy performed at the time of urodynamics (with an interval of >5 years) were reviewed. Hydronephrosis and new scars in scintigraphy were used as the outcome measures. Results The study group consisted of 115 subjects with a median age of 4 (0-23) years at the time of the first urodynamic study. The median follow-up was 6 (5-14) years. PAUC and its derivatives (UMSP and TEFP) had the best discriminative power in predicting high grade hydronephrosis (0.830, 95% CI:0.732-0.927, p < 0.001), worsening in hydronephrosis (0.827, 95% CI:0.723-0.931, p < 0.001), and new scar formation (0.704, 95% CI: 0.576-0.832, p = 0.002). PAUC>0.1 significantly correlated with urinary tract dilatation (p < 0.001) and new scar formation (p = 0.002). In the multivariate analysis, our three parameters and having scars at admission were the only independent risk factors for new scars (p = 0.001 and p = 0.002, respectively) and worsening in hydronephrosis (p < 0.001 and p = 0.001, respectively). Discussion Our results show that our three parameters derived from area under the urodynamic curve are more reliable than other urodynamic measures. Their major theoretical advantage is to incorporate all the pressure during filling phase giving a more accurate picture of what the intravesical pressure milieu is. Using these measures, we demonstrated their superiority in predicting clinical outcomes. Major limitations of this study are the retrospectively collected data and lack of longitudinal follow-up starting from infancy in each patient. Conclusion Our new parameters (PAUC, UMSP and TEFP) which incorporate the impact of entire filling phase pressure changes in the analysis, may be useful tools to identify those patients who are under the risk of kidney damage with neurogenic lower urinary tract dysfunction.

BackgroundPsychiatric consultation is important in the follow-up of disorders of sex development (DSD) patients. In this study, we aimed to present the 12-year psychiatric follow-up data of the patients who were referred by Ege University Medical Faculty DSD Multidisciplinary Team and followed up in Child and Adolescent Psychiatry.MethodsPsychiatric data of 118 patients, who were followed by the DSD multidisciplinary team between 2007 and 2019, were reviewed retrospectively. The psychiatric diagnoses of the patients were evaluated according to semi-structured interview form Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Turkish Version.ResultsThe mean age of the 118 cases was 13.21 years (±7.18). Endocrine diagnoses of the cases were 46 XX DSD in 35 (29.6%), 46 XY DSD in 81 (68.7%), and chromosome disorders in 2 (1.7%). There was at least psychiatric diagnosis in 36 (30.5%) cases. The most common psychiatric diagnosis was attention deficit and hyperactivity disorder (ADHD) (n = 18, 15.3%). ADHD was most common in congenital adrenal hyperplasia (n = 4, 22.4%) and androgen synthesis defects (ASD) (n = 4, 22.4%); depression was most common in complete gonadal dysgenesis and ASD (n = 3, 23.1%); and mental retardation was most common in ASD (n = 3, 37.5%).ConclusionsIn order to provide a healthy perspective for cases with DSD, it is important to make a psychiatric evaluation and to share observations and clinical findings in regular team meetings.

WOS: 000418709600008, Aim: Laparoscopic cholecystectomy (LC) as day surgery is widely performed on adults; however, experience in pediatric LC in an out-patient setting is limited. We aimed to review our experience and investigate related factors. Materials and Methods: Medical records of patients who underwent elective LC from June 2005 to July 2016 were retrospectively reviewed. Patients were grouped according to the duration of hospital stay, and patient characteristics and outcome were compared. T-test and chi-square were used for statistical analysis. Results: A hundred and sixty-seven patients with a mean age of 10.4 years were enrolled. There was no conversion to open surgery, with only one postoperative complication in a patient with consumption coagulopathy. Same-day discharge (SDD), overnight stay (ONS) and prolonged stay (PS) groups were constituted of 50, 92, 25 patients respectively. All groups had similar preoperative characteristics and median postoperative pain scores. Previous history of cholecystitis and underlying hematological diseases were more common in the PS group (p

