The association of meatal stenosis and infant circumcision.

BACKGROUND: The association of meatal stenosis with age at circumcision is controversial. We noticed a high rate of meatal stenosis in a region where early circumcision is traditional. The aim of this study is to compare the age at circumcision between boys with or without meatal stenosis. METHODS: After ethical approval, families of children with meatal stenosis were questioned about age at circumcision and reason for circumcision. Control group consisted of patients with diagnoses other than penile abnormalities, a normal urethral meatus, and having no symptoms about urination. Patients with a history of therapeutic circumcision were excluded from the study. RESULTS: Between November 2016 and November 2020, 115 patients with meatal stenosis were admitted. All were corrected with ventral meatotomy under general anesthesia. Median age at circumcision was 3 (min:0-max:111) monthsand age at admission was 74 (min:22-max:194) months. Control group consisted of 205 boys. Median age at circumcision was 5 (min:0-max:122) months and age at admission was 96 (13-202) months. There was a statistically significant difference between groups in terms of age at circumcision (p=0.024) but none for age at admission (p=0.356). There was a twofold increase in the meatal stenosis rate (39% vs. 23%) if circumcision was performed before age one (p=0.018). There was no difference between the patients circumcised in the newborn period and later (38% vs 36%, p=0.778). CONCLUSIONS: Our study supports the previous reports suggesting a relation of risk for meatal stenosis and age at circumcision and presents data that age one might be a cutoff for this risk.

Dorsal Dartos Flap Prepared Before Urethroplasty, Less Bleeding of Operation: A New Perspective on Hypospadias.

BACKGROUND: The benefits of preparing the dorsal dartos flap before urethroplasty were investigated. MATERIALS AND METHODS: Patients with coronal, subcoronal, and distal penile hypopadias without severe cordee who underwent surgical repair between October 2016 and September 2020 were included in the study. Tubularized incised plate urethroplasty technique was applied to all patients. The patients were divided into two groups: In Group 1, the dorsal dartos flap was prepared after urethroplasty, which is the commonly used technique today, and sutured on the neourethra. In Group 2, the dorsal dartos flap was prepared before the post-degloving urethroplasty. The amount of bleeding, the duration of the surgery, and the complications between the two groups were recorded and compared. RESULTS: Twenty-two patients who could be followed up for at least 3 months were examined. There were 10 patients in Group 1 and 12 patients in Group 2. A statistically significant difference was found between the amount of bleeding of the operation in the two groups. Duration of operation, hematoma, infection, skin necrosis, or glanular dehiscence were not observed in any patient. CONCLUSIONS: Preparing the dorsal dartos flap, before urethroplasty significantly reduces the amount of bleeding. This may be a new modification alternative in hypospadias surgery.

Does desmopressin withdrawal strategy affect relapse rates in monosymptomatic enuresis treatment?

Desmopressin plays a major role in the treatment of monosymptomatic enuresis but has the drawback of a high relapse rate after medical treatment. This study investigated the effect of the type of treatment termination on relapse in a large population of patients. A total of 1013 patients who were admitted with bedwetting to our paediatric urology clinic between October 2016 and April 2018 were evaluated retrospectively. Four hundred forty-seven monosymptomatic enuresis patients were treated with 120 µg/day oral desmopressin lyophilisate for 3 months, after which the treatment was terminated in one of two ways: immediate cessation of desmopressin (group 1; N = 209) and structured withdrawal (group 2; N = 238). In the structured withdrawal group, the patients continued to take desmopressin every other day for 15 days. All the patients were followed up 1 month after the drug was withdrawn, and the relapse rates were recorded. One month after cessation of treatment with oral desmopressin lyophilisate, the relapse rate in group 1 was 42.5% (89/209), and that in group 2 was 41.1% (98/238) (p > 0.05).Conclusion: This study, with the highest number of patients among reports in the literature, revealed that the methods used to terminate desmopressin treatment are not significantly different in monosymptomatic enuresis management. What is Known: • It is still unclear how to end the treatment in patients who are started desmopressin because of the complaint of monosymptomatic nocturnal enuresis. • Although there are papers in the literature suggesting that the drug should be discontinued gradually or by reducing the dose, there are also authors stating the opposite. What is New: • This study including vast amount of patients managed with desmopressin reveals that withdrawal strategy has no impact on relapse.

