Efficacy of transcutaneous posterior tibial nerve stimulation in children with functional voiding disorders.

AIMS: To assess the efficacy of transcutaneous posterior tibial nerve stimulation (TPTNS) on functional voiding disorder (FVD) and investigate the utility of urine biomarkers (UBs: nerve growth factor, transforming growth factor-beta 1, and tissue inhibitor of metalloproteinases 2) in diagnosis and follow-up. METHODS: A total of 44 children were included to this randomized controlled trial prospectively. After randomization, 20 of 30 children with storage phase dysfunction those were unresponsive or noncompliant to medical treatment received TPTNS treatment (test group) and 10 children underwent TPTNS with no current (sham group) for 12 weeks. Fourteen healthy children constituted the nonsymptomatic group. UB levels, dysfunctional voiding and incontinence scoring system (DVISS), voiding diary, and quality of life (QoL) scores were assessed before and after treatment in the treatment groups. RESULTS: QoL scores, overall and day-time DVISS scores were significantly decreased in both sham and test groups (p < 0.05). In addition to these findings, the frequency of incontinence and urgency episodes were also significantly reduced (p < 0.05) in the TPTNS treatment group. This effect in the test group was still valid 2 years after intervention. There was no significant difference in UBs measurements between treatment and nonsymptomatic groups and between pretreatment and posttreatment measurements of test and sham groups. CONCLUSIONS: TPTNS is an efficient minimally invasive treatment in children with FVD who do not respond to medical treatment. TPTNS provides a significant improvement on episodes of frequency, episodes of incontinence, overall and day-time DVISS scores, and QoL scores. The effectiveness of treatment continues even at the end of the second year of intervention. UBs were not found to be predictive in terms of diagnosis and evaluating the treatment response.

Shockwave lithotripsy for kidney stones as a first-line therapy in children younger than 2 years.

BACKGROUND: The incidence of urolithiasis in children has risen worldwide over the last decades with geographical varieties. As pediatric patients begin forming stones earlier in life, they have high risk of recurrence. Extracorporeal shockwave lithotripsy (SWL) is a non-invasive treatment modality that is preferred in the management of pediatric stones. Reports about the safety and efficacy of SWL in patients younger than 24 months are scarce in the literature. OBJECTIVE: The aim of the study was to evaluate the effectiveness and safety of SWL in patients younger than 24 months. The authors also aimed to assess the validity of the Dogan nomogram in predicting stone-free rates. STUDY DESIGN: Between January 2009 and March 2019, data of 247 patients younger than 24 months at the time of SWL were retrospectively collected. Analysis was performed on 260 renal units. Success was considered in patients who were completely free of stones after the first session. RESULTS AND DISCUSSION: The female/male ratio was 103/157, with a median age of 15 (5-24) months, a median stone size of 8 (3-30) mm and a median follow-up period of 7 (3-20) months. Multiple stones and lower calyx stones were observed in 19.6% (51/260) and 23.4% (61/260) of patients, respectively. Complications were detected in 5.8% (15/260) of patients (9 with steinstrasse, 3 with UTI, 2 with vomiting, 1 with hematuria). After the first session, 56.9% (148/260) of patients were stone-free. Forty-six of the failed 112 first sessions underwent second session. A total of 5 patients had a third session. The efficacy quotient was 57%. On univariate analysis, younger age (≤16 months), single stone, small stone size (<10 mm), and non-lower pole location were significant predictors of stone clearance. On multivariate analysis, younger age (=<16 months) and single stone remained significant. The Dogan nomogram score lower than 150 was found to be a good cutoff point to predict better stone clearance (Table). CONCLUSION: Shockwave lithotripsy is a safe and effective treatment modality in patients younger than 24 months and could be the first option in this particular age-group in whom the other endourological modalities are not always applicable. The Dogan nomogram is reliable in predicting the stone-free rate in this age-group.

Predictors of Recurrence and Complications in Pediatric Pyeloplasty.

OBJECTIVE: To assess the predictors of recurrence and complications, we retrospectively analyzed our experience in primary pediatric pyeloplasty. Management of pyeloplasty failure is challenging both for patients and for surgeons, especially in pediatric cases. Early detection of recurrence and early manipulation may help preserving renal function. METHODS: We analyzed 490 renal units who underwent primary dismembered pyeloplasty with eligible data between June 2001 and October 2016 retrospectively. Patient's demographic features, operative data, clinical findings, complications, and recurrence rates were evaluated. RESULTS: Mean age at operation and the mean follow-up time after pyeloplasty was 33.9 (±43.5) and 47.6 (±37.7) months. Our recurrence and complication rates were 6.7% and 11.4%, respectively. Urinary tract infection (7.8%), diversion-related complications (1.8%), and urinoma (1.4%) were the most common complications. Presence of preoperative diversion (P = .020) and presence of early complications (P < .001) after pyeloplasty were significantly related to recurrence. Complication rates were found less in children with transanastomotic diversions (P = .002) and children without preoperative diversion (P = .005). The analysis of patients in chronological order revealed an increase in prenatal diagnosis in the recent years (P < .001). Recurrence and complications were not related to age, gender, side, preoperative radionuclide renal scan results, hydronephrosis grade, surgery type, and surgical findings. CONCLUSION: Early postoperative complication is a predictor of recurrence after pediatric pyeloplasty. Transanastomotic diversion reduces the complication rates. Presence of a preoperative diversion increases both complication rates and recurrence rates after pyeloplasty.