EgeUn###, Purpose:Hinman syndrome is a rare disease with urodynamic findings and a clinical course resembling neuropathic bladder, without a neuropathic etiology. Diffusion tensor imaging is a special technique of magnetic resonance imaging that has recently been used to evaluate the peripheral nerves but has been demonstrated to be applicable for evaluation of the lumbosacral plexus. We examined the lumbosacral plexus using diffusion tensor imaging, which has not previously been reported in patients with Hinman syndrome.Materials and Methods:The study included 12 patients who fulfilled criteria for Hinman syndrome, with severe bladder dysfunction on urodynamics, renal scarring on scintigraphy and no pathological findings on magnetic resonance imaging. The 12 subjects serving as controls required pelvic or spinal magnetic resonance imaging for reasons other than spinal abnormalities. Evaluation was performed with a 3.0 Tesla magnetic resonance imaging system and 16-channel body coil. Tractography was done to examine the lumbosacral plexus. Fractional anisotropy and mean diffusivity were computed and compared between groups for the right and left plexuses.Results:Mean fractional anisotropy was 0.24 and 0.35 for the right plexus in patients and controls, respectively, and 0.24 and 0.36 for the left plexus. Mean diffusivity was 1.39 for the right and left plexuses in patients, and 1.28 for the right and left plexuses in controls (p, Aliye Uster Foundation (Izmir, Turkey), Supported by Aliye Uster Foundation (Izmir, Turkey) research scholarship.

Robotic surgery is gaining wider utility in adults; however, few reports have addressed the applicability of robotic surgery for renal tumors in children. The aim of this report is to share our experience in an 8-year-old child with metanephric stromal tumor. To our knowledge, besides being a rare tumor, this is the youngest case reported in the literature whose kidney tumor has been successfully removed with robotic partial nephrectomy. There is a worldwide tendency to perform minimal invasive surgery for kidney tumors. In the presence of an experienced team and proper conditions, we believe that robotic partial nephrectomy will be the preferred option in future.

Amac: Beta talasemi tasiyiciligi (BTT) olan olgularda ozellikle otoimmun hastaliklarin daha sik goruldugu bilinmektedir. Ancak bu hastalarda alerjik hastalik sikligini arastiran sadece bir calisma mevcut olup bu calismada BTT’li olgularda astimin anlamli derecede daha sik goruldugu belirtilmistir. Calismamizda, bolgemizde sik gorulen BTT’li cocuklarda astim ve diger alerjik hastaliklarin sikliginin arastirilmasi amaclanmistir. Gerec ve Yontemler: Calismaya BTT tanisi alan olgular hasta grubu olarak alindi. Kontrol grubu olarak da yas ve cinsiyet ozellikleri benzer cocuk poliklinigine rutin tetkiklerini yaptirmak amaciyla basvuran olgular alindi. Olgularin sosyodemografik ozellikleri kaydedildi, alerjik hastaliklarla iliskili semptomlari Turkceye cevrilmis olan “ISAAC: The International Study of Asthma and Allergies in Childhood” soru anketi esas alinarak sorgulandi. Ayrica olgularin mutlak eozinofil sonuclari degerlendirildi. Bulgular: Calismaya yaslari 5 ile17 arasinda degisen toplam 171 olgu (BTT:85, Kontrol:86) dahil edildi. ISAAC anket sonucuna gore yasam boyu hisilti sikligi (BTT:%28.2, Kontrol:%18.6), yasam boyu rinit sikligi (BTT:%30.6, Kontrol:%23.3), yasam boyu kasintili tekrarlayici dokuntu sikligi (BTT:%9.5, Kontrol:%10.5), yasam boyu besin alerjisi sikligi (BTT:%2.4, Kontrol:%8.1) olarak bulunmustur. Semptomlar acisindan BTT grubunda hisilti ve alerjik burun akintisi daha sik olsa da gruplar arasinda anlamli bir fark bulunmadi. Benzer sekilde BTT grubunda doktor tanili astim ve alerjik rinit daha fazla tespit edildi ancak aradaki fark istatistiksel olarak anlamli degildi. Ayrica BTT grubunda mutlak eozinofil sayisi kontrol grubuna gore anlamli derecede yuksekti. Sonuc: Calismamizda BTT’li olgularda tekrarlayan hisilti ve burun akintisi gibi alerjik hastaliklari dusundurecek semptomlarin ve doktor tanili astim ve alerjik rinit sikliginin saglikli cocuklara oranla daha fazla oldugu tespit edilmistir. Ancak bu oran istatistiksel olarak anlamli duzeyde degildir. Olasi sikligi netlestirebilmek icin daha fazla ve genis kapsamli calismalara ihtiyac vardir.

