Ultrasound-guided dorsal penile nerve block is a safe block in hypospadias surgery: A retrospective clinical study.

Caudal and dorsal penile nerve blocks are commonly used regional anesthesia methods in hypospadias surgery. Some studies have reported that regional anesthesia methods are risk factor for the development of postoperative complications following hypospadias surgery. The aim of the current study is to evaluate the relationship between postoperative complications and regional anesthesia methods used in distal hypospadias surgery. Forty-nine distal hypospadias patients were included. Patients had either received caudal or ultrasound (US)-guided dorsal penile nerve block. The age, type of hypospadias, regional anesthesia method, operation time, and postoperative complications were recorded. Fisher exact test and Mann-Whitney U tests were used to compare the data. Caudal epidural block was used in 25 (51%) patients and US-guided dorsal penile nerve block in 24 (49%) patients. There was no statistically significant difference between the groups regarding the types of hypospadias, operation time, and age. Fistula developed in 4 (16%) patients in the caudal block group and in none of the patients in the dorsal penile nerve block group. Fistula rates were statistically significantly different between the groups (P = .030). Conflicting data are found in the literature on the long-term postoperative complications of the regional anesthesia techniques used in hypospadias surgery. In our study, all patients with urethrocutaneous fistula were in the caudal block group. We believe that our study will contribute to the literature as it is the only study comparing caudal block with US-guided dorsal penile nerve block using in-plane technique in terms of postoperative complications in hypospadias surgery.

Dorsal Versus Ventral Dartos Flap to Prevent Fistula Formation in Tubularized Incised Plate Urethroplasty for Hypospadias.

PURPOSE: The purpose of this study is to evaluate the results of two different flap procedures for prevention of urethrocutaneous fistula in hypospadias patients undergoing tubularized incised plate urethroplasty . PATIENTS AND METHODS: We retrospectively reviewed 89 patients who underwent hypospadias repair. The standard technique of tubularized incised plate urethroplasty was used. There were 45 patients in Group 1 and 44 patients in Group 2, in which ventral and dorsal dartos flaps were used to cover the neourethra respectively. Surgical complications were assessed as the main outcomes. The results were analyzed with Chi-square and Mann-whitney u tests. RESULTS: There was no significiant difference between the groups in terms of age and meatus location. We observed postoperative surgical complications in 15 (33.3 %) patients in Group 1 and in 4 (9.1 %) patients in Group 2. The complications noted in the Group 1 were urethrocutaneous fistula in 10 patients ( 22.2 %) and meatal stenosis in 5 patients ( 11.1 %). In Group 2, fistula was observed in 2 patients (4.6 %) and stenosis in again 2 patients (4.6 %). Urethrocutaneous fistulas occurred statistically more frequently when ventral based dartos flaps were used (P < .05). CONCLUSION: Several flap procedures and their modifications have been suggested to avoid fistula formation. Within these procedures, dartos flaps are reported to be very useful for primary distal or proximal hypospadias repair and reoperations. In this study, we concluded that ; vascularized dorsal preputial dartos flap procedure is safe and more effective than ventral based flap in prevention of fistula formation.

Can serum Neutrophil Gelatinase Associated Lipocalin and Kidney Injury Molecule-1 help in decision making for surgery in antenatally dedected hydronephrosis.