Non-Invasive Stent Removal after Ureteroneocystostomy in Pediatric Patients: Long-Term Results.

OBJECTIVE:  Among the more serious problems in urological interventions among the pediatric age group is the requirement of general anesthesia. The advantages of removing a double-J stent (DJS) without anesthesia in ureteroneocystostomy (UNC) operations among children were investigated in this study. PATIENTS AND METHODS: In all, 25 patients who underwent UNC surgery between November 2016 and November 2018 were retrospectively divided into two groups according to the method used for the removal of the DJS. In Group 1, the stent was tied to the urethral catheter by a suture and retrieved postoperatively on the fourth day without anesthesia and cystoscopy. In Group 2, we inserted the stent according to the classical method with no suturing to the catheter and removed it 3 to 4 weeks after the first operation, with cystoscopy under anesthesia. RESULTS: A total of 16 girls and 9 boys were included in the study. The mean age was 4.3 and 6.3 years in groups 1 and 2, respectively. We did not observe statistically significant difference between the groups in long-term renal function or hydronephrosis regression. CONCLUSION: We consider that the removal of a stent placed in pediatric intravesical UNC operations without anesthesia and cystoscopy is less invasive and affords safety and long-term results comparable to the standard method.

Management of lower pole renal stones: the devil is in the details.

Shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and minimally invasive percutaneous nephrolithotomy (MIP) are highly effective treatment options for lower pole stones up to 2 cm. Selecting the best treatment modality represents a controversial area in urology, because each treatment methods have their own advantages and disadvantages. Donaldson and co-workers have recently published a very comprehensive review and meta-analysis to compare the benefits and harms of SWL, RIRS and PNL techniques.

Sleep analysis of patients with nocturia and benign prostatic obstruction.

OBJECTIVE: To analyze the timing of nocturia during sleep and its effect on sleep quality using the polysomnography (PSG) findings from patients with benign prostatic obstruction. METHODS: From August 2009 to August 2010, 20 patients diagnosed with benign prostatic obstruction were enrolled in the present study. The sleep evaluation was performed by PSG. The Epworth index was used to evaluate the sleepiness of the patients. The effect of nocturia on sleep quality is evaluated by sleep efficacy, total sleep time, and rapid eye movement sleep duration, calculated from the hypnograms derived from the polysomnograms. RESULTS: The mean age, total International Prostate Symptom Score, nocturia frequency on International Prostate Symptom Score, and frequency of nocturia recorded during PSG was 60.4 ± 8.5 years (range 44-74), 19.3 ± 4.9 (range 10-28), 3.5 ± 1.05 (range 2-5), and 1.35 ± 1.2 (range 0-4), respectively. In 6 patients (30%), the Epworth sleepiness score was pathologic (score >8). Nocturia correlated positively with increased daytime sleepiness, however it did not correlate with sleep efficacy or total sleep time. These parameters were affected by the apnea-hypopnea index, the major determinant of obstructive sleep apnea. Of the 20 patients, 14 (70%) experienced nocturia during PSG, and in these patients, we recorded 23 nocturia episodes that mostly occurred in the superficial sleep stage (16 [70%] of 23). Only 7 nocturia episodes (30%) occurred in the deep sleep stage. The sleep quality of patients with deep sleep nocturia did not differ from that of patients with superficial sleep nocturia. CONCLUSION: The results of our study have shown that nocturia predominantly occurs during the superficial sleep or rapid eye movement stage and is related to increased daytime sleepiness in patients with benign prostatic obstruction. The timing and frequency of nocturia had no significant affect on sleep quality; however, the presence of obstructive sleep apnea negatively interfered with these parameters.