WOS: 000431261100035, PubMed ID: 29714467, Background/aim: The aim of this study was to combine some easy and economical defined methods and constitute a comprehensive cell culture model to use in the bowel diseases characterized by inflammation. Materials and methods: Induction of inflammation was performed using lipopolysaccharide (LPS) or a cytokine mixture (TNF-alpha: 10 ng/mL; IFN-gamma: 100 ng/mL; IL-1 beta: 1 ng/mL). IEC-6 cells were grown to confluence and serum-starved, wounds were constituted, and progress of cell migration into the wounds was photographed at 0, 2, 4, 6, 8, 10, 12, and 24 h in the presence or absence of an inflammatory environment. Cells were then grown and multiple scratches were performed to replicate the conditions of migration assay. Nitric oxide synthase-2 (iNOS) and cyclooxygenase-2 (COX-2) protein expressions were assessed. Results: Cells covered 88% of the initial wound at 24 h in the control group, 54% in the LPS group, and 35% in the cytokine mixture group. LPS and the cytokine mixture were also found to independently increase iNOS and COX-2 expressions. Conclusion: Our study, being inexpensive and practical, describes a model that integrates some methods to constitute a basic model for bowel diseases characterized by inflammation. It can be integrated as a preliminary experiment for etiopathogenesis and drug research studies., Research Foundation of Ege University, Izmir, TurkeyEge University [2012-TIP-053], This study was supported by the Research Foundation of Ege University (Project No: 2012-TIP-053), Izmir, Turkey. The authors thanks Prof Dr Mehmet Orman (Ege University, Faculty of Medicine, Department of Biostatistics) for his contribution in statistical analysis of the study data. Some of the data given in this article were presented as a poster presentation at the 22nd National Congress of Pharmacology, Antalya, Turkey.

WOS: 000440379800004, PubMed ID: 29595517, Objective: Disorders of sex development (DSD) is a nomenclature intended to defeat the discomfort of families and patients and has found worldwide usage. The aim of this study was to address the perception and usage of terminology among the parents of DSD patients in a tertiary center in western Turkey. Methods: The records of the DSD council (multidisciplinary team where each patient with DSD is discussed) between years 2008-2015 were reviewed retrospectively. Data including details of the management process, patient characteristics and follow-up details were noted. Then inquiries reflecting parental perception about terminology were implemented during clinical visits. Results: In total, 121 patients were evaluated in monthly meetings of the DSD council and 79 inquiries were completed. Fifty-one percent of the families admitted knowing the terms DSD, ambiguous genitalia, "dubious genitals" and intersex. However, only 2% preferred using DSD, 6% intersex and 14% ambiguous genitalia. Fifty-two percent of the parents used a disease name in Latin (mostly hypospadias) addressing the disorder. The offspring of 69% of the parents who were familiar with the name "dubious genitals" were diagnosed in the neonatal period. The preferred terminology used by parents was strongly associated with the terminology used most commonly in the medical speciality their child most often attended. Conclusion: Each country has its own social norms. We suggest therefore that local committees including medical professionals, patients and families should be employed to develop proper terminology.

WOS: 000451852300017, PubMed ID: 30325612, Introduction: Various bulking agents were utilized for endoscopic correction of VUR. A study reviewing multi-institutional data showed that the amount of injection material has increased over time with the purpose of improving success rates, which also resulted in costs. We noticed an opposite trend in our center since we started using a new bulking agent. The aim of this study was to evaluate evolution of our practice with different bulking agents. Patients and Methods: Records of VUR patients who underwent subureteric injection with polyacrylate polyalcohol copolymer (PPC) and dextronomere hyaluronic acide (DxHA) between 2005 and 2014 were reviewed. Variation of different parameters throughout the study period was evaluated along with the success rate. Success was defined as complete resolution of reflux. Results: A total of 260 patients with 384 refluxing units were included. The success rate was higher in PPC group compared to DxHA group. There was no statistically significant difference between years regarding distribution of VUR grade, body weight, patient height, and age in PPC group. Despite significant reduction in injection volume, success rate did not decrease through the years with PPC. Conclusion: Different bulking agents may require different injection volumes to achieve the same success rate in endoscopic treatment of vesicoureteral reflux. Habits gained with previous experience using other materials should be revised while using a new went.