INTRODUCTION: Congenital obstructive uropathies are among leading reasons for renal failure in children. Answers to questions such as what the critical threshold of obstruction is or which degree of obstruction disrupts the development of the kidney still remain unclear. Several biomarkers such as Kidney Injury Molecule 1 (KIM-1) and Neutrophil Gelatinase Associated Lipocalin (NGAL) may help clinicians in the clinical evaluation and appropriate planning of the disease. OBJECTIVE: This study aimed to investigate whether serum and urinary KIM-1 and NGAL levels contribute to conventional methods in decision-making for surgery in the postnatal period of infants with antenatal hydronephrosis. STUDY DESIGN: 34 patients with the diagnosis of antenatal hydronephrosis were evaluated prospectively. Renal pelvis diameters of all patients were above 10 mm in the ultrasonography (USG). Patients underwent diuretic renal scintigraphy after neonatal period. Patients were divided into two groups as surgery or follow-up based on USG and scintigraphy findings. Blood and urine samples were collected at first visits in both groups and again at the 3. Postoperative month in the surgery group. Serum and urinary NGAL and KIM-1 levels were measured by ELISA method. Study data were compared through the Mann-Whitney U and Wilcoxon Signed-Ranks test. RESULTS: There were 10 patients in the surgery group and 24 patients in the follow-up group. The age and gender did not differ between the groups. The surgery group had significantly higher median serum NGAL values (259.2 ng/mL) than that in the follow-up group (46.8 ng/mL, p = 0.028). The postoperative reduction of the median serum NGAL to 68.1 ng/mL compared to preoperative level was also found to be significant (p = 0.037) in the surgery group. Between the groups and within the surgery group no statistically significant difference was detected in terms of median urinary NGAL, and serum and urine KIM-1 levels. DISCUSSION: USG and renal scintigraphy are frequently used in determining whether patients with antenatal hydronephrosis need surgical intervention in the postnatal period. Several new biomarkers might help clinicians in decision making for surgery. KIM-1 and NGAL levels can be measured both in urine and serum. To our knowledge, this is the only study where serum NGAL and KIM-1 levels were measured in patients with antenatal diagnosis. Small sample size, lack of long term findings and control group are limitations of our study. CONCLUSION: Serum NGAL levels of patients with antenatal hydronephrosis may help in decision making on the surgical intervention.

A Comparison of the Postoperative Analgesic Effectiveness of Ultrasound-Guided Dorsal Penile Nerve Block and Ultrasound-Guided Pudendal Nerve Block in Circumcision.

AIM: The aim of this study was to compare the postoperative analgesic effectiveness of the 2 block types. We also aimed to evaluate the effect of these block types on the postoperative complications and parental satisfaction. MATERIALS AND METHODS: This prospective observational study was conducted between April and July 2019 at a training and research hospital. Patients aged between 5 and 12 years in the ASA I-II group, who were scheduled for circumcision, were included in the study. The primary outcome was the pain measured using the Children's Hospital Eastern Ontario Pain Scale and the Faces Pain Scale-Revised. The secondary outcomes were the postoperative complications and parenteral satisfactions. RESULTS: The number of patients receiving a pudendal block (n = 40) and dorsal penile nerve block (DPNB) block (n = 40) was equal. No statistically significant difference was found between the groups that were administered a DPNB and pudendal block in terms of pain scores (p > 0.05). We did not observe any postoperative block-related complications or side effects. Parents reported excellent satisfaction in both groups. DISCUSSION: Ultrasound (US)-guided pudendal nerve block and US-guided DPNB provided effective and long-lasting postoperative analgesia for circumcision surgery. CONCLUSIONS: This study has shown that both blocks provide postoperative analgesia with similar effectiveness and ensured a very comfortable period at the circumcision surgery. Clinicians can use either of these techniques depending on their clinical circumstances and experience.

Caudal epidural block versus ultrasound-guided dorsal penile nerve block for pediatric distal hypospadias surgery: A prospective, observational study.

