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

Yüksek Dereceli Kasa İnvaze Olmayan Mesane Tümörlerinde Histolojik Derecelendirme Oranının Progresyona Etkisi

Aim: Histopathological classification is one of the main prognostic factors for non-muscle invasive bladder tumors (NMIBT). Weevaluated the relationship between tumor progression and the ratio of high-grade differentiation plus other routine pathologicalparameters in NMIBT.Materials and Methods: Ninety-two patients diagnosed with high grade NIMBT were analyzed between 2010-2018. Demographicinformation, tumor size, localization, multicentricity, and recurrence/progression situation were evaluated retrospectively. The high/lowgrade percentage ratio of tumor cells, tumor stage, differentiation, necrosis, lamina-propria invasion, lymphovascular invasion, andcarcinoma in-situ presence were also examined by two uro-pathologist. The effect on tumor progression was evaluated with pathologicalfindings.Results: Seventy-four (80.4%) of the patients were reported as T1 and 18 (19.6%) as Ta. The mean ratio of high-grade findings was11.9±8.5% and 69.5±28.1% for Ta and T1 patients, respectively(p25%, >50% and >75% was found to be 67(72.8%),54(58.7%) and 43(46.7%), respectively. The high-grade ratio for >25% was in only 1 Ta patient while it was in 66 of the T1patients(p75%(p50%(p=0.025).Conclusion: When evaluating the nuclear grade, defining tumors solely as high-grade leads to stratifying a highly heterogeneouspopulation in a single group. Higher rate of progression is observed in NIMBT patients with high-grade ratio >50%.KİOMT’de yüksek dereceli hücresel farklılaşma oranı ve diğer rutin patolojik parametrelerin progresyona etkisi değerlendirildi. Materyal ve Metot: Çalışmaya 2010-2018 yılları arasında transüretral mesane rezeksiyonu sonrası yüksek dereceli KİOMT tanısı alan 92 hasta dahil edildi. Hastaların demografik bilgileri, tümör çapı, lokalizasyonu, multisantrisitesi ve nüks/progresyon varlığı-süresi retrospektif olarak değerlendirildi. Ayrıca tümör hücrelerinin yüksek derece/düşük derece yüzdesi, tümör evresi, diferansiyasyon, nekroz, lamina propria invazyonu, lenfovasküler invazyon ve karsinoma in-situ varlığı iki üro-patolog tarafından incelendi. Elde edilen bulguların tümör progresyonu üzerine etkisi araştırıldı. Bulgular: Hastaların 74’ü(%80,4) T1, 18’i(%19,6) Ta olarak rapor edildi. Ta tanılı hastalarda yüksek derece oranı %11,9±8,5 iken, T1’lerde %69,5±28,1 olarak tespit edildi (p%25,>%50 ve>%75 olan hasta sayısının sırasıyla 67(%72,8), 54(%58,7) ve 43(%46,7) olduğu görüldü. Ta olan hastaların sadece 1’inde yüksek derece oranı>%25 olarak gözlenirken, T1 hastalarının 66’sında yüksek derece oranının>%25 olduğu belirlendi (p%75 olduğu görüldü. T1 yüksek derece oranları>%50 olan hastalarda progresyon, patolojik evresi T1 yüksek derece oranları %50 olan hastalarda progresyon anlamlı derecede artmaktadır

Urodynamic findings of multiple sclerosis patients at a single institution

Aim: Multiple sclerosis (MS) is a chronic and progressive disease of the central nervous system (CNS). The destructive effect of MS on the urogenital system has been demonstrated in many studies especially in young adults. Urodynamic evaluation is recommended in the diagnosis of urogenital system pathologies for MS patients. Unfortunately, there are not enough studies evaluating the urodynamic examinations of MS patients in our country. In this study, urodynamic findings of patients with MS were evaluated. Material and Method: A total of 58 patients (39 female and 19 male) were included in the study. The urodynamic findings of the patients in the same center between January 2011 and October 2017 were evaluated retrospectively. Urodynamic evaluation was performed with 20 ml of infusion per minute according to the International Continence Society standards. Results: The mean age of the patients was 47.4 +/- 8.8 years. The mean duration of multiple sclerosis was 11.8 +/- 7.4 years. When the features of multiple sclerosis were evaluated, 13 (22.4%) patients had a progressive type, 20 (34.5%) had a secondary progressive type, and 25 (43.1%) had relapsing-remitting (with relapses and remissions). The urodynamic findings of the patients are shown in Table 1. Urodynamic evaluations of patients with urinary incontinence are reported as 'Urge type urinary incontinence' was observed in 30 (83.3%), 'stress type urinary incontinence' in 5 (13.9%) and 'mixed type urinary incontinence' in 1 (2.8%) patient. Discussion: Multiple sclerosis is a common neurological pathology which has different urinary system findings. Detrusor overactivity is the most common urinary manifestation, and patients may also have impaired contractility, detrusor sphincter dyssynergia, urodynamic stress incontinence, and bladder outlet obstruction

