A Survey Study on Evaluation and Management of Nocturnal Enuresis in Pediatricians and Family Physicians

Objective:Nocturnal enuresis (NE) is one of the most common disorders in pediatric urology, and patients often turn to family physicians (FP) and pediatricians (P) initially. The aim of this study was to understand the awareness, self-confidence and suggestions of physicians regarding the management of NE.Materials and Methods:In this study, 360 FP and family medicine residents (FMR), as well as 280 P and pediatrics residents (PR), were contacted through a cellular phone texting system. A simple multiple-choice questionnaire (Surveymonkey®) consisting of 10 questions was used to gather data. The survey included questions about their experience, training, evaluation, and management of NE.Results:A total of 119 FPs and Ps (18.5%) filled the questionnaire. Thirty (25.21%) of the participants were P, 27 (22.69%) PR, 3 (2.52%) FP and 59 (49.58%) FMR. The rate of physicians who encounter at least 5 children with NE per month is 31.33%. The mean self-confidence in the management of NE was 4.5 out of 10. The self-confidence of pediatricians was significantly higher than that of PR and FMR (p<0.001, p<0.001). Most (n=78, 65.55%) of the participants stated that they received training on EN during medical faculty and 62 (52.10%) during residency. Psychological problems (89.92%), sleep disorders (78.15%), and excessive fluid intake (75.63%) were the most frequently considered factors in etiology. While most responders (75.63%) considered dietary regulation and behavioral interventions as the first-line treatment, 25.21% consult a pediatric urologist and only 1.6% recommend medical treatment.Conclusion:Although FP and P admit they had training on NE, they mostly felt incompetent to manage NE and exclusively avoided pharmacological treatment

The efficacy of neoadjuvant chemotherapy in invasive bladder cancer

Radical cystectomy is the gold standard in the treatment of invasive bladder cancer. However, five-year disease-free survival is low most probably due to micrometastatic disease at the time of surgery. The neoadjuvant chemotherapy may be performed as the first line management for invasive bladder tumors in order to treat micrometastases found at the diagnosis and improve resectability of larger neoplasms. A total of 43 patients diagnosed with invasive bladder tumors and 11 patients received neoadjuvant chemotherapy. The mean age of patients was 64 (43-74) years, and mean follow-up period was 52 months (12-114). Neoadjuvant chemotherapy protocol consisted of methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) or cisplatin, methotrexate, and cisplatin (CMV). All patients in neoadjuvant chemotherapy group underwent radical cystectomy. There was no significant difference between the groups with respect to disease-free survival time and overall survival time. In patients who received neoadjuvant chemotherapy, the respective disease-free and overall survival times were 31 months and 36 months versus 30 months and 35 months in patients who were treated with surgery only (p > 0.05). Five-year survival rates were 36% and 31% in the chemotherapy and no-chemotherapy groups, respectively. In the present study, 5-year survival rate was not affected by neoadjuvant chemotherapy in invasive bladder tumor. Complete pathological remission (stage p0) was found in 28% and pathological downstaging (stage < T2) was seen in 9% of patients in the neoadjuvant chemotherapy group. Five-year survival rates were 75% and 14.2% in patients who responded to chemotherapy, and in patients with no response, respectively (p < 0.05). The most favorable prognostic factor in this study was the response to neoadjuvant chemotherapy revealed as complete remission or pathological downstaging. The most important issue remains the prediction of patients who would respond and benefit from neoadjuvant chemotherapy

The Effects of Hormonal Therapy on Quality of Life in Prostate Cancer

The incidence of prostate cancer is dramatically increasing. Androgen blockade is widely utilized in the management of metastatic and locally advanced prostate cancer. Despite the benefits of this treatment, side effects and shortcoming of quality of life (QoL) constitute the major drawbacks of the hormonal treatment. The proper approach includes precautions in order to provide a lesser impairment in QoL. Therefore, physicians should consider the complications of hormonal treatment and should inform their patients. This review was prepared to point out the QoL changes regarding the hormonal treatment

Spontaneous severe retroperitoneal hemorrhage with concomitant renal pelvis rupture during the course of COVID-19 infection: a case report

