Histological and morphological development of the prepuce from birth to prepubertal age.

PURPOSE: To study the histological changes of the preputial tissue from birth to prepubertal age in order to define unnoticed morphological changes. MATERIALS AND METHODS: Prepuce samples were obtained from 79 healthy boys who underwent routine ritual circumcision. Specimens were divided into six groups according to the boys' age: newborn, 0-1 year of age, 2-3 years of age, 4-5 years of age, 6-7 years of age, and 8-9 years of age. Histologic analysis of the specimens was performed by H&E, Masson's trichrome, Verhoeff-Von Gieson, immunohistochemical staining. RESULTS: Microscopic examinations showed that average epithelial thickness increased after the neonatal period (p=0.001). When collagen fiber density was evaluated, no significant differences between groups were found (p=0.083). When the elastic fibers in the dermis were evaluated, it was determined that the number and thickness of elastic fibers increased with age. Immunohistochemical examinations showed that the number of peripheral nerves marked with S100 was lower in the neonatal period than at other ages (p=0.048). When the vessels marked with CD105 antibody were counted, there was no significant difference between the groups (p=0.078). CONCLUSIONS: This is the first study to examine the age-related structure of connective tissue elements in the foreskin. Our results showed that the prepuce's prepubertal maturation process is continuous, and the first 2 years of life are appropriate not only in relation to the physiological effects of age but also the optimum structural changes for wound healing, such as vessel diameter, epithelium thickness, peripheral nerve count.

Are lower urinary tract conditions more common in children with sleep bruxism?

INTRODUCTION: Sleep bruxism is a parasomnia caused by rhythmic and non-rhythmic activity of the masticatory muscles during sleep. Prevalence of sleep bruxism is reported up to 40.6% in the literature. Sleep bruxism is a multifactorial issue and associated with multiple dental complications, sleep-related disorders, and psychosocial problems. We aimed to investigate if children with sleep bruxism suffer more from lower urinary tract conditions. MATERIALS AND METHODS: Prospectively 128 children were included in this study. Sixty-four children constituted in the bruxism group and 64 children constituted in the control group. Children who admitted to the pediatric dentistry clinic with bruxism symptoms were recruited in the bruxism group. Control group constituted of consecutive 64 children who admitted to the pediatric dentistry clinic for routine dental examination. Parents were asked to fill out a questionnaire including Dysfunctional Voiding and Incontinence Scoring System (DVISS) form. Children's demographic data, presence of urinary frequency, presence of urgency, behaviour of voiding postponement, presence of daytime urinary incontinence, presence of enuresis nocturna, presence of fecal incontinence, presence of constipation, status of circumcision, and presence of bruxism related symptoms were recorded. Children with a DVISS score above 8 were considered to have functional voiding disorder. All children underwent a dental examination. RESULTS: The mean age of children was 73.3 ± 26.9 months. For all children (n = 128), the girl to boy ratio was 40:88. Mean DVISS score was 2.5 ± 3.8 and the mean QOL score was 0.1 ± 0.4 for all children. Eight (6.3%) children were found to have functional voiding disorder based on the DVISS score. There was no statistically significant difference for any lower urinary tract condition between the bruxism group and the control group (Table). Children with bruxism significantly had more tooth wear and masseter muscle hypertrophy (<0.001 and < 0.05). DISCUSSION: Sleep bruxism has been linked to a number of health issues including dental, systemic and psychosocial problems. Tooth wears, fatigue/pain in chewing muscles, gum recession, facial pain, masseter muscle hypertrophy and temporomandibular joint damage are the main complications of bruxism. Moreover, bruxism has been associated with systemic diseases and sypmtoms like asthma, respiratory illnesses, enuresis nocturna, anxiety, and stress. CONCLUSIONS: Children with sleep bruxism suffer more from tooth wear, masseter muscle hypertrophy, and regional pain over the jaw. Additionally morning fatigue, relationship issues, and respiratory illnesses are more common in bruxist children. Lower urinary tract conditions are not more frequent in children with sleep bruxism.

Ability of ESWL nomograms to predict stone-free rate in children.

