Low-Grade Injury following Testicular Torsion: A Multicenter Study Confirming a Disturbing Possibility.

INTRODUCTION: There is an ongoing debate whether to perform orchiectomy or orchidopexy following testicular torsion (TT) in cases where the testis seems non-viable. The main problem is lack of objective criteria defining testicular viability. The aim of this study was to investigate the grade of injury in orchiectomy specimens obtained from cases of TT and its association with clinical findings. METHODS: This multicenter retrospective study involved double-blinded reassessment of the patient files and the pathological specimens using Mikuz classification to analyze the relation between clinical and pathological findings. RESULTS: A total of 289 patient charts from 14 centers were reviewed and 228 were included in this study. Twenty (8.8%) patients had grade 1 injury which refers to reversible injury. The clinical findings of these 20 patients were compared to 208 patients with higher grades of injury. As expected, there was statistically significant difference regarding duration of symptoms (p < 0.001); however, range was wide in both groups (as long as 96 h for grade 1 and as short as 7 h for higher grades). There was no statistically significant difference in any other variable including age (median 14 for both, p = 0.531), symptoms (pain: 19/20 vs. 189/202, p = 0.801; swelling: 13/19 vs. 168/197, p = 0.094), absence of blood flow in Doppler US (15/19 vs. 164/197, p = 0.635), or degree of torsion (median 720° for both, p = 0.172). CONCLUSION: Our study revealed necessity for better criteria to define viability of testis following TT. Histopathological injury appeared to be reversible even in some patients with more severe perioperative findings, late admission, or high degree of twisting. Our findings support the tendency for testicular fixation instead of orchiectomy as none of the clinical or perioperative findings could be attributed to high-grade injury.

Perianal abscess in children: an evaluation of microbiological etiology and the effectiveness of antibiotics.

PURPOSE: We aimed to evaluate the demographic characteristics of children with perianal abscess, distribution of microbiological etiology, antibiotic susceptibility, and identify the effectiveness and coverage of antibiotics due to culture results. METHODS: A retrospective study was designed to evaluate pediatric patients with perianal abscesses between January 2013 and December 2022. RESULTS: A total of 197 episodes in 135 patients were evaluated. The median age of the patients was 10 months (22 days-17 years). The isolated microorganisms were Gram-positive bacteria in 56 (28.4%) patients and Gram-negative bacteria in 141 (71.6%) patients. The most common isolated species was Escherichia coli (n = 70, 35.5%), followed by Klebsiella spp. (n = 48, 24.4%), Staphylococcus aureus (n = 37, 18.9%), and Enterobacter spp. (n = 9, 4.5%). Forthy-two percent (n = 58) of isolates were positive for extended-spectrum beta-lactamase, 8% (n = 11) were carbapenem-resistant in Gram-negative bacteria, and 37.5% (n = 21) were methicillin-resistant, 7.1% (n = 4) were vancomycin-resistant in Gram-positive bacteria. According to bacterial culture results, ertapenem plus glycopeptide had the highest antimicrobial coverage rate (92.3%), followed by ertapenem plus clindamycin (89.8%), ertapenem (81.7%), third-generation cephalosporin plus glycopeptide (82.2%), third-generation cephalosporin plus clindamycin (69.5%). CONCLUSION: Ertapenem can be a good choice in the empirical treatment of perianal abscesses in children due to its high coverage rate.

Early endoscopic injection may prevent new scarring in idiopathic detrusor overactivity disorder with vesicoureteral reflux in children.

OBJECTIVE: To present baseline characteristics and the long-term treatment results of three groups of patients with idiopathic detrusor overactivity (IDOD) and vesicoureteral reflux (VUR) according to different treatment regimens, which underwent endoscopic subureteric injection (STING) in the early phase of targeted treatment (TT) (ES group), underwent STING in the late phase of TT (LS group) and with TT only (TT group). PATIENTS AND METHODS: A total of 49 IDOD cases with VUR which were divided into three groups according to treatment regimens were evaluated in terms of age, symptoms, bladder capacities, involuntary contraction pressures (ICP), presence and degree of renal scar, differential renal functions (DF), new scar formation and STING success. RESULTS: There was no significant difference between the groups in terms of age, side, symptoms, presence of urinary tract infection (UTI), DF, ICP and bladder capacity at diagnosis. A high grade of reflux was found to be significantly lower in the TT group (p = 0.037). There was no significant difference in terms of ICP, DF, bladder capacity and reflux grade between ES and LS Group. But new scar formation was more in LS Group (p = 0.003). CONCLUSION: The STING success is satisfactory in IDOD cases with VUR, waiting a long period of time for diminishing symptoms may cost new scar formation.

