How well do ESWL nomograms predict treatment success in pediatric patients?

OBJECTIVE: To study was to identify the variables that influence the outcomes of pediatric SWL patients in our clinic and to compare our findings to previously published nomograms. METHODS: All children who underwent SWL at a single center between 2005 and 2020 were included in this retrospective study. Depending upon the age and mental state of the children, SWL procedures were performed with or without anesthesia. Data from the hospital information system were obtained on patient characteristics, metabolic evaluation, imaging, SWL details, and post-procedure results, and their correlation with the Onal and Dogan nomograms was evaluated. RESULTS: The present study included 112 pediatric patients in total. The average age was 8.22 ± 4.9 (83.3 ± 58.1 months, 4 months-16 years), and the median stone size was 9.5 ± 3.2 mm (4-20 mm). Even though there was quite a significant positive correlation between age and the number of shots and the intensity of shots (intensity and number of shots increased with increasing age), there was no statistical difference in the number of sessions and stone-free rates. The number of shots and sessions was significantly lower in patients with hydronephrosis (N = 70) than in those without (N = 42) (p < 0.001). When the stone-free rates of patients without and with hydronephrosis were compared, it was discovered that they were 69.05% and 92.86%, respectively, which was statistically significant (p < 0.01). CONCLUSIONS: It is believed that the nomograms developed for SWL in pediatric patients should be reviewed, and larger, prospective studies should be conducted.

Comparing Crystallized Phenol and Surgical Excision Treatments in Pilonidal Sinus Disease.

OBJECTIVE: To compare the results of commonly used treatments (Karydakis Flap method and crystallized phenol application) in the treatment of pilonidal sinus. STUDY DESIGN: Comparative study. PLACE AND DURATION OF STUDY: Adana Seyhan State Hospital, Adana City Hospital, and Hisar Intercontinental Hospital Pediatric Surgery Clinic, from January 2016 to December 2020. METHODOLOGY: Patients who were treated for pilonidal Sinus and treated with surgical repair (karydakis flap method) and crystallized phenol method were included in the study. The efficacy and complications of both treatments were compared. RESULTS: Of the patients, 111 (34.7%) were treated with surgical repair, and 208 (65.3%) with the crystallized phenol method. Of the patients included in the study, 166 (52%) were male and 153 (48%) were female. The mean age was calculated as 15.5 (± 1.4). The mean hospital stay in the surgery group was 1.6 ± 0.4 days. The mean time to return to school was 2.8 ± 1.02 days in the phenol group and 12.3 ± 2.2 days in the Surgery group. Despite the third session of phenol application, recovery could not be achieved in 12 (5.7%) patients. Among those who had surgery, recurrence occurred in 7 (6.3%) patients and they had to be operated once more. CONCLUSION: Crystallized Phenol application can be applied in uncomplicated cases due to high success, low complication, rapid recovery, early return to daily activities. KEY WORDS: Crystallized phenol, Surgical treatment, Pilonidal sinus disease.

Comparison of hypochlorous acid and Povidone Iodine as a disinfectant in neonatal circumcision.

INTRODUCTION: Neonatal circumcision is a procedure used worldwide which has very low rates of complication if conducted by a specialist. The present research aims to examine the wound healing effects of Hypochlorous Acid (HCOL) and Povidone Iodine (PI) used as a disinfectant prior to the procedure of circumcision and their antibacterial effectiveness. MATERIAL AND METHOD: The findings of sixty infants subjected to neonatal circumcision at the Hisar Intercontinental Hospital between January 2021 and June 2021 were prospectively recorded. Based on the disinfectant used, the patients were divided into two group: Group 1 including 28 patients for whom HCOL was used as an antiseptic solution, and Group 2 including 32 patients to whom PI was administered. RESULTS: Group 1 was formed of 28 patients while Group 2 included 32 patients. The mean ages of each group was 15.46 ± 10.58 (2-29) and 12.63 ± 10.00 (2-28) days, respectively. When the complications were examined individually, no significant difference was found between the groups. However, when all complications were analyzed collectively, it was determined that there was a significant difference, and the complication rate of Group 2 was greater (p = 0.037). In Group 2, the rate of edema and wound healing delay was significantly greater than that of Group 1 (p: 0.037 p: 0.036) (Table 1). CONCLUSION: It was determined that HCOL is reliable to be used as a disinfectant prior to neonatal circumcision.