To Save or not to Save the Kidney: Relieving Unilateral Obstruction May Significantly Improve an Initially Low Split Renal Creatinine Clearance

Objective The aim of this study was to evaluate the change in acute/subacute unilateral renal function after the relief of complete unilateral ureteral obstruction by nephrostomy. Materials and Methods Thirty patients were prospectively enrolled in the study. All had ureteral stone, which were located in the upper ureter in 24 (80%) and in the middle ureter in 6 (20%) patients. As all patients had high-grade hydronephrosis, a percutaneous nephrostomy catheter was placed for the relief of obstruction. At the first week of urinary diversion, 24-hour creatinine clearance (CC) of both affected and normal kidneys were evaluated. In order to determine the difference, same evaluation was performed on the fourth week of nephrostomy placement. Results The mean age of the patients was 44.6 (36-54) years. The mean CC of the affected kidney was 38.8 similar to 4.9 ml/min in the first week of urinary diversion and increased to 42.5 similar to 5.4 ml/min at the end of the fourth week (p<0.001). All patients showed an improvement in CC levels ranging between 2.3% and 17.3% with a mean rate of 8.5 similar to 4.7%. Conclusion According to our results, kidney function may improve during the first month after the relief of obstruction. This improvement may be significant for borderline renal function to determine the curative treatment of an obstructed kidne

Lateral Transperitoneal Laparoscopic Adrenalectomy: a Single Center Experience

Amaç: Laparoskopik adrenalektomi, benign adrenal kitlelerin tedavisinde altın standart yöntem olarak kabul edilmektedir. Ancak birçok cerrah, benign adrenal kitle tedavisinde açık cerrahiyi tercih etmektedir. Bu tercihin nedeni, cerrahların laparoskopik adrenal cerrahinin ileri düzey laparoskopik cerrahi olduğunu ve öğrenme eğrisinin yüksek olduğunu düşünmeleri olabilir. Bu çalışmada, transperitoneal laparoskopik adrenalektomi cerrahisi sonuçlarımızı bildirmeyi amaçladık. Yöntemler: 2013 ile 2015 tarihleri arasında Namık Kemal Üniversitesi Tıp Fakültesi Hastanesin Üroloji Anabilim Dalında yapılmış olan laparoskopik adrenalektomi vakalarının verileri retrospektif olarak değerlendirildi. Hastaların demografik özellikleri, adrenal kitle patolojileri, kanama miktarı, hastanede kalış süreleri ve komplikasyonlar değerlendirildi. Bulgular: Toplam 21 hastanın verileri değerlendirildi. Bu hastaların 12'sine (%57,1) sağ adrenalektomi yapılırken, 9'una (%42,9) sol adrenalektomi uygulandı. Hastaların ortalama operasyon süresi 130,2±39, dk, ortalama kanama miktarı 197,6±72,4 ml ve ortalama hastanede kalış süresi 3,09±1,57 gün olarak tespit edildi. Patolojik değerlendirmede hastaların 4'ünde feokromasitoma, birinde miyeloma ve 16'sında adenoma olduğu tespit edildi. Boyut olarak 5 cm'den büyük kitlelerde kanama miktarı, operasyon süresi ve hastanede kalış süresi, 5 cm'den daha küçük kitlelere gore belirgin anlamda yüksek tespit edildi (p<0,05).Sonuç: Laparoskopik adrenalektomi, benign adrenal kitlelerin tedavisinde kolay ve güvenilir bir cerrahi tekniktir. Başlangıç vakalarında transperitoneal yaklaşım çok daha uygun bir yöntemdir. Cerrahi tekniğin seçilmesinde cerrahlar, tümör boyutunu, tümörün yerini ve olası patolojiyi değerlendirerek karar vermelidirler.Objective: Laparoscopic adrenalectomy is the gold standard surgical technique for benign adrenal tumors. On the other hand, most surgeons still prefer to perform open surgery for adrenal tumors. This may be related with the surgeons opinions that laparoscopic adrenalectomy is an advanced laparoscopic surgery and has a high learning curve. In this article we present the results of our initial transperitoneal laparoscopic adrenalectomy cases.Methods: Lateral transperitoneal laparoscopic adrenalectomy cases that were performed between 2013 and 2015, were retrospectively analyzed. Patients demographics, pathological types, operation time, blood loss, hospitalization time and complications were evaluated and compared with the literature. Results: A total of 21 patients were analyzed. Twelve (57.1%) patients had right and 9(42.9%) patients had left laparoscopic adrenalectomy. Mean operation time was 130.2&plusmn;39.1 min, mean blood loss was 197.6&plusmn;72.4 ml and mean hospitalization time was 3.09&plusmn;1.57 days. Pathology reports of adrenal tumors were pheochromocytoma at 4 patients, myeloma at 1 patient and adenoma at 16 patients. Patients with tumor size &gt; 5 cm had significantly higher blood loss, operation time and hospitalization time compared to tumors &lt; 5 cm. (p&lt;0.05)Conclusion: Laparoscopic adrenalectomy is a safe and feasible technique. Transperitoneal approach would be more suitable technique for initial cases. Surgeons must consider the tumor size and possible pathology of adrenal tumor to decide the surgical technique

