What is the Critical age for the Improvement of Parenchymal Thickness after Pyeloplasty?

PURPOSE: The most important point in cases of ureteropelvic junction obstruction (UPJO) is to decide on the need and timing of surgical treatment. Renal damage may become irreversible as the duration of the obstruction is prolonged. Worsening of hydronephrosis and decrease in renal parenchymal thickness after pyeloplasty may herald an irreversible renal damage. It is important to know at what age this damage begins. In this study, we aimed to determine the relationship between the age of the patients at the time of pyeloplasty performed for UPJO and parenchymal recovery. MATERIALS AND METHODS: In our study, 156 patients (mean age: 43.5 months) who underwent pyeloplasty with the diagnosis of UPJO between 2007 and 2019 were evaluated retrospectively. Demographic characteristics, ultrasonographic (USG) and nuclear renal scintigraphy findings, previous surgeries  â€‹of the patients  were recorded. RESULTS: Numerical variables were evaluated statistically, and the best cut-off point was determined. Parenchymal thickening was determined as the most important criterion in postoperative renal recovery which was more evident at early ages. Based on statistical assessments , the cut-off age for renal parenchymal recovery was determined as 38 months. While parenchymal recovery was inadequate after pyeloplasty performed in patients older than 38 months, the most significant improvement in renal functions was seen in children younger than 13 months of age. CONCLUSION: Pyeloplasty should be performed in patients with UPJO before development of severe renal damage. Statistically, the best parameter to evaluate the recovery after pyeloplasty is the change in parenchymal thickness. With advancing age, it is impossible to reverse the obstructive nephropathy.

Clinical practice in vesicoureteral reflux with respect to EAU guidelines: A multicenter study.

PURPOSE: We designed a multicenter, retrospective study to investigate the current trends in initial management of reflux with respect to European Association of Urology (EAU) Guidelines in Urology clinics of our country. MATERIALS AND METHODS: The study group consisted of 1988 renal units (RU) of 1345 patients treated surgically due to vesicoureteral reflux (VUR) (between years 2003 and 2017) in nine different institutions. Patients were divided into two groups according to time of initial treatment and also grouped according to risk factors by "EAU guidelines on VUR." RESULTS: In this series, 1426 RUs were treated initially conservatively and 562 RUs were initially treated with surgery. In initially surgically treated group, success rates of surgery decreased significantly in low and moderate risk groups after 2013 (P = .046, P = .0001, respectively), while success rates were not significantly different in high risk group (P = .46). While 26.6% of patients in low risk group were initially surgically treated before 2013, this rate has increased to 34.6% after 2013, but the difference was not statistically significant (P = .096). However, performing surgery as the initial treatment approach increased significantly in both moderate and high risk groups (P = .000 and P = .0001, respectively) after 2013. Overall success rates of endoscopic treatments and ureteroneocystostomy (UNC) operations were 65% and 92.9% before 2013 and 60% and 78.5% after 2013, respectively. Thus, the overall success rate for surgery was 72.6%. There was significant difference between success rates of UNC operations before and after 2013 (P = .000), while the difference was not significant in the injection group (P = .076). CONCLUSION: Current trends in management of reflux in our country do not yet follow the EAU guidelines on VUR in low and moderate risk groups despite these reliable and accepted guidelines were expected to influence our daily approach.

Can ultrasound guidance reduce radiation exposure significantly in percutaneous nephrolithotomy in pediatric patients?

In this study, we aimed to compare clinical and technical outcomes between pediatric patients who underwent percutaneous nephrolithotomy (PCNL) under fluoroscopy (FL) and those that underwent this procedure under FL with ultrasound assistance (FLUSA). The data of 66 PCNL patients were analyzed retrospectively. Renal puncture was successful in 22 patients in the FLUSA group and 44 patients in the FL group. In all cases, FL was used for tract dilation and confirmation of ureteral catheter positioning at the beginning of the procedure. The sample consisted of 46 males and 20 females with a mean age of 7.2 ± 2.1 years (range 1-17 years). Stone size varied from 8.0 to 75.4 mm, and 89% of patients achieved a completely stone-free state. The median puncture time was 130.5 ± 25.3 s for FLUSA and 295 ± 82.8 s for FL, the median fluoroscopic screening time was 95 ± 33 and 230 ± 116 s, respectively, and the median radiation dose was 19.04 ± 9.9 dGy/cm2 and 54 ± 21.4 dGy/cm2, respectively. The median puncture time, fluoroscopic screening time, and radiation dose were statistically lower in the FLUSA group (p = 0.001, Mann-Whitney U test). The greatest problem in PCNL is the use of fluoroscopy. Due to some anatomical differences from adults, applying PCNL in pediatric patients using only ultrasound may decrease the success rate. Puncture with ultrasound significantly reduces the radiation dose in children. Puncture with ultrasound and dilation under fluoroscopy is a successful and safe treatment method with low morbidity and high success rates and shorter hospital stay in pediatric patients.