Semi-Rigid Ureteroscopy Should Not Be the First Option for Proximal Ureteral Stones in Children.

PURPOSE: To investigate the factors that predict the success and complication rates of semi-rigid ureteroscopy (URS) in pediatric population. MATERIALS AND METHODS: This is a retrospective analysis of the database including 182 patients who underwent URS between 2001 and 2016. The possible factors that might affect the outcome were age, gender, stone laterality, largest stone size, number of stones, stone location, orifice dilatation status, and caliber of ureteroscope. RESULTS: The mean age was 68.1 (7-204) months, and male-to-female ratio was 94:88. Operative side was left for 97, right for 82, and bilateral for 3 patients. One hundred and forty-four patients had a single stone, and 38 patients had multiple stones. The median largest stone size was 7 (2-20) mm. Postoperative ureteral stenting was performed in 150 (86.2%) patients. The overall success rate was 84.6%, while 81.6% and 85.4% in 8F URS and 4.5F URS groups, respectively (p = 0.560). Stone-free rate was higher among patients who were older than 36 months, distal ureteral stones and single stones (p = 0.012, 0.002, and 0.009, respectively). Complication rate was higher for proximally located stones (p = 0.029). The mean follow-up was 23.9 ± 32.5 months. CONCLUSION: URS is a safe procedure with acceptable success rates in the pediatric population. Younger age, multiple stones, and proximal location are the predisposing factors for failure, whereas proximal location was the only factor for complication occurrence. Therefore, semi-rigid ureteroscopy should not be the first choice in the treatment of proximal ureteral stones, and alternative methods should be preferred, if available.

Positioning the Instillation of Contrast Cystography: Does It Provide Any Clinical Benefit?

OBJECTIVE: To outline positioning the instillation of contrast cystography (PICC)'s benefits in clinical practice. MATERIALS AND METHODS: A total of 198 patients underwent PICC with the following indications: patients with positive preoperative conventional voiding cystourethrography (VCUG) for a single ureteric side, patients with urinary tract infection (UTI), and negative VCUG for both ureteric sides. Patients with positive VCUG served as the control group. Preoperative, intraoperative, and postoperative features of all patients were compared. RESULTS: The reflux rate for the contralateral vesicoureteric reflux (VUR) investigation group was 39.1%. Only the cystoscopic view of the anatomically deficient ureteric orifice was found to be a significant predictor of contralateral reflux (P = .002). For patients who presented with UTI, the reflux rate was 58.3%. Resolution of infection was assessed for patients who presented with UTI, and 54.1% of these patients had a complete response in the follow-up period. When the patients were classified as PICC positive and negative, infection-free rates were 58.3% and 48%, respectively (P = .296). CONCLUSION: PICC is an effective diagnostic method for revealing occult reflux. However, the clinical significance of this finding is vague. In patients with UTI, PICC was useful for diagnosing occult VUR and clearing the symptoms in more than half of the patients. Further, the symptom-free state in the follow up period was slightly higher but not more significant than it was in those with no VUR diagnosed.

Comparing the effectiveness of intranasal desmopressin and doxazosin in men with nocturia: a pilot randomized clinical trial.

PURPOSE: We aimed to compare the effectiveness of intranasal desmopressin and doxazosin treatments in patients with nocturia and benign prostatic hyperplasia (BPH). MATERIAL AND METHODS: Thirty one men with BPH and three or more episodes of nocturia were randomized to receive 2 mg doxazosin at night for two weeks increasing to 4 mg for a further two weeks versus 20 µg intranasal desmopressin at night. For all patients, number of nocturia, urinary flow rate, residual urine volume and quality of life score were checked. Outcomes were measured at two months. The comparison of before and after treatment changes between the groups were done by student's t-test. RESULTS: In doxazosin group, mean number of nocturia were 3.2 &plus mn; 0.4 (3-4 times) times per night and 1.2 +/- 0.8 (0-3 times) times per night before and after treatment, respectively. In desmopressin group, mean number of nocturia were 3.4 +/- 0.5 (3-4 times) and 1.5 +/- 0.6 (1-3 times) times per night before and after treatment, respectively. In doxazosin group, mean residual urine volumes were 44.3 +/- 35.9 ml (range 0-120 ml) and 23.1 +/- 18.8 ml (range 0-50 ml) before and after treatment, respectively. In desmopressin group, mean residual urine volumes were 36.6 +/- 32.4 ml (range 0-120 ml) and 14.0 +/- 26.9 ml (range 0-90 ml) before and after treatment, respectively. Improvements in number of nocturia, residual urine volume, quality of life scores and peak urinary flow rates weren't statistically significant between two groups, whereas change in international prostate symptom score (IPSS) score was more significant in doxazosin group. CONCLUSION: Intranasal desmopressin, is an effective symptomatic treatment of men with BPH complaining of nocturia, as well as doxazosin treatment.