Is the Reference Electrode Location Important for the Electromyography Evaluation of the Pelvic Floor in Urodynamic Studies?

PURPOSE: Perineal electromyography (EMG) is a crucial part of urodynamic studies. Many researchers focused on the standardization of techniques in urodynamics, but no study has yet evaluated the differences with various reference electrode placements. The aim of this study was to determine the optimal placement of the reference electrode for recording pelvic floor activity in urodynamic studies. METHODS: Children over 6 years of age without anatomic or neurological abnormalities were invited to participate in the study. Four reference electrodes were placed on the right kneecap, the inner surface of the right inner thigh, the right anterior iliac spine (AIS), and the skin over the left gluteal muscles for simultaneous recording. The EMG signal formed by pelvic contraction during forceful straining was recorded both in the supine and sitting positions. The root mean square (RMS) value of each muscle contraction signal was calculated. RESULTS: Twenty-one participants (10 boys and 11 girls) were included. The mean age was 10.19±3.20 years. The highest RMS values were obtained with the reference electrode on the thigh in the supine position and the AIS in the sitting position. Significant differences were found between the mean RMS values of the knee and other locations of reference electrodes in the supine position, as well as between mean RMS values in all regions except the thigh and gluteus in the sitting position. The minimum mean RMS values in both positions were obtained with the reference electrode on the knee. CONCLUSION: During urodynamic studies, reference electrodes shall be placed on AIS in the sitting and on the inner thigh in the supine position. The knee is not a suitable option for reference electrode placement. This information may help improve EMG recordings in the evaluation of pelvic floor muscles.

Central Precocious Puberty Secondary to Adrenocortical Adenoma in a Female Child: Case Report and Review of the Literature.

BACKGROUND: Pediatric adrenocortical tumors are rare but significant causes of virilization and peripheral precocious puberty (PPP). CASE: A 4-year-old girl presented with development of breast, pubic hair, and facial acne. Her bone age was advanced, and her gonadotropin level did not elevate in a gonadotropin-releasing hormone (GnRH) test. High levels of dehydroepiandrosterone sulfate, estradiol, and testosterone, and detection of a tumor in the left adrenal gland of the abdomen using computed tomography led to a diagnosis of PPP due to adrenal tumor. Adrenal adenoma was diagnosed with pathology after the tumor was removed. Ultrasonography detected multicystic ovaries before surgery. Although the androgen levels decreased, high estrogen levels persisted after complete tumor resection. Approximately 1 year after the surgery, the patient's breast development persisted, bone age progressed rapidly, and gonadotropin levels increased in a GnRH test. Central precocious puberty was diagnosed, and treatment with GnRH analogues was started. SUMMARY AND CONCLUSION: Adrenal adenoma might present with isosexual PPP as well as virilization in girls. The ovaries should be carefully assessed in these patients. Prolonged exposure to androgen and estrogen might cause ovarian multicysts leading to persistence of high estrogen levels and initiation of central precocious puberty.

Sonic hedgehog, TBX18, and TSHZ3 proteins involved in pyeloureteral motility development are overexpressed in ureteropelvic junction obstruction. An immunohistochemical, histopathological, and clinical comparative study.

OBJECTIVES: To compare pathological samples obtained from cases that underwent surgery for ureteropelvic junction (UPJ) obstruction with samples obtained during autopsies of subjects.  METHODS: Retrospectively, 42 patients who had undergone surgery due to UPJ obstruction (group 1) were included in the study. Histopathological and immunohistochemical features for sonic hedgehog (SHH), TBX18, and TSHZ3 of UPJ were evaluated and findings were compared with 20 autopsy cases (group 2).  RESULTS: In group 1, the scores were statistically significantly higher in terms of cytoplasmic SHH, nuclear TBX18, cytoplasmic and nuclear TSHZ3 staining. Statistically, no correlation was found between age and the staining scores belonging to these 3 antibodies in group 1 and group 2. Intense inflammation was found to be related with nuclear staining for TBX18.  CONCLUSION: Gene product expressions of SHH, TBX18 and TSHZ3 are statistically higher in patients with UPJ obstruction, when compared with control group. The explanation may be the reactivation of the processes, which had shown their effects in the embryological period, due to the chronic inflammation and long-term micro-trauma created by the disease.

Schwannoma Localized Retroperitoneally in a 14-Year-Old Boy.

Schwannomas usually occur in adults being between the second and fifth decades, and such neoplasms are extremely rare in a pediatric population. In addition, they are not normally found in the retroperitoneal region. Here, we present a pediatric case of a retroperitoneal schwannoma in an adrenal location where the tumor was not able to be preoperatively differentiated from other benign or malign adrenal gland tumors. In our opinion, this tumor can be included in the differential diagnosis of a nonfunctioning retroperitoneal adrenal mass in children.

A rare cause of glans penis masses in childhood: Fibroepithelial polyp.

Fibroepithelial polyps of glans penis are very rarely seen in childhood. A 6-month-old male admitted to our institution with a slowly enlarging glans penis mass on the ventral side of the glans penis. The mass was totally excised, and hystopathological diagnosis was a fibroepithelial polyp. All of the reported cases published previously, except one, are of adult age and all of them have been associated with the history of long-term condom catheter use. The presence of the case in childhood; however, suggests that the pathology might be congenital. This is the second pediatric case presented in the English literature.