Can Freehand Elastosonography Be an Alternative to Renal Scintigraphy in Pediatric Vesicoureteral Reflux Cases?

INTRODUCTION: Detecting renal scar is important in pediatric patients with vesicoureteral reflux (VUR) for deciding on treatment option. The aim of this study is to detect whether freehand elastosonography technique could be an alternative to dimercaptosuccinic acid (DMSA) scan in determining renal scar formation. MATERIALS AND METHODS: Between November 2015 and April 2016, 25 VUR patients, age ranging from 3 to 17 years admitted to our clinic, had urinary ultrasound and elastosonography, and data of approximately 147 renal region were recorded. Data were upper, middle, and lower pole renal parenchymal thickness and echogenicities obtained by ultrasound and these poles strain target (ST), strain reference (SR), and strain index (SI) values obtained by freehand elastosonography. DMSA scan data (differential function and upper, middle, and lower pole parenchymal scar formation) were recorded. RESULTS: Scar formation and more than 10% reduction in differential function in renal scan were statistically higher in renal regions in which parenchymal thinning and echogenicity increase was detected by ultrasound. There was no elastosonographic data difference between renal units with and without differential function decrease. Also, there was no elastosonographic data difference between renal units with and without scar formation. CONCLUSION: In this study, we could not find any significant difference in term of tissue tension values (ST and SI) measured by freehand elastosonography between renal units with and without scar formation in renal scan.

Effect of Splenectomy to Short Bowel Syndrome in Rats.

The aim of this study was to determine the effect of splenectomy in the short bowel syndrome. Twenty-four Wistar-albino rats weighing between 210 and 375 g were used. They were divided into three groups. In group A, short bowel syndrome (SBS) was created by 75 % bowel resection. In group B, SBS and splenectomy was performed. In group C, after transecting the bowel, it was anastomosed. Before and 45 days after the procedures, all rats were weighed. In all three groups, the first and final weight of the rats, the final bowel weight and length, the ileal and jejunal crypt depths, the villus height, the luminal diameter, the bowel wall thickness, and the number of apoptotic cells and mitosis per 100 crypt cell were compared. Periportal fibrosis, infiltration, bile stasis, and bile duct proliferation were detected in liver samples. The rat intestinal length and weight was the least in group B while the jejunal crypt depth was higher in group B than in group A and it was exactly the opposite for the jejunal and ileal villus heights. The ileal and jejunal luminal diameter, the ileal bowel wall thickness, the jejunal and ileal apoptotic cell number, the jejunal mitosis, and the periportal fibrosis were highest in group B. Adding splenectomy to an SBS model has a negative impact on bowel adaptation.

Is there a role of interstitial cells of Cajal and mast cells and eosinophils in appendicitis in children?

BACKGROUND/AIM: The aim of this study was to compare the distribution of interstitial Cajal cells, eosinophils, and mast cells in normal and inflamed appendices, and to evaluate the correlation of presence of these cells with severity of inflammation in appendicitis. MATERIALS AND METHODS: The appendicitis group (n = 30) was divided further into three groups according to the macroscopic description and the histological findings. Ten normal appendices served as controls. Tissue samples were processed for routine histological examination. Additionally, all sections were immunohistochemically stained with CD117 and mast cell tryptase antibodies. RESULTS: When specimens were compared in terms of Cajal cells, the observed mean number for the appendicitis group was 4.9 and for the control group it was 8.3. In contrast, eosinophils and mast cells were significantly increased in the appendicitis group when compared with the control group. CONCLUSION: We detected that eosinophils and mast cells are increased in appendicitis, and correlate with the degree of inflammation of the appendix. The density of interstitial Cajal cells was significantly lower in patients with severe appendix inflammation compared to controls. The histopathological differences observed in this study may help elucidate the pathophysiology of appendicitis.

One surgeon experiences in childhood inguinal hernias.

PURPOSE: In this manuscript we report one pediatric surgeon's experience in childhood inguinal hernia repair. METHODS: From 2005 to 2008, 402 children with inguinal hernias were operated on by one surgeon. A retrospective survey of their charts was carried out to evaluate the demographics and clinical aspects of these patients. RESULTS: The ages ranged from 20 days to 16 years with a male-to-female ratio of 2.5:1. 64.9% right, 27.1% left, and 7.9% bilateral hernias. Hydroceles were present in 6.2% assosiated hernias. Incarceration occurred in 8.7% of children. An opposite-side hernia developed in 5.7%. 5.3 percent of patients with a hernia repair on the right side later developed a hernia on the left side, and 8.2% of patients with a hernia repair on the left side later developed one on the right side. 4.5 percent of all male patients in this series and 8.6% of female patients developed an opposite-side hernia. While overall recurrence rate was 1.2%, our recurrence rate was 0.25%. There was a 0.24% wound infection rate, and 1 (0.24%) testicle was atrophic at follow-up. CONCLUSION: In this study, in the recurrence of childhood hernia, the general surgeon's intervention was the prominent cause. It is suggested by the study that inguinal hernias on the contralateral side becomes symptomatic within the first six months following initial operation.Therefor, close observation is needed in that time.