Spontan renal pelvis rüptürü nadir rastlanılan ürolojik olay olup idrarın extravazasyonuna neden olan bir durumdur. Sıklıkla üriner sistemde gelişen obstrüksiyonlara sekonder olarak pelvis içi basıncın artması sonucu gelişir. Spontan retroperitoneal hematom da yine benzer şekilde travma veya altta yatan bir patoloji olmaksızın ortaya çıkan retroperitoneal kanamalardır. Bu çalışmada 63 yaşında antikoagulan tedavisi alan Covid-19 tanılı bir bayan hastada, retroperitonda spontan olarak oluşan hematom ve hematomun basısına sekonder olarak gelişen spontan renal pelvis rüptürü olgusunu sunuyoruz. Bu olgu ışığında Covid-19 infeksiyonuna bağlı yaygın endotel hücre hasarının, spontan ciddi retroperitenal kanamaya ve eşlik eden renal pelvis rüptürüne neden olabileceğini vurgulamak istiyoruz. Nadir görülen durumlar olan spontan renal pelvis rüptürü ve spontan retroperitoneal kanamanın aynı anda aynı hastada görüldüğü literatürde ilk kez bildirilmektedir.Spontaneous rupture of the renal pelvis is a rarely encountered urological event that causes extravasation of urine. It often occurs as a result of increased intrapelvic pressure secondary to obstructions developed in the urinary system. Similarly spontaneous retroperitoneal hematoma is retroperitoneal hemorrhage that occurs without trauma or an underlying pathology. In this study, we present a case of spontaneous rupture of the renal pelvis that developed secondary to compression of the hematoma that occurred spontaneously in the retroperitoneum in a 63-year-old female patient who received anticoagulant therapy with the diagnosis of Covid-19 infection. In the light of this case, we would like to emphasize that widespread endothelial cell damage associated with Covid-19 infection may cause spontaneous severe retroperitenal bleeding and accompanying renal pelvis rupture. In which both the rarely encountered spontaneous rupture of the renal pelvis and spontaneous retroperitoneal bleeding are seen simultaneously in the same patient, is reporting for the first time in the literatur

Does experience affect the cancer detection rate in cognitive fusion prostate biopsy? A comparison of the first and last 60 cases

Objective: We aimed to determine the contribution of the clinical experience gained in cognitive fusion prostate biopsy with the increase in the number of cases to the cancer detection rate. Materials and Methods: The records of 120 patients who underwent cognitive fusion biopsy were retrospectively analyzed. All patients underwent 3-T multiparametric magnetic resonance imaging (Mp-MRI) and they were evaluated with Prostate Imaging Reporting and Data System (PIRADS). The initial 60 cases were included in group 1, and the later subsequent 60 cases performed by the same surgeon were included in group 2. Any cancer and clinically significant prostate cancer (CSPrCa) detection rates in groups 1 and 2 were compared. Results: The mean ages of the patients for group 1 and group 2 were determined as 64.08 ± 8.15 and 65.15 ± 6.93 years, respectively. Age, prostate specific antigen (PSA), prostate volumes and the number of suspicious lesions of the groups were similar. Any cancer positivity rate was 33.3% for group 1, and 40% for group 2, without any significant intergroup difference (p=0.494). CSPrCa positivity was 40% and 70.83% for groups 1 and 2, respectively, and there was a significant improvement in CSPrCa detection in favor of group 2 (p=0.027). Conclusion: Regarding the cognitive fusion biopsies, a learning curve is required. It was concluded that the rate of detecting clinically significant prostate cancer was almost doubled with the increased experience in fusion biopsy.Amaç: Bilişsel füzyon prostat biyopsisinde elde edilen klinik deneyimin vaka sayısındaki artışla birlikte kanser tespit oranına katkısını belirlemeyi amaçladık. Gereç ve Yöntemler: Kognitif füzyon biyopsisi yapılan 120 hastanın kayıtları geriye dönük olarak incelendi. Tüm hastalara 3-T multiparametrik manyetik rezonans görüntüleme (Mp-MRG) yapıldı ve Prostat Görüntüleme Raporlama ve Veri Sistemi (PIRADS) ile değerlendirildi. İlk 60 vaka grup 1'e dahil edildi ve daha sonra aynı cerrah tarafından gerçekleştirilen sonraki 60 vaka grup 2'ye dahil edildi. Herhangi bir kanser ve klinik olarak anlamlı prostat kanseri (CSPrCa) tespit oranları grup 1 ve 2'de karşılaştırıldı. Bulgular: Grup 1 ve grup 2 hastaların yaş ortalamaları sırasıyla 64.08 ± 8.15 ve 65.15 ± 6.93 yıl olarak belirlendi. Grupların yaş, prostat spesifik antijen (PSA), prostat hacimleri ve şüpheli lezyon sayıları benzerdi. Herhangi bir kanser pozitifliği oranı grup 1 için %33.3 ve grup 2 için %40 idi ve gruplar arası anlamlı bir fark yoktu (p=0.494). Grup 1 ve 2 için CSPrCa pozitifliği sırasıyla %40 ve %70.83 idi ve CSPrCa tespitinde grup 2 lehine anlamlı bir gelişme vardı (p=0.027). Sonuç: Bilişsel füzyon biyopsileri ile ilgili olarak bir öğrenme eğrisi gereklidir. Füzyon biyopsisinde artan deneyim ile klinik olarak anlamlı prostat kanseri tespit oranının neredeyse iki katına çıktığı sonucuna varıldı

