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

Sacral neuromodulation treatment for urinary voiding dysfunctions: Results of treatment with the largest single-center series in a tertiary referral center in Turkey

Background/aim: Sacral neuromodulation (SNM) is a minimally invasive treatment that modulates spinal reflexes to regulate bladder, urinary sphincter, and pelvic floor and has successfully been used in the treatment of refractory voiding dysfunctions. The aim of this study was to present our experience with SNM in a tertiary referral center with the largest number of patients and review the safety and efficacy of the procedure. Materials and methods: A total of 42 patients with refractory lower urinary tract symptoms were included into the study. After an initial test period, patients who showed more than 50% improvement in their symptoms underwent the second stage of SNM. Twelve patients had overactive bladder (OAB), bladder pain syndrome/interstitial cystitis (BPS/IC) and 17 had urinary retention. The clinical success was examined during follow-up by voiding diary, urodynamics, and global response assessment. Results: Between February 2015 and December 2020, a total of 29 patients underwent stages I&II SNM procedures. The mean ages of patients in OAB/BPS group and retention group were 40 (37–57 years) and 35 (27–44 years), respectively. Mean follow-up time was at least 1 year. Overall, 58.5% success rate was observed in OAB, BPS/IC, and urinary retention groups. Global response assessment score in both groups increased significantly (p = 0.001). No statistically significant difference was found between success or failure rates when sex and age were variable parameters (p > 0.05). Conclusion: SNM appears to be an effective and safe treatment option in restoring voiding dysfunctions in patients with refractory idiopathic and neurogenic voiding dysfunctions. Our initial series revealed favorable results; however, further studies with larger series and longer follow-up are needed

Clinicopathological Characteristics and Oncological Outcomes of Non-urothelial Bladder Carcinomas: A Multicenter Study

Objective: The incidence of non-urothelial bladder cancers is very low, so our knowledge about their treatment protocols and prognosis is limited. We evaluated the clinicopathological characteristics of 26 patients in three different clinics and aimed to determine the prognostic factors affecting oncological outcomes. Materials and Methods: Between January 2012 and October 2019, we retrospectively analyzed the data of twenty-six patients aged between 44-75 years who were diagnosed and treated due to non-urothelial bladder carcinomas in three clinics. Results: Among twenty-six cases, nineteen (73.1%) were male and seven (26.9%) were female. The mean age at diagnosis was 60.77 +/- 8.52. The most common presenting complaint was gross hematuria (84.6%). It was followed by lower urinary tract symptoms (38.4%). Histological types of tumors were squamous cell carcinoma (9 cases, 34.8%), adenocarcinoma (eight cases carrying different histopathologic subtypes: Mucinous, signet ring cell, plasmacytoid/signet ring cell mixed variant and signet ring cell containing osteoclast-like giant cell, 30.8%), small cell carcinoma (3 cases, 11.5%), large cell neuroendocrine carcinoma (2 cases, 7.7%), extra-gastrointestinal stromal tumor (1 case, 3.8%) and malignant undifferentiated mesenchymal tumor (1 case, 3.8%) and leiomyosarcoma (2 cases, 7.6%). At a median follow-up of 13 (2-42) months, the progression-free survival rate was 61.5%, while the overall survival rate was 46.1%. In Kaplan-Meier analysis, the median survival of all cases was found to be 16 (9-33) months. Overall survival times were lower in the presence of advanced (3-4) pathological stages (p=0.006) and higher (>= 2) ECOG scores (p=0.005). Conclusion: In our cases, we observed that overall survival rates increased in patients undergoing multimodal treatments involving radical cystectomy compared to the bladder-sparing approach. The survival rates were higher in squamous cell carcinomas, while the rate of metastasis was higher in adenocarcinoma and neuroendocrine tumors. Up-staging rates after cystectomy were higher in adenocarcinomas, sarcomas and squamous cell carcinomas

Clinicopathological Characteristics and Oncological Outcomes of Non-urothelial Bladder Carcinomas: A Multicenter Study

Objective: The incidence of non-urothelial bladder cancers is very low, so our knowledge about their treatment protocols and prognosis is limited. We evaluated the clinicopathological characteristics of 26 patients in three different clinics and aimed to determine the prognostic factors affecting oncological outcomes

Abnormal DMSA renal scan findings and associated factors in older children with vesicoureteral reflux

Aim There are scanty data on the rate of abnormal Tc-99 m dimercaptosuccinic acid (DMSA) renal scintigraphy and associated factors in children older than 5 years with diagnosis of VUR. We do not have knowledge about which older children should undergo DMSA after VUR diagnosis. This study aims to assess the rate of abnormal DMSA findings and associated factors in children older than 5 years of age diagnosed with VUR. Materials and methods We retrospectively reviewed the medical records of 258 children with VUR diagnosed at or older than 5 year age. 179 children [42 (23.5%) males and 137 (76.5%) females] with complete data were included. 268 reflux units were compared according to gender, bilaterality, grade, reflux phase at voiding cystourethrography, febrile urinary tract infection (fUTI), lower urinary tract dysfunction (LUTD), and DMSA findings with uni- and multivariate analysis. Results The median age was 110 (60-216) months. VUR grades were I, II, and III in 197 (73.6%) units and IV-V in 71 (26.4%). 138 (51.5%) renal units had abnormal DMSA. VUR grade (p < 0.01), unilaterality (p = 0.048), and fUTI (p = 0.031) in univariate but only grade and unilaterality in multivariate analysis are significantly associated with abnormal DMSA. Although reflux at filling phase was predominant in high-grade VUR group, reflux at voiding phase (p = 0.006) in low-medium-grade (1-3) VUR was associated with abnormal DMSA. Conclusion Children older than 5 years of age diagnosed with VUR should be regarded as a high-risk group for abnormal DMSA regardless of gender, unilaterality, grade, reflux phase, fUTI, and LUTD