General evaluation of neurogenic bladder in children

Son yıllardaki tıbbi gelişmelerle, üroloji kliniklerinde nörojen mesanesi olan çocukların sayısı artmıştır. Erişkin hastalardan farklı olarak, çocuklardaki nörojen mesane en sık embriyolojik dönemde oluşan nöral tüp defektleri sonucu oluşmaktadır. Bu defekt sonrası çocukların bir kısmı açık spinal disrafizm ile doğmakta ve genel olarak büyük merkezlerde değerlendirilip takibe alınmaktadır. Ancak hastaların bir kısmında nöral tüp defektleri gizli kalmakta ve nörojen mesanenin neden olduğu semptomlar ile kliniklere başvurulmaktadır. Bu nedenle, üroloji hekimleri mesleki hayatlarında nörojen mesanesi olan çocukları değerlendirmek ve tedavilerini düzenlemek durumunda kalmaktadır. Bu gruptaki hastalara zamanında tanı konulması ve uygun tedavinin uygulanması, nörojen mesanenin neden olabileceği olumsuz sonuçları engellemekte ve hastaların yaşam sürelerini uzatıp, hayat kalitesini düzeltebilmektedir. Bu derlemede, çocuklarda nörojen mesanenin tanısal değerlendirilmesi, tedavisi ve takibi hakkında genel yaklaşımlar özetlenmiştir.With the recent developments in medicine, the number of children with neurogenic bladder has been increased in urology clinics. Being different from adult patients, neurogenic bladder in children is mostly caused by a neuronal tube defect occured during the embryological life. Some of the children are born with an open spinal dysrafism which usually evaluated and followed-up in big centers. But, some of the children with neurogenic bladder are born with an occult spinal dysrafism and they are presented in clinics with the symptoms of neurogenic bladder. Therefore, urologists have to evaluate and treat the children with neurogenic bladder in their practice. Early diagnosis and correct treatment of these patients prevent negative outcome of neurogenic bladder and improve both the survival and quality of life of the patients. In this review, the diagnostic evaluation, treatment and follow-up strategies in children with neurgenic bladder were summarized

Treatment and follow up results of patients with monosymptomatic enuresis nocturna

Objective: To evaluate the treatment results of patientswith monosymptomatic enuresis nocturna.Methods: 97 patients with monosymptomatic enuresisnocturna were included. First, motivation and behavioraltreatment have been applied to the patients for 3 months.60-120 mcg desmopressin has been applied to 79 patientswho did not want to continue to the motivation andbehavioral treatment or who did not have benefit from motivationand behavioral treatment or whose disease haverelapsed. It is accepted as “full response” if the numberof wetting decreases 90-100%, “middle response” decreases50-90%, “failed response” decreases less than50%. Treatment and relapse rates were evaluated basedon the response to therapy at the time of controls.Results: Mean age of the patients was 7.75±1.96 (5-12)years. 20 of 97 (21%) patients who have taken motivationand behavioral treatment have been cured. Two (%10)of these patients’ diseases have relapsed. Desmopressinhas been applied to79 patients who did not have benefitfrom motivation and behavioral treatment or whosediseases have relapsed. Full dryness has been providedin 36 (46%) patients who have taken desmopressin andcame to the control visit. “Middle response” has been obtainedin 22 (28%) patients. “Failed response” has beenobtained in 21 (26%) patients. Relapse has been seen incase of quitting desmopressin in 35 (60%) patients whohave benefit from desmopressin.Conclusion: Although, Desmopressin is the most preferredmethod in monosymptomatic enuresis nocturna,because of easy usage and fast response, relapse ratio ishigh following discontinuation of the drug.Key words: Monosymptomatic enuresis nocturna, desmopressin,treatmen

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

Ordinary glass spheres as an alternative injectable material for endoscopic correction of vesicoureteral reflux

Purpose: Although they are therapeutically effective, injectable materials for urinary tract are associated with various disadvantages, precluding their universal acceptance. In this study we investigated glass spheres (GSs) as an alternative injectable substance to correct vesicoureteral. reflux (VUR) in an animal model. Materials and Methods: We used 150 to 300 mu GSs suspended in agarose gel to form the injection paste. GS paste was injected into the rectus muscle and submucosa of the bladder in 8 adult New Zealand male rabbits. As a control group, vehicle only was injected into 4 rabbits. The rabbits were sacrificed to harvest the bladder, pelvic lymph nodes, kidney, liver, brain, spleen and lung at month 1 and year 1 of injection. A VUR model was then created by unroofing the 2 ureteral orifices of 12 adult sheep. GS paste was injected into the right subureter and vehicle only was injected into the left subureter. Cystourethrographies were performed at month 3 and year 1 of injection. The sheep were sacrificed at cystourethrography to harvest the bladder, lymph nodes, kidney, liver, brain, spleen and lung. Results: At month 3 and year 1 of injection into rabbit tissues nodule formation was stable in position and volume. Histopathological studies of local and distant organs of the rabbit did not show any granuloma formation or migration of GS. GS paste injection corrected VUR in sheep. Re-injection of GS into still refluxing left units corrected VUR. Local and distant organs, harvested from sheep did not demonstrate distant migration. Conclusions: When injected into bladder submucosa and rectus muscle, GS appears to be inert, biocompatible and efficient. Similarly it is effective for correcting VUR in an animal model. We present our data on GS, encouraging further investigation to develop an alternative injectable material for endoscopic VUR correction

Academic incentive allowance: Scientific productivity, threats, expectations

The purpose of this study is to uncover the views of the instructors regarding the regulation on the Academic Incentive Allowance (AIA) applied in Turkey, to understand its reflection on the quality of the scientific products and to determine whether the findings to be obtained are generalizable. In the qualitative phase of the research conducted according to the mixed method paradigm, exploratory sequential mixed method design, three themes were obtained as potentials, problems and suggestions; and the qualitative findings were found to be generalizable. Despite the uncertainties and the new problems brought about by the AIA, it was found that positive results may be obtained and that the teaching staff has a positive attitude towards the application. However, it was also found that it leads to concerns about unethical publications and about focusing on the quantity rather than the quality

Performance enhancement of real-time protocol master of science

Thesis (Master)--Izmir Institute of Technology, Computer Engineering, Izmir, 2010Includes bibliographical references (leaves: 69-71)Text in English; Abstract: Turkish and Englishx, 71 leavesA mechanism is described for dynamic adjustment of the performance requirements of multimedia applications. The sending application uses RTP receiver reports to compute packet loss and control mechanism periodically measures the utilization. Based on these and some other metrics the control mechanism can make necessary adjustments. Several experiments have been run in order to tune and evaluate the mechanism. The results indicate that the mechanism can be applied efficiently and the performance of the RTP can be increased

Performance enhancement of real-time protocol master of science

Thesis (Master)--Izmir Institute of Technology, Computer Engineering, Izmir, 2010Includes bibliographical references (leaves: 69-71)Text in English; Abstract: Turkish and Englishx, 71 leavesA mechanism is described for dynamic adjustment of the performance requirements of multimedia applications. The sending application uses RTP receiver reports to compute packet loss and control mechanism periodically measures the utilization. Based on these and some other metrics the control mechanism can make necessary adjustments. Several experiments have been run in order to tune and evaluate the mechanism. The results indicate that the mechanism can be applied efficiently and the performance of the RTP can be increased