Practical recommendations of the EAU-ESPU guidelines committee for monosymptomatic enuresis-Bedwetting

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 (R) was performed and the relevant literature was reviewed and prospectively registered on the European Urology bedwetting enuresis resource center (). 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

Are there any benefits of using an inlay graft in the treatment of primary hypospadias in children?:A systematic review and metanalysis

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

Sub- and super-shear ruptures during the 2023 Mw 7.8 and Mw 7.6 earthquake doublet in SE Türkiye

An earthquake doublet (Mw 7.8 and Mw 7.6) occurred on the East Anatolian Fault Zone (EAFZ) on February 6th, 2023. The events produced significant ground motions and caused major impacts to life and infrastructure throughout SE Türkiye and NW Syria. Here we show the results of earthquake relocations of the first 11 days of aftershocks and rupture models for both events inferred from the kinematic inversion of HR-GNSS and strong motion data considering a multi-fault, 3D geometry. We find that the first event nucleated on a previously unmapped fault before transitioning to the East Anatolian Fault (EAF) rupturing for ~350 km and that the second event ruptured the Sürgü fault for ~160 km. Maximum rupture speeds were estimated to be 3.2 km/s for the Mw 7.8 event. For the Mw 7.6 earthquake, we find super-shear rupture at 4.8 km/s westward but sub-shear eastward rupture at 2.8 km/s. Peak slip for both events were as large as ~8m and ~6m, respectively

Genetic relationships of European, Mediterranean, and SW Asian populations using a panel of 55 AISNPs

The set of 55 ancestry informative SNPs (AISNPs) originally developed by the Kidd Lab has been studied on a large number of populations and continues to be applied to new population samples. The existing reference database of population samples allows the relationships of new population samples to be inferred on a global level. Analyses show that these autosomal markers constitute one of the better panels of AISNPs. Continuing to build this reference database enhances its value. Because more than half of the 25 ethnic groups recently studied with these AISNPs are from Southwest Asia and the Mediterranean region, we present here various analyses focused on populations from these regions along with selected reference populations from nearby regions where genotype data are available. Many of these ethnic groups have not been previously studied for forensic markers. Data on populations from other world regions have also been added to the database but are not included in these focused analyses. The new population samples added to ALFRED and FROG-kb increase the total to 164 population samples that have been studied for all 55 AISNPs

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Percutaneous Removal Of A Broken Malecot Nephrostomy Tube

We report a case of a broken re-entry Malecot nephrostomy tube inserted after an uneventful percutaneous nephrolithotomy (PCNL) procedure. The remained parts within the renal pelvis and around the kidney were removed using a percutaneous approach under general anesthesia using the PCNL access tract. Although this complication did not cause severe morbidity, it converted a successful uneventful PCNL procedure to a grade IIIB complicated one according to the modified Clavien classification system. This complication should be held in mind and a percutaneous approach should be considered before attempting an open surgery.Wo

Ureteroneocystostomy In Primary Vesicoureteral Reflux: Critical Retrospective Analysis Of Factors Affecting The Postoperative Urinary Tract Infection Rates