The Management of Phimosis Seen After Circumcision with Thermocautery

Objective: One of the most frequent complications after circumcision by thermocautery is phimosis. In this study, we aimed to present the functional and cosmetic results of the modified sleeve technique for the correction of this iatrogenic phimosis. Materials and Methods: The study group included iatrogenic phimosis cases who underwent circumcision using thermocautery during the last eight years. Initially, steroid creams were applied on these patients for six weeks. Patients who did not respond to this treatment underwent surgery using the modified sleeve technique. Control visits were performed at the first and fourth postoperative weeks. Results: A total of 32 patients with a median age of 5.1 +/- 1.1 years were included in the study out of 13285 circumcisions by thermocautery. No positive treatment outcomes were obtained by topical steroids, and all patients proceeded to surgery by modified sleeve technique. Median operative time was 25 +/- 2.3 minutes. Cosmetic and functional outcomes were satisfactory in all cases. Conclusion: There is no place for topical steroids in management of iatrogenic phimosis after thermocautery is observed, thus, early surgery is advised to avoid emotional stress. Our modified sleeve technique can achieve maximum cosmetic and functional outcomes without leading to extreme shortening of the penile skin and mucosa

Epidermoid cyst of the urinary bladder: a case report

Epidermoid cyst of the bladder is a very rarely encountered benign lesion. Up to our knowledge, we present the second case of epidermoid cyst of the urinary bladder in literature. We report a case of epidermoid cyst developed in a 59-year-old patient followed up with bladder tumor

Prostatic Carcinosarcoma: A Case Report

Prostatic carcinosarcoma is a rare malignancy composed of sarcomatous and carcinomatous elements. Predominantly, they are very aggressive tumors with a poor prognosis. In this case report, a 78 year-old male patient with prostate adenocarcinoma developing prostatic carcinosarcoma after using androgen blockade for 3 years was presented. We tried to define the clinical and pathological features of this rare malignancy with current information

The Efficacy of Early Mobilization after Urologic Radical Surgery

Contemporary evidence based trials suggest that same changes in the traditional approach for the care of patients provide a rapid recovery and return to daily life after surgery. Consequently, a decrease in the surgical complications and shorter hospital stay would be provided. These new multi-perspective approaches which are different from the classical approach are defined as fast track surgery. Early mobilization besides early extubation and rapid discharge from extensive care unit constitute the major components of fast track surgery in order to bring a shorter hospital stay. Nurses together with surgeons and anesthesiologists are all active members of the care team which may also include the patient by him or herself. The aim of this review was to discuss the efficacy of early mobilization after urologic surgeries

The Effectiveness of Caudal Block with Low Doses of Dexmedetomidine and Pethidine in Transrectal Prostate Biopsy: Preliminary Results

Purpose To evaluate the effectiveness of caudal block (CB) using dexmedetomidine and pethidine instead of local anesthesia (LA) for prostate needle biopsy and the effect of CB on urinary retention. Material and Methods A transrectal ultrasound-guided prostate needle biopsy (TRUS-Bx) was performed on 68 patients with a mean age of 65 +/- 2.18 years. CB with a combination of dexmedetomidine and pethidine without LA was administered to the patients. The pain levels of the patients were determined using numeric rating scale (NRS) scores to evaluate the effectiveness of CB. Preoperative and postoperative postvoid residual urine volumes (PRUV) were also calculated. Results The CB success rate was 93.15%. The NRS scores were 0.79 +/- 0.19 and 0.89 +/- 0.22 during probe entry and manipulation and biopsy, respectively, without any significant differences between them (p = 0.382). The mean PRUVs before and after biopsy did not differ significantly (41 +/- 15.6 vs. 71.93 +/- 22.3, p = 0.379). The degree of sedation, as assessed using the Ramsay scale, was 2 or 3 in all patients. Conclusion The combination of dexmedetomidine and pethidine for CB in TRUS-Bx provided quality analgesia for the patient and prevented the development of postoperative urinary retention