The delay in the diagnosis and treatment of newly diagnosed bladder cancer patients during COVID 19 pandemic

Background: To evaluate the newly diagnosed bladder cancer(BC) patients during the pandemic period and compare them with the corresponding last4 years. Objectives: To document the time schedules of BC patient evaluation and define the possible delays and investigate the reasons. Methods: Newly diagnosed BC patients who underwent transurethral resection of bladder tumour in the last5 years were retrospectively included to study.The patients were divided into 5 groups.Group-1 was composed of patients diagnosed be-tweenMarch,1,2016-March-1,2017. The patients who were diagnosed in the further corresponding years formed group 2,3 and 4. The last group(Group-5) was composed of patients who were diagnosed during the pandemic period which was between March,1,2020 and March,1,2021. The clinicodemographic properties and diagnostic time schedules of the patients were com-pared between the groups. Results: There were56 patients in Group-1,60 patients in Group-2,61 patients in Group-3,68 patients in Group-4,and58 pa-tients inGroup-5. The mean hospital admission period was102.5 +/- 179.0days during the pandemic period which ranged be-tween24.5 +/- 32.0 and38.3 +/- 69.1days before thepandemic.(p=0.002)The diagnosis-anesthesia period was significantly higher during the pandemic pandemic period.(p=0.034) Conclusions: The pandemic period has caused some delays in the diagnosis and treatment of BC patients. Telemonitoring systems may be useful to prevent the possible diagnostic and treatment delays for newly diagnosed BC patients

The Use of an Anterior Abdominal Wall Peritoneal Flap in the Laparoscopic Repair of Vesicouterine Fistula

Vesicouterine fistula (VUF) is a rare type of genitourinary fistula. Lower-segment cesarean section is the leading cause of VUF. Patients mostly present with the classical triad of menouria, amenorrhea, and urinary incontinence, with the history of a previous cesarean section. Conservative management with catheterization and open, laparoscopic, and robotic surgeries are the prescribed treatment options. We present the case of a 35-year-old woman who presented with cyclical menouria and urinary incontinence. After diagnosis of VUF by cystoscopy, the laparoscopic approach was chosen. During the procedure, we used anterior abdominal wall peritoneum and adjacent adipose tissue interposition for the first time, instead of omental interposition, because of the unavailability of omentum. The postoperative period was uneventful, and the procedure was successful. In conclusion, the laparoscopic approach is feasible and the anterior abdominal wall peritoneal flap can be used instead of omentum for tissue interposition when the omentum is not available

EVALUATION OF THE ASSOCIATION OF PIGMENTARY MACULOPATHY IN PRIMARY BLADDER PAIN SYNDROME PATIENTS RECEIVING PENTOSAN POLYSULFATE SODIUM TREATMENT

