Tourniquet and adrenaline use in hypospadias surgery: a survey on the current practice in Turkey.

OBJECTIVE: Aim of the study is to determine the hemostatic techniques among pediatric urologists in Turkey. MATERIAL AND METHODS: Questionnaire forms were sent to 459 pediatric urologist by e-mail. RESULTS: Ninety eight of 459 participants answered the questionnaire forms. Eighty-one (84.4%) of the participants were using tourniquet. The participants who didn't use tourniquet stated their justifications as follows: lack of need (n=10: 66.7%), development of edema, ischemia, delay of wound-graft healing and fistula risk (n=5: 33.3%). The indications of tourniquet use were stated as follows: penile (91.4%: n=74), distal (72.8%: n=59), penoscrotal (55.6%: n=45) hypospadias; fistula repair (33.3%: n=27), cripple hypospadias (33.3%: n=27), repair with flaps (30.9%: n=25), repair with grafts (27.2%: n=22), and isolated penile curvature (21%: n=17). Most commonly used tourniquet material (49.9%) was latex glove. Erection test was applied by 43.8% of participants. Scalp vein set was the most commonly (54.8%) used injector during erection test. Only 9.4% of participants were using adrenaline. Adrenaline dosages used at 1/100.000 dilution by 55.6%, lidocaine with 1/100.000 adrenaline by 44.4% of participants. CONCLUSION: Beside a few experimental ones there is a paucity of studies that can serve as a guideline for using these techniques in the literature. There is a necessity of realizing prospective, randomized studies with long-term follow up to evidence that postoperative complications could develop secondary to hemostatic techniques and also to facilitate safe use of these techniques.

Stuck tunneled central venous catheters in children: Four cases removed by angiography assistance.

Ates U, Tastekin NY, Mammadov F, Ergün E, Göllü G, Can ÖS, Uçar T, Bingöl-Kologlu M, Yagmurlu A, Aktug T. Stuck tunneled central venous catheters in children: Four cases removed by angiography assistance. Turk J Pediatr 2018; 60: 221-224. Adherent tunneled catheters can usually be removed by a surgical cut down, but in some cases the line can become stuck to the wall of the central veins. In such cases, forceful traction can cause vascular injury, or fracture of the catheter. We present four cases of fixated cuffed tunneled catheters. Three children had acute lymphoblastic leukemia and one had an immunodeficiency syndrome. All catheters were made from polyurethane. Indwelling times were 12-24 months. All patients` catheters were removed with great difficulty by trans-femoral access. The angiography-assisted technique is safe and easily-applied for the removal of stuck catheters in pediatric patients. These cases raise important questions concerning the maximum indwelling time and the choice of catheter material when implanting permanent central venous catheters (CVCs) in children.

Laparoscopic Gastrostomy in Children: 10 Years of Experience.

OBJECTIVES: Laparoscopic gastrostomy is a widely used procedure in children with failure to thrive, feeding disorders, or neurologic impairment. Various methods of laparoscopic gastrostomy and fixing stomach to abdominal wall have been described. Trocar site primary gastrostomy under laparoscopic control is a simple and easy technique that does not require special instruments and a kit. The aim of this study was to present 10 years of experience in laparoscopic gastrostomy. METHODS: The charts of 128 children who underwent laparoscopic gastrostomy between 2006 and 2016 were retrospectively reviewed. The data, including demographics, operative procedures, and complications, were recorded. All children underwent preoperative contrast imaging and 24-hour Ph monitorization. In all patients, the trocar site primary gastrostomy was done. A gastrostomy tube or a button was inserted into the stomach in the center of a purse-string suture loop, and the stomach was fixed to the anterior rectus sheath extracorporeally. RESULTS: There were 49 girls (38.3%) and 79 boys (61.7%). The mean age was 50 months at surgery (1 day-18 years), and the average body weight was 13 kg (2300 gr-65 kg). Both laparoscopic Nissen fundoplication and gastrostomy were done in 116 (90.6%) patients, and 12 (9.4%) patients had only laparoscopic gastrostomy. Infection at the site of gastrostomy, which was treated by antibiotics, was the most common complication, observed in 14 (11%) patients. Peritoneal leakage within 30 days was seen in 9 (7%) patients. Severe dislodgement of gastrostomy resulting in operative intervention occurred in 5 (3.9%) patients. Granuloma developed in 4 (3.1%) patients and was treated with silver nitrate. CONCLUSION: The trocar site primary laparoscopic gastrostomy is a safe and easy technique with complication rates comparable to other gastrostomy methods.

Urethral Calculi in a 7-Year-old Boy Presenting as a Large Scrotal Mass After Surgery of Exstrophy-epispadias Repair.

Urethral calculi are extremely rare in pediatric population and are usually presented with dysuria, hematuria, lower urinary tract obstruction, and rarely as a scrotal mass. We here report a giant primary urethral stone presenting as a scrotal mass that developed in the penile urethra resulting from a postsurgical complication of exstrophy-epispadias repair. A 7-year-old boy was admitted with the complaint of scrotal mass and dysuria. Computerized tomography confirmed giant urethral stone impacted to diverticulum of urethra. Cystoscopy revealed a nonobstructed stone in the urethra related to a posterior diverticulum. After scrotal incision, stone was removed with open diverticulectomy.