PubMed ID: 25239432, Conclusion: Inhaled nitric oxide therapy seems to increase survival in PH due to CDH. No predictive parameters to orient patient selection could be identified; however, the early response seemed to predict the overall outcome. Good results in our series were attributed to routine use of sildenafil and dopamine, along with the nitric oxide inhalation.Background: Pulmonary hypertension (PH) is the most important complication of congenital diaphragmatic hernia (CDH) and still has a high mortality rate. The aim of this study was to evaluate the effectiveness of inhaled nitric oxide therapy in PH due to CDH.Methods: Hospital records of children who had undergone inhaled nitric oxide therapy for PH due to CDH between June 2009 and December 2011 were reviewed.Results: Twenty-nine patients had a diagnosis of CDH at the time of study, and eight of these patients underwent nitric oxide therapy because of failure of conventional ventilation techniques, which was successful in five of these patients. Patients who had a good overall outcome of nitric oxide therapy experienced rapid improvement (pretreatment, mean PaO2 = 44.8 mmHg; after the first hour of therapy, mean PaO2 = 96.8 mmHg), whereas patients with no response did not have a similar course (pretreatment, PaO2 = 37 mmHg; after the first hour, PaO2 = 54.6 mmHg). © 2014, The Author(s).

Objective To evaluate the clinical course of multicystic dysplastic kidney (MCDK) and to reveal any criteria indicating spontaneous involution. Material methods Hospital records of patients with MCDK followed in two different institutions in 1994–2009 were reviewed and data were analyzed regarding involution. Results Records of 96 patients were reviewed, of whom 46 were diagnosed antenatally and followed for more than 1 year. Fourteen patients had undergone nephrectomy. There was one case of hypertension which resided with nephrectomy. There was no malignancy. Involution rate was 53.6% (15/28) for right-sided and only 16.7% (3/18) for left-sided kidneys. The initial size of the kidney was found to be another predictive parameter for involution. Initial sizes of 43 (15 involuted and 28 non-involuted) kidneys were documented. Mean standard deviation score for involuting and non-involuting kidneys was −3.19 and 3.12, respectively. The chance of involution for a large kidney on the left was zero; however, involution risk for a small right-sided kidney was 67%. Conclusion Reviewing a 15-year period of our patient records conveyed data supporting current literature mainly encouraging non-operative management of MCDK. Further studies are required; however, our two objective indicators, the initial size and side of dysplastic kidney, may contribute to the management.

Antibiyotiklerin sayısı ve kullanım alanları her geçen gün artmaktadır Antibiyotikler doğru tanıyla doğru zamanda doğru kullanım şekli ile ve doğru bir antibiyotik seçimi ile kullanılmalıdır Antibiyotikler mümkünse kültür gönderildikten sonra başlanmalıdır Ampirik antibiyotik kullanımı ciddi ve acil durumlarda tercih edilmelidir Türk Ped Arş 2010; 45: 80 Yıl: 50 2 Anahtar sözcükler: Antibiyotik çocuk enfeksiyon, The spectrum of antibiotics and diseases which are treated with antibiotics are increasing Antibiotics should be used in correct diagnosis indication dose and way of consumption Antibiotics should be started after pending the cultures Empiric choosing of antibiotics could be preferred in emergency and severe conditions Turk Arch Ped 2010; 45: 80th Year: 50 2 Key words: Antibiotics child infection

Purpose Minimally invasive surgery has evolved into single-incision laparoscopic surgery (SILS) in the recent years. Few reports have addressed the practicality of SILS in children. Our current experience with regard to feasibility and effectiveness of SILS in children is presented. Methods A retrospective review of the operative database for patients operated on using SILS in our department from March 2009 to July 2010 was performed. Data regarding the type of the procedure, age, sex, operative performance, hospital stay, and complications were collected. Main Results Among 43 patients, cholecystectomy was performed in 11; appendectomy, in 10; unroofing for ovarian cysts, in 5; unroofing for splenic cysts, in 4; oophorectomy, in 6 (ovarian torsion, 2; teratoma, 4); ovary-preserving teratoma excision, in 1; splenectomy, in 1; gonadectomy, in 3; and varicocelectomy, in 2. There were no conversions to standard laparoscopic or open techniques. The only postoperative complication was a wound infection that occurred after an appendectomy. Conclusion Although currently more expensive, SILS can be performed in children in almost every pediatric surgical procedure that can be accomplished with conventional laparoscopic techniques. The most significant contribution of SILS procedure is cosmesis. Postoperative pain and length of hospital stay were not improved.