Desmopressin versus desmopressin + oxybutynin in the treatment of children with nocturnal enuresis.

INTRODUCTION: Enuresis is identified as voluntary or involuntary leakage of urine for at least three consecutive months in the daytime and/or nighttime on clothes for children older than five. Monosymptomatic nocturnal enuresis (MNE) describes nighttime wetting without daytime leakage of urine in children with no pathology in the urinary system and it is 80% more common than enuresis. Desmopressin is the most common medical treatment for MNE. The aim of this study is to retrospectively compare the effectiveness of desmopressin as monotherapy and desmopressin + oxybutynin as a combination therapy in the treatment of nocturnal enuresis. MATERIAL AND METHOD: This study retrospectively evaluated 183 patients who applied to pediatrics, pediatrics surgery and urology clinics with the complaint of nocturnal enuresis and diagnosed with primary monosymptomatic nocturnal enuresis between January 2014 and December 2019. The patients were divided into two groups (91 patients) who only received desmopressin therapy (Group 1), and those (92 patients) who received desmopressin and oxybutynin combination therapy (Group 2). Response to treatment, compliance and recurrence ratios were determined in the evaluation. Complete response was accepted as 90-100% decrease in the number of nighttime wetting, partial response was accepted as 50-90% decrease in the number of nighttime wetting and those below 50% were regarded as non-response. The 1st, 3rd, and 6th months of control data of treatment effectiveness of both groups were evaluated and their responses to treatment and the side effects of drugs were examined. RESULTS: The mean age 183 patients of whom 103 were male and 80 were female was 10 (6-16) year. In the first month of control of Group 1, 71.4% had a complete cure, 8.8% had a partial cure and 19.8% had no response to treatment. In the third month of control of Group 1, 74.73% gave a complete response and were cured, 5.5% gave a partial response and 19.78% had no response. In the sixth month of Group 1, 70 patients were evaluated as complete response (79.5%), and 5 patients were evaluated as partial response (5.6%). In the first month of control of Group 2, 75% gave a complete response, 10.9% gave a partial response, 14.1% had no response to treatment. In the third month of control of Group 2, 86.9% gave a complete response, 6.52% gave a partial response, and 6.52% had no response. In the sixth month of the control of Group 2, the number of patients who did not come for control and could not be reached was 2, 83 patients out of 90 patients were evaluated as complete response (92.2%), 6 patients were evaluated as partial response (6.6%). CONCLUSION: Desmopressin is the only FDA approved pharmacologic treatment for nocturnal enuresis. Desmopressin reduces urine production and the anticholinergic agent allows the bladder to store more urine. Therefore, combined therapy can be recommended in the MNE treatment for specially selected cases.

Reliability of thermocautery-assisted circumcision: retrospective analysis of circumcision performed voluntarily in countries of low socioeconomic status.