BACKGROUND: The surgery of hypospadias is very painful in the postoperative period and requires long-term analgesia. A dorsal penile nerve block (DPNB) and caudal epidural block (CEB) are commonly used regional anesthesia techniques for postoperative pain control. OBJECTIVES: The primary aim of the prospective, observational study was to use the duration until the first postoperative analgesic requirement after two different block techniques to compare the analgesic effect. The secondary aims were to compare the two methods for postoperative Children's Hospital Eastern Ontario Pain Scale (CHEOPS) scores, complications and parental satisfaction level. STUDY DESIGN: This study was conducted with male patients aged 1-5 years in the ASA I-II group, who were scheduled for hypospadias surgery. A CEB or ultrasound (US)-guided DPNB with the in-plane technique was administered under general anesthesia before the operation. Postoperative analgesic need, postoperative pain, complications and parental satisfaction were noted. STROBE checklist was followed for reporting. RESULTS: The study was conducted with 26 patients in total, divided into 13 patients receiving CEB and 13 patients receiving DPNB. The mean CHEOPS score (p = 0.003) and 12th hour CHEOPS score (p = 0.003) were statistically significantly higher in the CEB group than the DPNB group. The need for additional postoperative analgesia was higher in the CEB group than the DPNB group (p < 0.001). No complications were seen in two groups. DISCUSSION: Dorsal penile nerve block with the US-guided in-plane technique provided effective and long-lasting postoperative analgesia for hypospadias surgery. CONCLUSION: The postoperative analgesia was better with DPNB than with CEB in hypospadias surgery, particularly in the first 12 h. Parental satisfaction was higher with DPNB thanks to the minimum postoperative analgesia requirement and lack of complications. CLINICALTRIALS. GOV IDENTIFIER: NCT04215874.

A comparison of the postoperative analgesic effectiveness of low dose caudal epidural block and US-guided dorsal penile nerve block with in-plane technique in circumcision.

BACKGROUND: Circumcision can be performed under sedo-analgesia, general anesthesia, or regional anesthesia. It may cause serious postoperative pain and patients often require additional analgesia. Dorsal penile nerve block (DPNB) and caudal epidural block are commonly used regional anesthesia methods to provide effective postoperative pain control in circumcision. OBJECTIVE: In this prospective observational study, we aimed to investigate the postoperative analgesic efficiency of DPNB with the ultrasound (US)-guided in-plane technique and single-dose caudal epidural block in circumcision. STUDY DESIGN: Male patients aged 4-12 years in the ASA I-II group, who were scheduled for circumcision, were included in the study. A caudal epidural block or US-guided DPNB with the in-plane technique was administered under general anesthesia before the operation. Postoperative pain was evaluated using the Children's Hospital Eastern Ontario Pain Scale (CHEOPS) and Faces Pain Scale-Revised (FPS-R). Postoperative analgesic need and parental satisfaction were also noted. RESULTS: There were 140 patients in our study. The number of patients receiving a caudal block (n = 70) and DPNB block (n = 70) was equal. Side effects were only seen in five patients in the caudal group. No side effects were seen in patients in the DPNB group. Analgesics were required in 3.6% of the patients in the caudal group and none of the patients in the DPNB group postoperatively. CHEOPS mean scores in the caudal block group were found to be statistically significantly higher than in the penile block group. FPS-R 24th. hour mean score was statistically significantly higher in the caudal block group (P < 0.001). Postoperative parental satisfaction in the penile block group was found to be statistically significantly better than in the caudal block group (P = 0.028). DISCUSSION: This study demonstrated that DPNB conducted with the US-guided in-plane technique was more effective than caudal block in providing postoperative analgesia. The parental satisfaction was also higher, and no side effect was seen in the DPNB group. CONCLUSION: DPNB conducted with the US-guided in-plane technique is a simple and safe regional anesthesia method used to provide effective postoperative analgesia for male circumcision. Complications related to DPNB can be prevented with the help of the real-time imaging provided by ultrasound.

Effectiveness of endoscopic balloon dilatation in grade 2a and 2b esophageal burns in children.

PURPOSE: To evaluate the predictability of the initial endoscopic evaluation of the effectiveness of endoscopic balloon dilatation (EBD) in childhood esophageal strictures caused by corrosive ingestion. MATERIAL AND METHODS: Medical records of 635 endoscopies caused by corrosive ingestion between January 2000 and December 2015 in children between the ages of 0 and 18 years were retrospectively analyzed. Among them, five children with grade 2a and 15 with grade 2 b who developed esophageal strictures were evaluated for the effectiveness of endoscopic balloon dilatation. RESULTS: The stricture rate was 5/136 (3.6%) in grade 2a and 17/25 (68%) in grade 2 b esophageal burns. Strictures with grade 2a burn had seven (1-10) EBD sessions, and grade 2 b had 8.8 (1-30) EBD sessions. For grade 2a burns, the treatment period was 15 months and 18.8 months for grade 2 b burns. Three patients with grade 2 b and two patients with grade 2a are still on the EBD program. CONCLUSION: Initial endoscopy for caustic ingestion and esophageal injury grading may help to provide healthcare givers with information about future stricture formation and management.