Introduction: To determine the parameters affecting the outcome of ureteroneocystostomy (UNC) procedure for vesicoureteral reflux (VUR). Materials and Methods: Data of 398 patients who underwent UNC procedure from 2001 to 2012 were analyzed retrospectively. Different UNC techniques were used according to laterality of reflux and ureteral orifice configuration. Effects of several parameters on outcome were examined. Disappearance of reflux on control VCUG or absence of any kind of UTI/symptoms in patients without control VCUG was considered as clinical improvement. Results: Mean age at operation was 59.2 +/- 39.8 months and follow-up was 25.6 +/- 23.3 months. Grade of VUR was 1-2, 3 and 4-5 in 17, 79, 302 patients, respectively. Male to female ratio was 163/235. UNC was performed bilaterally in 235 patients and intravesical approach was used in 373 patients. The frequency of voiding dysfunction, scar on preoperative DMSA, breakthrough infection and previous surgery was 28.4%, 70.7%, 49.3% and 22.4%, respectively. Twelve patients (8.9%) with postoperative contralateral reflux were excluded from the analysis. Overall clinical improvement rate for UNC was 92%. Gender, age at diagnosis and operation, laterality and grade of reflux, mode of presentation, breakthrough infections (BTI) under antibiotic prophylaxis, presence of voiding dysfunction and renal scar, and operation technique did not affect the surgical outcome. However, the clinical improvement rate was lower in patients with a history of previous endoscopic intervention (83.9% vs. 94%). Postoperative UTI rate was 27.2% and factors affecting the occurrence of postoperative UTI were previous failed endoscopic injection on univariate analysis and gender, preoperative BTI, postoperative VUR state, voiding dysfunction on multivariate analysis. Surgery related complication rate was 2% (8/398). These were all low grade complications (blood transfusion in 1, hematoma under incision in 3 and prolonged hospitalization secondary to UTI in 4 patients). In long term, 12 patients are under nephrologic follow-up because of hypertension in 5, increased serum creatinine in 5, proteinuria in 1 and hematuria in 1 patient and all these patients had preoperative scarred kidneys. Conclusions: Despite its invasive nature, UNC has a very high success rate with a negligible percent of complications. In our cohort, the only factor that negatively affected the clinical improvement rate was the history of previous antireflux interventions where the predictive factors for postoperative UTI were previous failed endoscopic injection, female gender, preoperative BTI, persistent VUR and voiding dysfunction.WoSScopu

Sonographic Diagnosis Of Large-Cell Calcifying Sertoli Cell Tumor

Large-cell calcifying Sertoli cell tumor is a very rare neoplasm of the testis with less than 100 reported cases. It is associated with some genetic syndromes, and it has some features that help to distinguish benign and malign cases. An 11-year-old boy presented with testicular lesions in both testicles. He underwent right radical orchiectomy in another institution and was referred to our hospital for further treatment. The lesions were reported as large-cell calcifying Sertoli cell tumors in our institution. There were multiple hyperechoic lesions with calcifications in the left testis and lesions showed vascularization on Doppler. Sonographic features of these lesions were also suggestive of benign large-cell calcifying Sertoli cell tumor. The lesions were stabile during follow-up. The ultrasonographic appearance of large-cell calcifying Sertoli cell tumor is descriptive and, together with clinical findings, allows differential diagnosis. It can direct patient management, with a more conservative approach. We report a child with large-cell calcifying Sertoli cell tumor who could have been saved from extensive surgery, such as radical orchiectomy, if the tumor had been diagnosed correctly with sonography.PubMedWoSScopu

FACTORS AFFECTING COMPLICATION RATES OF PERCUTANEOUS NEPHROLITHOTOMY IN CHILDREN: RESULTS OF MULTI-INSTITUTIONAL RETROSPECTIVE ANALYSIS BY PEDIATRIC STONE DISEASE STUDY GROUP OF TURKISH PEDIATRIC UROLOGY SOCIETY

WOS: 000308488203234

Local Anesthetic Infiltration During Pediatric Percutaneous Nephrolithotomy Improves Postoperative Analgesia

Objective: Percutaneous nephrolithotomy is not pain-free due to the procedure itself and presence of post-operative diversion. Our purpose was to evaluate the efficacy of local anesthetic infiltration in postoperative analgesia in children who undergo percutaneous nephrolithotomy. Materials and Methods: Forty-two renal units were included to our study. Local anesthesia group received prilocaine and bupivacaine injection through the percutaneous access line where patients received no local anesthetic constituted the control group. All patients received the same anesthesia protocol and 15 mg/kg paracetamol infusion postoperatively four times a day. Post-operative pain scores of patients were evaluated by using FLACC-FPS scales. Patients with pain scores >= 4 received meperidine 1 mg/kg as rescue analgesic. Results: Between the two groups there was no significant difference in pain scores except 24th hour, where the local anesthesia group found to be favorable. The need (p=0.040) and total number (p=0.018) of rescue analgesic was significantly less in local anesthesia group. According to need for repetitive analgesic dose, the local anesthesia group was founded to be more advantageous (p=0.017). The postoperative analgesic satisfaction of parents' was favorable in local anesthesia group (p=0.002). Conclusion: In pediatric percutaneous nephrolithotomy, preemptive local anesthetic infiltration reduces postoperative pain, the need for analgesics, the number of analgesics used and also improves patient comfort and analgesic satisfaction.Wo