OBJECTIVE: The objective of this study was to evaluate the reliability of thermocautery-assisted circumcision performed voluntarily in patients of poor countries. MATERIAL AND METHODS: Between 2016 and 2019, 32,000 children aged 7 days to 17 years were circumcised in multiple countries. The patients' urological examinations were done before the administration of local anaesthesia. Patients revealed to have undescended testicle, inguinal hernia, hypospadias, varicocele, penile rotation anomaly, epispadias and infection were not circumcised. All procedures were performed under local anaesthesia by using thermocautery. Afterwards, mucosa and skin were sutured using absorbable suture and the circumcised penis was dressed. Patients were instructed to remove the dressing after 3 days. RESULTS: Bleeding, requiring surgical intervention and drug reactions were not observed. The most observed complication was mucosal oedema, which occurred in approximately one-quarter of patients (26%, 8320/32,000) and continued for 3-5 days after the surgery. The most serious complication was a trapped penis, which occurred in 25 patients (0.078%). In six (0.018%) cases, meatal stenosis developed. Wound infection developed in only 10 (0.03%) cases, through the formation of an aseptic environment. Penile adhesion was seen in 35 cases (0.1%) and improved with anti-inflammatory treatment without any surgical intervention. CONCLUSION: Thermocautery-assisted circumcision can be used as an effective, safe and useful technique with few complications and rapid healing rates.

Prevalence and associated factors of day wetting and combined day and night wetting.

BACKGROUND: This study was conducted to determine the prevalence of diurnal enuresis (DE) and its association with background variables among children aged 5-15 years living in Sivas and Kahramanmaras, Turkey. METHODS: The parents of 1,760 children voluntarily completed a questionnaire consisting of 42 items under supervision of a researcher. RESULTS: Overall, the reported prevalence of DE was 4.2%, with a tendency to decrease with increasing age and with no difference between genders. Smoking during pregnancy, delayed initiation and dealing with the child by punishment in toilet training, urination frequency, urgency, soiling, arousal difficulty, urinary infection history, lower school performance, poor social adaptation, wetting history in the family, were all significantly prevalent among diurnal enuretics (p < 0.05). Socioeconomic or sociodemographic factors based on families and stressful life events were not associated with DE (p > 0.05). 63.9% of all parents reported some level of concern about the wetting problem and 51.7% of the diurnal enuretics had previously visited a physician. CONCLUSIONS: The prevalence of DE in our sample is not too different from the prevalence rates reported previously from Turkey and other countries. This type of enuresis seems to be more associated with an organic neurological or urological disorder than is nocturnal enuresis.

Congenital scaphoid megalourethra: report of two cases.

Congenital megalourethra is a rare congenital malformation of the penile urethra. It is defined as the diffuse dilatation of the anterior urethra due to the absence of development of the erectile tissue of the penis. Since the initial description, nearly 80 cases with megalourethra have been reported in English literature. Congenital megalourethra has been classified into scaphoid and fusiform types and is usually associated with additional urinary tract and other system anomalies, irrespective of its type and severity. We report two rare cases of scaphoid megalourethra without any associated anomaly. A 13-year-old boy and an 8-month-old boy were admitted to the Department of Pediatric Surgery with complaints of penile swelling and dysuria since birth. Physical examination and retrograde cystourethrogram confirmed the diagnosis of congenital scaphoid megalourethra. Both patients underwent a reduction urethroplasty. They did well postoperatively and voided with a normal stream without any abnormality of the penile shaft.

Nonketotic Hyperosmolar Coma Associated With Splenic Rupture in Congenital Afibrinogenemia.

Nonketotic hyperosmolar coma is uncommon in children. Splenic rupture in congenital afibrinogenemia is also a rare event. The authors described a 5-year-old girl with congenital afibrinogenemia who presented with nonketotic hyperosmolar coma associated with spontaneous splenic rupture. Management consisted of correction of the nonketotic hyperosmolar condition and increasing fibrinogen concentration by blood products, followed by splenectomy, resulting in the survival of the patient.

Nonketotic hyperosmolar coma associated with splenic rupture in congenital afibrinogenemia.

Nonketotic hyperosmolar coma is uncommon in children. Splenic rupture in congenital afibrinogenemia is also a rare event. The authors described a 5-year-old girl with congenital afibrinogenemia who presented with nonketotic hyperosmolar coma associated with spontaneous splenic rupture. Management consisted of correction of the nonketotic hyperosmolar condition and increasing fibrinogen concentration by blood products, followed by splenectomy, resulting in the survival of the patient.