Splenogonadal fusion is a rare congenital anomaly which is characterized by fusion formation between the spleen and gonad. We report a case of a 14-month boy with spleongonadal fusion-limb deformity syndrome focusing on the importance of awareness of this syndrome. The patient was admitted to our clinic because of a left undescended testis, and preoperative diagnosis was not made. During the operation, “spleen-like” tissue attached to the gonad induced splenogonadal fusion, which was confirmed by laparoscopy. The patient also had a short right femur, hip dysplasia and a syndromic face. Splenogonadal fusion anomaly should be considered in the evaluation of undescended testis, especially in patients with facial and limb deformities.

Fecal incontinence (FI) is a devastating problem for children. The failure of optimal medical treatment may require further interventions such as appendicocutaneostomy. We report on a patients' perspective of the success of a Malone procedure for FI.The records of 32 patients who had undergone ACE procedure in the past 9 years were reviewed. Patients and families were contacted, and telephone inquiries were conducted to assess the overall success of the operation. The questionnaire covered the concerns of patients/families about the stoma, functional results and changes in the patients' quality of life (QOL).The indications for ACE stomas were meningomyelocele in 17 patients, anorectal malformation in 8, Hirschsprung/NID in 3, spinal tumor in 3 and traumatic spinal injury in one. 7 laparoscopic and 25 conventional operations were performed. The vermiform appendix was used in 27 of the patients and a cecal flap was used in 5. The most frequent complication was stenosis of the stoma orifice observed in 14 patients. 8 patients responded to dilatations while 6 patients required minor surgical revision. There were 2 perforations during catheterization, and they required surgical repair of the conduit. 5 patients had mild leakage from the stoma; all 5 were open ACE procedures, and required revision. 25 patients could be reached by phone. 5 of these children stopped using the stoma due to previous perforation in 2 patients and stricture in 1. The remaining 2 stopped using their stomas because "they did not like the idea of it". 16 patients are completely clean. 3 patients have occasional soiling. Only one patient was not satisfied with using the ACE stoma and stated that it did not sufficiently improve her condition. 8 patients complained about the duration of the enema (longer than 1 h); however, 5 of them refuse to use the stoma every day. All patients but one perceived a significant improvement in their QOL. Mean QOL scores before and after the procedure were 5.8 (2-9) and 11.5 (5-14), respectively.ACE stomas provide a satisfactory improvement in patients' quality of life. Stoma-related complications are not uncommon. The most common problems are strictures, followed by stoma leakage.

Despite a mostly self-limiting course, infantile hemangiomas can cause severe functional and/or cosmetic problems. The aim of this study was to determine the efficiency of propranolol treatment on infantile hemangiomas.Sixty-seven infantile hemangioma patients were included in propranolol protocol in two institutions from 2009 to 2011. Participants included 36 boys and 31 girls. An associate protocol with radiology and pediatric cardiology was constructed for appropriate patient selection. Patients received a dose of 2 mg/kg/day, and all were admitted for the first 24 hours of therapy.Sixty-seven patients were included in the study. Mean age at the initiation of therapy was 7 months (1 to 24 months), and eleven patients were older than 12 months of age when propranolol was started. All patients showed improvement with varying responses. No side effects were detected during the treatment.Previously defined treatments for hemangiomas were efficient, yet had a limited usage because of side effects. Propranolol, with a high efficacy (not as total involution but stabilization and regression) and feasibility deserves to be the first line therapy for infantile hemangiomas even after the proliferation phase.

