Characteristics and predictors of chronic kidney disease in children with myelomeningocele: a nationwide cohort study.

BACKGROUND: Myelomeningocele (MMC) is highly prevalent in developing countries, and MMC-related neurogenic bladder is an important cause of childhood chronic kidney disease (CKD). This nationwide study aimed to evaluate demographic and clinical features of pediatric patients with MMC in Turkey and risk factors associated with CKD stage 5. METHODS: Data from children aged 0-19 years old, living with MMC in 2022, were retrospectively collected from 27 pediatric nephrology centers. Patients > 1 year of age without pre-existing kidney abnormalities were divided into five groups according to eGFR; CKD stages 1-5. Patients on dialysis, kidney transplant recipients, and those with eGFR < 15 ml/min/1.73 m2 but not on kidney replacement therapy at time of study constituted the CKD stage 5 group. RESULTS: A total of 911 (57.8% female) patients were enrolled, most of whom were expectantly managed. Stages 1-4 CKD were found in 34.3%, 4.2%, 4.1%, and 2.4%, respectively. CKD stage 5 was observed in 5.3% of patients at median 13 years old (range 2-18 years). Current age, age at first abnormal DMSA scan, moderate-to-severe trabeculated bladder on US and/or VCUG, and VUR history were independent risk factors for development of CKD stage 5 (OR 0.752; 95%; CI 0.658-0.859; p < 0.001; OR 1.187; 95% CI 1.031-1.367; p = 0.017; OR 10.031; 95% CI 2.210-45.544; p = 0.003; OR 2.722; 95% CI 1.215-6.102; p = 0.015, respectively). Only eight CKD stage 5 patients underwent surgery related to a hostile bladder between 1 and 15 years old. CONCLUSION: MMC-related CKD is common in childhood in Turkey. A proactive approach to neurogenic bladder management and early protective surgery in selected cases where conservative treatment has failed should be implemented to prevent progressive kidney failure in the pediatric MMC population in our country. A higher resolution version of the Graphical abstract is available as Supplementary information.

Low-Grade Injury following Testicular Torsion: A Multicenter Study Confirming a Disturbing Possibility.

INTRODUCTION: There is an ongoing debate whether to perform orchiectomy or orchidopexy following testicular torsion (TT) in cases where the testis seems non-viable. The main problem is lack of objective criteria defining testicular viability. The aim of this study was to investigate the grade of injury in orchiectomy specimens obtained from cases of TT and its association with clinical findings. METHODS: This multicenter retrospective study involved double-blinded reassessment of the patient files and the pathological specimens using Mikuz classification to analyze the relation between clinical and pathological findings. RESULTS: A total of 289 patient charts from 14 centers were reviewed and 228 were included in this study. Twenty (8.8%) patients had grade 1 injury which refers to reversible injury. The clinical findings of these 20 patients were compared to 208 patients with higher grades of injury. As expected, there was statistically significant difference regarding duration of symptoms (p < 0.001); however, range was wide in both groups (as long as 96 h for grade 1 and as short as 7 h for higher grades). There was no statistically significant difference in any other variable including age (median 14 for both, p = 0.531), symptoms (pain: 19/20 vs. 189/202, p = 0.801; swelling: 13/19 vs. 168/197, p = 0.094), absence of blood flow in Doppler US (15/19 vs. 164/197, p = 0.635), or degree of torsion (median 720° for both, p = 0.172). CONCLUSION: Our study revealed necessity for better criteria to define viability of testis following TT. Histopathological injury appeared to be reversible even in some patients with more severe perioperative findings, late admission, or high degree of twisting. Our findings support the tendency for testicular fixation instead of orchiectomy as none of the clinical or perioperative findings could be attributed to high-grade injury.

I Thought I Saw a Retrocaval Ureter; Don't Bite the Fish-Hook Sign So Easily.

Background: During the management of patients with hydronephrosis, a possibility of retrocaval ureter (RCU) may emerge indicated by a fish-hook sign or its mimickers. Owing to infrequent incidence, the proper way to diagnose or exclude an RCU is challenging and has not been discussed previously. Methods: The aim of this study was to retrospectively evaluate the children who were suspected to have an RCU during management for urinary tract dilation. An RCU may be missed or misdiagnosed owing to rare incidence. Results: The children with urinary tract dilation in whom RCU was considered are enrolled in the study (n = 13). The demographics of the patients, findings suggesting RCU, evaluation process, management, and final diagnosis are retrospectively evaluated. The final diagnosis of the patients was RCU (n = 4), ureteropelvic junction obstruction (UPJO) (n = 7), and duplicated collecting system (n = 2). An RCU was confirmed or excluded by ultrasonography (US) while there was a stent in the ureter in 6 patients and by laparoscopic exploration in the other 7 patients. Four underwent correction for RCU, 7 for UPJO, 1 for reflux, and 1 ureterocele puncture. Conclusion: The fish-hook sign is a rare conflicting radiological finding that can be encountered in imaging studies. This uncommon finding needs confirmation or exclusion of a possible RCU as missed cases manifested after failed pyeloplasty or ureteroneocystostomy were reported. Radiological evaluation (by US or cross-sectional studies) while there is a stent in the ureter is the most satisfactory radiological technique to confirm or exclude an RCU. Alternatively, being aware of a possible RCU and performing a more extensive dissection may be necessary during surgery to confirm or exclude it. If available, laparoscopy may provide this goal in a minimally invasive manner with superior visualization.