Are interleukin-6, body mass index and atopy crucial in infantile intussusception?

OBJECTIVE: To determine the role of inflammation related to body mass index (BMI) and atopy in the etiology of idiopathic intussusception (IS) which is seen more frequently in obese children and which is considered to increase in the allergy season. METHODS: The study comprised a study group consisting of 22 infants with IS and a control group consisting of 20 healthy infants with age and BMI matched. In both groups, gender, weight, height, month of birth, month of admittance (allergy season) of each infant were recorded. Information regarding whether or not the child had any skin rash, atopy, oral allergy syndrome, and whether or not the patient had been fed cow's milk and breast milk was recorded. Hemoglobin (Hb) levels, white blood cell (WBC) and eosinophil counts, interleukin-6 (IL-6) levels and allergy panel were studied in all patients. Additionally, cross reactive protein (CRP) and blood urea nitrogen (BUN) levels were determined in the study group. During statistical comparison p < 0.05 was considered statistically significant. RESULTS: Mean IL-6 levels in the control and study groups were 1.59 ± 0.15 pg/ml and 4.12 ± 5.04 pg/ml, respectively. IL-6 levels were statistically different between each groups and between cases with barium reduction and cases reduced manually by laparotomy within the study group. Both groups were similar statistically with regard to the others parameters. No atopy was detected by allergy panel. When binary logistic regression analysis with the cut-off value of IL-6 set as 1.6 pg/ml was applied to all data, statistically significant values were obtained only when the case was in the study group and when CRP levels were increased (p = 0.05 and p = 0.001, respectively). CONCLUSIONS: We demonstrated that IL-6 levels are increased in the study group, especially in the operated patients, however, that high BMI and atopy have no effects on this fact and that atopy is not associated with IS in the clinical study.

Transcutaneous cervical and transabdominal ultrasonography as a diagnostic tool in gastroesophageal reflux in childhood.

BACKGROUND/AIM: The aim of this study is to investigate if there is a diagnostic expressive difference in the angle of His, upper and lower esophageal diameter (UED and LED), wall thickness of cervical esophagus (WTCE) measured by cervical and transabdominal ultrasonography (USG) between children with (+) and without gastroesophageal reflux (GER-). METHODS: 50 children were separated into 2 groups. Group 1 was the control group (n = 30) consisting of children who had no symptoms of GER and had no GER detected in USG. Group 2 was the study group (n = 20) consisting of children with complaints related to GER, and who were GER+ by USG and esophageal pH monitoring. The USG examinations were completed after having observed 3 episodes of reflux or after 30 min if no reflux was detected. The angle of His, UED, LED and WTCE were measured. In 24-hour esophageal pH monitoring, acid contact to the proximal or distal probe greater than 5.0% of the total time below pH 4 was accepted as pathologic reflux. RESULTS: The age range of the 50 children (30 boys) was 4-13 years. Between the 2 groups there were no differences with regard to age and gender. Values of UED, LED and WTCE were statistically higher in group 2 compared with group 1. The angle of His was higher in the control group, but this was not statistically significant. CONCLUSION: Our study is the first in the literature that shows that measuring UED, LED and WTCE by USG, which is a noninvasive, readily available repeatable, cheap and fast technique, has a high diagnostic value in children with suspected GER.

A novel mutation in the vascular Ehlers-Danlos syndrome: a case presenting with colonic perforations.

A 15-year-old girl who had chronic constipation presented with peritonitis caused by sigmoid colon perforation. After her sigmoid colon was resected and an end colostomy performed, as there were no apparent causes for perforation, she was followed-up. After the second colonic perforation proximal to the end colostomy, as the pathologic findings revealed myopathic changes, the connective tissue disorders were evaluated. Her molecular biology studies revealed an undefined missense mutation in the COL3A1 gene, confirming the diagnosis of vascular Ehlers-Danlos syndrome (EDS). As she refused a permanent stoma, total colectomy and ileorectal anastomosis were performed, but the postoperative complications resulted in a fatal progression. The typical progression of vascular EDS will be discussed with the presented case by means of a review of the English medical literature on children diagnosed with vascular EDS.