Objective Studies on the use of intradetrusor botulinum toxin A injection for children with neuropathic bladders are insufficient and the results are controversial. The aim of the present study was to evaluate the effect of intradetrusor botulinum toxin A injection for children with neuropathic bladders that are resistant to anticholinergic treatment, and to reveal any criteria indicating treatment success. Patients/methods Hospital records were reviewed of 16 children with neuropathic bladders due to myelomeningocele, and who had botulinum toxin A injections between 2007 and 2010. Botulinum toxin A (10 units/kg) was injected endoscopically into various sites of the detrusor, except the trigone. The success was defined as complete dryness between clean intermittent catheterizations. Urodynamic studies before and after the application were evaluated and parameters, including bladder capacity (measured/expected) and compliance, were also analyzed. Reviewing the results, patients were then classified into two groups: as having fibrotic bladders (noncompliant, acontractile bladders with high pressures) or overactive bladders. Urodynamic findings and therapy success were then compared between the groups. Results A total of 19 injections, including repeat injections in three patients, were performed. Results of the 16 initial injections were evaluated. Nine patients had detrusor overactivity, and five out of nine (56%) applications in this group resulted in complete dryness between clean intermittent catheterizations. In bladders with typical detrusor overactivity, there was a significant increase in both the capacity (from 0.53 to 0.74) and compliance (from 4.7 to 8.6 ml/cm H2O). Looking at the seven patients that displayed fibrotic bladders with very low compliance and no contraction at all, none of them presented with notable clinical improvement from injections. Comparing the urodynamic findings, there was no significant difference in compliance (3.1 ml/cm H2O before and 3.5 ml/cm H2O after) and bladder capacity (0.58 before and 0.52 after the treatment) in the fibrotic bladders. Discussion Despite its worldwide usage and FDA approval, studies on the effectiveness of botulinumtoxin A on neuropathic bladders in children are controversial. There are now numerous studies attesting to the good results of BoNTA in neuropathic detrusor overactivity; however, only scarce reports comment on the specific features of the disease process among patients and reasons for failure in some. In our study, reviewing the urodynamic findings carefully, it was observed that the patients who did not respond to injections were the ones with no contractions, despite high pressures and low compliance. Therefore, describing the indications of BoNTA as neuropathic detrusor overactivity and urinary incontinence despite anticholinergic medications may lead to mistreatment of patients in the decompensated phase of a hyper-reflexive detrusor. Pretreatment urodynamic evaluation might be a good indicator, without biopsies, of estimating the degree of fibrosis and the patients who will benefit from the injection. Conclusion Botulinum toxin A injection in the neuropathic bladder of myelomeningocele patients was found to be ineffective if the detrusor was fibrotic, of low compliance and had lost contractility. Urodynamic findings should be carefully analyzed in order to select appropriate patients that may benefit from Botulinum injection.

Purpose The aim of this study was to investigate the degree of variation in the values of pelvic anteroposterior (AP) diameter in hydronephrotic kidneys measured on two different levels, namely at hilum and at the point of maximum dilatation. Material and Methods Thirteen children with unilateral hydronephrosis (UPJ-type) aged between 2 months and 11 years (27.2±42.6 months) were recruited for the study. Serial renal ultrasound studies were carried out just before and 30 minutes after the completion of oral hydration. Six ultrasonographic studies were performed for each patient in a daytime. At mid-transverse sonograms we measured AP diameter of renal pelvis at its maximum dimension and at renal hilum. Additionally, renal parenchymal thickness, kidney dimensions and volume of bladder at the time of scanning were noted. Contralateral kidneys were assessed to exclude bilateral hydronephrosis. Repeated measurements ANOVA test was used for comparisons. Results The mean value of the maximum pelvic AP diameter before hydration was 20.5±11.4 mm. After hydration it significantly increased to 23.3±12.0 mm (p=0.003) (13.9% increase). The corresponding measurements at the renal hilum before and after hydration were 15.4±9.2 and 15.4±8.8 (p=0.943). Parenchymal thickness before and after hydration was 7.8±4.0 and 7.3±3.6 (p=0.313). Contralateral kidneys were all normal. Conclusions The commonly used ultrasonographic parameters in the follow-up examination of hydronephrotic kidneys are prone to hydration effects. The maximum AP diameter of the pelvis in hydronephrotic kidney increases significantly (over 10%) by hydration. However, the pelvic AP diameter at renal hilum is less affected and seems to be independent of hydration status, thus it is more reliable than maximum AP diameter as a follow-up tool in hydronephrosis.