Objective Primary bladder pain syndrome (PBPS) is characterized with suprapubic pain accompanied by at least one lower urinary tract symptoms including frequent urination, urinary urgency and nocturia for more than 6 weeks. While there are many alternative therapies for the treatment of PBPS, the only approved oral medication is PPS (pentosan polysulfate sodium). As it has been associated with retinal toxicity after its widespread use, this study aims to evaluate the relationship between PPS use and maculopathy. Material and Methods The patients diagnosed with PBPS between 2010 and 2020 who may only benefit from PPS use were included into the study after subgroup and phenotype assessment (urinary and non-ulcerative organspecific subgroups). In our study, patients who had history of degenerative maculopathy or diseases predisposing to maculopathy (age-related macular degeneration, diabetes mellitus, hypertension, chronic vascular disorders, central serous chorioretinopathy, retinal dystrophy, epiretinal membrane, and chronic exposure to hydroxychloroquine) were excluded to prevent possible misdirection. Patients underwent best-corrected visual acuity assessment using Snellen chart, anterior segment and fundus examination using slit lamp biomicroscopy, and intraocular pressure measurement. Color vision test (Ishihara test), posterior segment optical coherence examination and 10-2 visual field test were performed, and color images of the fundus and autofluorescence imaging were obtained. Best-corrected visual acuity, color vision results, macular, choroidal and mean retinal nerve fiber thicknesses, mean deviation of the visual field and fundus findings were recorded. Results Out of 15 patients included into the study, 4 (37.5%) were male and 11 (73.3%) were female. The mean age of the patients was 53.3±11.2 years. During the follow-up, the duration of oral PPS use was found to be 33.01±10.59 months, cumulative oral PPS dose to be 216.02±97.63 g and duration of diagnosis to be 66.64±39.37 months. The mean central macular thickness of the patients was measured to be 254.55±33.11 ?m, and the mean choroidal thickness to be 261.82±34.22 ?m. Mean deviation of the visual field of the patients was found to be -1.89 ±-1.25 dB. The mean retinal nerve fiber thickness was measured to be 98.1±17.62 ?m from the fundus autofluorescence images of the patients. Furthermore, in the present study, the ocular findings of the patients who are at below and above the mean cumulative dose and exposure period were compared. Conclusion This study detected no correlation between longterm PPS use and maculopathy. When forming the patient group; it is crucial to exclude patients with comorbidities such as diabetes mellitus and hypertension, and to form a homogeneous group by phenotype and subgroup assessment. Randomized, prospective, multi-center studies are needed to better assess this correlation

Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: A RIRSearch group study

Objective: To evaluate the effect of ureteral access sheath (UAS) use and calibration change on stone-free rate and complications of retrograde intrarenal surgery (RIRS). Methods: Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included. Firstly, patients were compared after 1:1 propensity score matching, according to UAS usage during RIRS (UAS used [+] 87 and UAS non-used [?] 87 patients). Then all UAS+ patients (n=481) were subdivided according to UAS calibration: 9.5–11.5 Fr, 10–12 Fr, 11–13 Fr, and 13–15 Fr. Primary outcomes of the study were the success and complications of RIRS. Results: Stone-free rate of UAS+ patients (86.2%) was significantly higher than UAS? patients (70.1%) after propensity score matching (p=0.01). Stone-free rate increased with higher caliber UAS (9.5–11.5 Fr: 66.7%; 10–12 Fr: 87.3%; 11–13 Fr: 91.3%; 13–15 Fr: 100%; p<0.0001). Postoperative complications of UAS+ patients (11.5%) were significantly lower than UAS? patients (27.6%) (p=0.01). Complications (8.7%) with 9.5–11.5 Fr UAS was lower than thicker UAS (17.3%) but was not statistically significant (p=0.08). UAS usage was an independent factor predicting stone-free status or peri- and post-operative complications (odds ratio [OR] 3.654, 95% confidence interval [CI] 1.314–10.162; OR 4.443, 95% CI 1.350–14.552; OR 4.107, 95% CI 1.366–12.344, respectively). Conclusion: Use of UAS in RIRS may increase stone-free rates, which also increase with higher caliber UAS. UAS usage may reduce complications; however, complications seemingly increase with higher UAS calibration. © 2022 Editorial Office of Asian Journal of Urolog

Effect of Mitomycin - C and Triamcinolone on Preventing Urethral Strictures

Urethral stricture is a common disease with high recurrence rate. Several manipulations were defined to prevent the recurrence but the results were disappointing. This study aimed to evaluate the efficacy of triamcinolone and mitomycin-C on urethral stricture formation and their effect on inhibition of urethral fibrosis. A total of 24 New Zealand rabbits were divided into 3 groups. Urethras of rabbits were traumatized with pediatric resectoscope. Resection area was irrigated with 10mL saline, swapped with a cotton wool soaked with 0.5mg/mL MMC and injected by 40mg triamcinolone in groups 1, 2 and 3 respectively. Retrograde urethrogram was performed at 28th day of procedure and the urethra was removed for histopathologic evaluation. There were significant differences in urethral diameters and in lumen reduction rate between the control and study groups (p< 0.001). Compared to control group, all treatment groups showed mild fibrosis, less collagen bundle irregularity, and lower numbers of fibroblasts (p= 0.003). The Tunnel assay showed that the number of apoptotic cells in the submucosal connective tissue was quantitatively higher in control groups (p= 0.034). In the view of efficacy and safety, MMC and triamcinolone have the potential to replace the use of stents, clean intermittent catheterization, or long term catheters following internal urethrotomy. There were no statistically significant differences between two agents in terms of preventing urethral stricture formation in the present study. Mitomycin C and triamcinolone decreased the recurrence rates of urethral stricture