Multidisciplinary treatment for a patient with Pentalogy of Cantrell in the COVID-19 pandemic.

In this article, we present a multidisciplinary approach for the treatment of a patient with Pentalogy of Cantrell, dextrocardia, perimembranous ventricular septal defect, secundum atrial septal defect, pulmonary valvular stenosis, and left ventricle diverticulum during the novel coronavirus disease 2019 pandemic.

Is cortical transit time a parameter to prove relief of obstruction after pyeloplasty in antenatally diagnosed ureteropelvic junction obstruction.

PURPOSE: The study aims to determine the possible improvement in cortical transit time (CTT) after surgery in infants with antenatally diagnosed ureteropelvic junction obstruction (UPJO), and investigate the correlation of CTT with preoperative renal function and parenchymal thickness. PATIENTS AND METHODS: Medical charts of 32 antenatally diagnosed children with UPJO operated on between 2014 and 2021 were reviewed. Patients' demographics, preoperative and postoperative anteroposterior diameter (APD), parenchymal thickness (PT) ratio, differential renal function (DF), drainage patterns and CTT were compared to determine operative benefit. Preoperative CTT of each patient was also grouped as severely delayed (> 6 min) and moderately delayed (3-5 min) and compared. The correlation between the preoperative CTT and preoperative DF and PT ratio was investigated. RESULTS: The median age of the patients was 8.8 months (1-24 months). The CTT (mean: 6.8 ± 3.0 min) was prolonged before surgery and was significantly improved (mean 4.6 ± 1.0 min) after the operation (p < 0.001). A significant negative correlation was detected between the CTT and preoperative DF and between the CTT and preoperative PT ratio. Preoperative DF was found significantly impaired in patients within the severely prolonged CTT group compared to those within the moderately prolonged CTT group. Significant improvement in DF was detected in patients in the severely prolonged CTT group after surgery. CONCLUSION: CTT is a parameter to prove relief of obstruction in patients with antenatally diagnosed UPJO after surgery. CTT is negatively correlated with preoperative DF and PT ratio. Severely prolonged CTT may be considered to be an indication of early surgical intervention.

Can deciphering the growth of Meckel's diverticulum help us to decide the resection technique?

Introduction: The employment of laparoscopic surgical techniques has reignited the debate on managing Meckel's Diverticulum (MD) due to its low complication rates. Nevertheless, concerns have been raised regarding completely removing any potential heterotopic mucosa. Our study aimed to compare surgical approaches in MD and assess the effectiveness of simple diverticulectomy. Methods: Between 2003 and 2022, 139 patients with MD were retrospectively analysed. The study examined the morphometric measurements of the diverticulum and the location of the heterotopic mucosa in the diverticulum regarding growth and symptoms. Results: Simple diverticulectomy achieved the lowest postoperative complication rate among excision techniques (p = 0.03). MD's length, diameter, and distance to the ileocecal valve increase linearly with growth in the first three years of life (p = 0.00, p = 0.01, p = 0.00) but not in subsequent years (p = 0.81, p = 0.43, p = 0.21). As the length of the MD increases, the heterotopic mucosa (HM) is displaced distally (p = 0.01). Patients in whom HM reaches the base of the diverticulum always present with bleeding (p = 0.02). Discussion: Simple diverticulectomy is a safe technique for Meckel's diverticulum resection. Meckel's diverticulum continues to grow until the age of 3. With this growth, the heterotopic mucosa is displaced distally and moves away from the base of the diverticulum. Bleeding is the main symptom in patients with HM reaching the base of the diverticulum. In patients with bleeding or younger than three years of age, simple diverticulectomy may not be considered safe.Level of Evidence: III.

Postoperative recurrent tracheoesophageal fistula: an unusual complication of oxidized regenerated cellulose (Surgicel®).

Oxidized regenerated cellulose (Surgicel(®)) is a commonly used material in Pediatric Surgery. We present a case of recurrent tracheoesophageal fistula (RTEF) repaired by Surgicel(®). In this case, tracheoesophageal fistula (TEF) recurred due to migration of Surgicel into the tracheal and esophageal lumen.