INTRODUCTION: We aimed to evaluate whether the pediatric extracorporeal shock wave lithotripsy (ESWL) nomograms can predict stone-free status in children effectively and whether they are applicable to our series. We hypothesize that two current nomograms predicting successful treatment with ESWL in pediatric patients are valid. STUDY DESIGN: We evaluated 415 renal units (children <18 years) with eligible data who received ESWL treatment for upper urinary tract stones. Children's age, gender, stone size, stone surface area, stone location and history of previous intervention were recorded. Children with no residual fragments after ESWL treatment were designated as stone-free. The nomograms described by Dogan and Onal were implemented to our series for the prediction of stone-free status. RESULTS: Mean age of children was 64.7 ± 57.2 months. Male to female ratio was 219:196.78.8% (327) of children had single stone. Mean stone size was 10.0 ± 3.7 mm and mean stone surface area was 380.0 ± 72.2 mm2. Our stone-free rate after single ESWL session was 52.5% (218/415). Mean residual stone size and stone surface area after single session was 6.4 ± 3.3 mm and 36.0 ± 44.2 mm2 respectively. There were no significant difference between stone-free children and children with residual fragments regarding gender, age and history of previous intervention. Mean stone size and stone surface area in stone-free children were lower and lower pole stones had the lowest stone-free rate (p < 0.05). Area under curve for Dogan and Onal nomogram were 0.628 and 0.580 respectively in ROC analysis (0.05). The agreement between Dogan and Onal score was moderate in our series. In multivariate analysis only stone surface area and Dogan score found to be independent predictors of stone-free status (p < 0.05). DISCUSSION: Only one study has assessed both nomograms in the literature. Both nomograms are reported to be independent predictors of stone free status. ROC analysis in our study revealed fair accuracy for both nomograms with higher area under curve for Dogan nomogram. Higher accuracy for both nomograms were reported by other authors. These nomograms offer practical data but more effective tools are needed to be developed for the prediction of stone-free status in pediatric ESWL. CONCLUSIONS: Stone size and stone surface area are associated with stone clearance. Dogan and Onal nomograms can be useful in prediction of stone-free status in children. Dogan nomogram is superior to Onal nomogram.

Does structured withdrawal of desmopressin improve relapse rates in patients with monosymptomatic enuresis?

PURPOSE: Relapse after cessation of desmopressin is an important problem in treating patients with enuresis. Structured withdrawal of desmopressin tablets has been shown to decrease relapse rates. However, scientific data are lacking on the structured withdrawal of the fast melting oral formulation of desmopressin. We compared relapse rates of structured withdrawal using placebo and direct cessation in a population of patients with enuresis who were desmopressin responders. MATERIALS AND METHODS: Patients diagnosed with enuresis and responding to desmopressin from 13 different centers were involved in the study. Patients were randomized into 4 groups. Two different structured withdrawal strategies were compared to placebo and direct withdrawal. Sample size was estimated as 240 (60 patients in each group), with a power of 0.80 and an effect size of 30%. Randomization was performed using NCSS statistical software (NCSS, Kaysville, Utah) from a single center. The relapse rates of the groups were compared using chi-square testing. Logistic regression analysis was performed to define the independent factors having an effect on relapse rates. RESULTS: Desmopressin treatment was initiated in 421 patients, and 259 patients were eligible for randomization. Relapse rates were 39 (1%) and 42 (4%) for the structured withdrawal groups, which were significantly less than for direct withdrawal (55, 3%) and placebo (53, 1%). Logistic regression analysis revealed that initial effective dose of 240 µcg, greater number of wet nights before treatment and nonstructured withdrawal were associated with higher relapse rates. CONCLUSIONS: We found that structured withdrawal with the fast melting oral formulation of desmopressin results in decreased relapse rates. Application of a structured withdrawal program was also an independent factor associated with reduced relapse rates, together with lower initial effective dose and number of wet nights per week. Relapse after cessation of desmopressin is an important problem, and in this study structured withdrawal was observed to be associated with decreased relapse rates compared to placebo and direct withdrawal.