A Diagnostic Dilemma for the Pediatrician: Radiolucent Tracheobronchial Foreign Body.

BACKGROUND: The purpose of this study is to determine the role of clinical history, physical examinations, and radiological findings in the evaluation of patients with suspected radiolucent foreign body aspiration. METHODS: The medical records of 236 children (under the age of 18 years), on whom a rigid bronchoscopy was performed between 1999 and 2015 because of suspected radiolucent foreign body aspiration, were analyzed retrospectively. Sensitivity, specificity, positive and negative predictive values of clinical history, physical examinations, and radiological findings were evaluated. RESULTS: In 71.1% of all cases, the children were under the age of 3 years. The bronchoscopy showed the presence of a foreign body in 52.9% of cases, with the locations of the foreign bodies being as follows: (1) right main bronchus, 47.2%; (2) left main bronchus, 36.0%; (3) trachea, 11.2%; (4) both bronchi, 5.6%. Organic foreign bodies were found in 78% of the patients, whereas inorganic foreign bodies were detected in 22% of the patients. The sensitivity and specificity of clinical history, physical examinations, and radiological findings were 98.4% and 54.9%, 47.2% and 74.7%, and 35.2% and 92.7%, respectively. CONCLUSION: Tracheobronchial foreign body aspirations usually occur prior to the age of 3 years, with the most frequently aspirated foreign bodies being food or items of a radiolucent nature. Clinical history, physical examinations, and radiological findings are not able to detect the presence of a radiolucent foreign body aspiration in children. Therefore, a bronchoscopy should be performed on children in whom a choking event has been witnessed, even in cases of normal radiological and clinical findings.

Unusual complication of a urinary stone in a child: spontaneous rupture of the renal pelvis with the migration of calculus into the retroperitoneum.

Spontaneous perforation of the renal pelvis and extravasation of urine into the perinephric space is an extremely rare condition in childhood. It is mostly related to underlying congenital urinary tract abnormalities and caused by urolithiasis or infection in the setting of urinary obstruction. Here, we report a case of an 18-month-old female patient with rupture of the renal pelvis by an extruded kidney stone and its management.

Dangerous Toys for Teenagers: Air Weapons.

INTRODUCTION: Air weapons are used for sport, hunting, firearm training or just for fun, especially by teenagers, worldwide. These weapons are generally regarded as toys, and injuries from these weapons are thought to be harmless by users, parents and even officials. Improvements in weapons technology make the penetration power of these toys similar to conventional hand guns. To increase awareness about the serious injuries associated with these guns. CASE PRESENTATION: The medical records of four teenage boys shot by air weapons between January 2012 and January 2013 in Mersin, Turkey, were retrospectively reviewed in this study. Of the four boys, two needed prompt thoracic intervention due to pneumo/hemothorax, one needed urgent abdominal exploration due to pneumoperitoneum and bleeding from the spleen and one was treated conservatively. CONCLUSIONS: Air weapons can cause serious injuries among children. Increased public awareness, limitations to their usage and strict legislation are needed to protect children.

Pyocalycosis: a report of two cases of complicated hydrocalycosis.

Hydrocalycosis is defined as cystic dilatation of a major calyx with a demonstrable connection to the renal pelvis and an epithelial lining of the cyst wall. Although this condition has long been known, there are no sufficient data concerning this pathology in the literature. In this study, we present two complicated hydrocalycosis--'pyocalycosis'--and discussed the therapeutic approaches.