Efficacy and safety of Hyadex for treatment of vesicoureteral reflux: a multicenter experience.

OBJECTIVE: This study was performed to evaluate the efficacy and safety of dextranomer/cross-linked hyaluronic acid (Hyadex) in patients with a clinical diagnosis of vesicoureteral reflux (VUR). METHODS: In this cross-sectional multicenter observational study, Hyadex was used in four different centers for the endoscopic treatment of VUR from 2020 to 2022. The study involved 74 patients (93 renal units) who were diagnosed with VUR according to voiding cystourethrography (VCUG) findings and were considered suitable for subureteric endoscopic treatment. The follow-up time (control VCUG time) was 3 months. RESULTS: In the VCUG evaluation, grade I VUR was found in 13 renal units, grade II in 23 renal units, grade III in 42 renal units, and grade IV in 12 renal units. The success rates of Hyadex treatment according to the degree of VUR were as follows: 84.6% for grade I, 82.6% for grade II, 71.4% for grade III, and 66.0% for grade IV. No major complications were observed. CONCLUSION: Endoscopic subureteric Hyadex injection had high success rates in appropriately selected patients with VUR and may be used as the first-line treatment for children with VUR.

What is the impact of inflammasome mechanisms on male infertility?

BACKGROUND: Mechanisms to explain inflammation in male infertility of unknown cause are still being investigated. The inflammasome is a key regulator of innate immunity in the inflammatory response to infections. Our study aims to investigate the effects of varicocele on infertility, its relationship with antioxidant and inflammasome mechanisms, and how it could be guided in azoospermic or nonazoospermic patients. METHODS: A cross-sectional cohort study was conducted at the department of urology in our university hospital. Eightyeight randomly selected men aged 20-45 admitted to our hospital because of infertility between September 2019 and July 2020 were included in the study. Patients were divided into four equal groups according to their clinical status, those with/without azoospermia and with/without varicocele. Blood and semen samples were taken from the patients. NOD-like receptor pyrin domain-containing 3 (NLRP3) and interleukin-1 beta (IL1ß) and total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels were measured in serum and semen, and the groups were compared statistically. RESULTS: Serum and semen NLRP3, IL1ß, TAS, TOS, and OSI values of the patients with varicocele or azoospermia were significantlyhigher than those without either varicocele or azoospermia (p < 0.05). The oxidative stress markers TAS, TOS, and OSI values were significantly higher in the other groups than those without azoospermia and varicocele (p < 0.05). DISCUSSION: Inflammasome mechanisms, such as NLRP3 and IL1-ß molecules, may provide additional benefit in evaluating the need and benefit of surgical or medical treatment in infertility with and without vascular pathology and with and without azoospermia.

Multiorgan Echinococcosis with Uterine Involvement Causing Bilateral Hydronephrosis in a Child: Case Report.

Hydatid cyst is a parasitic infection transmitted by oral ingestion of Echinococcus granulosus eggs. Hydatid cyst of the genital tract is rare and the occurrence in the uterus is an extreme rarity. We present an 8-yr-old girl with complaints of swelling of lower abdomen, pollakiuria and bilateral flank pain was brought to Emergency Department of Harran University, Turkey, in Jun 2019. The patient had simultaneous hydatid cysts of the liver, mesentery and uterus. We performed abdominal exploration and completely removed the inner germinal layer of cyst through an incision made in the anterior of the uterine fundus. Then, we applied total excision to the two cysts in the right and left colon mesentery. Finally, we performed partial cystectomy to the cyst in the liver, and we removed the cyst membrane totally. In endemic regions, hydatid cysts should be considered for the diagnosis of children with cystic mass lesions. Uterine-sparing approach should be kept in mind as an option, especially in young women. Early surgical treatment of large pelvic cysts that cause obstructive uropathy may prevent the progression of renal damage.

Comparison of two different minimally invasive techniques used in bladder stone surgery for preschool-aged children.

BACKGROUND: This study was designed to compare the outcomes of mini-percutaneous cystolithotomy (mPCL) and transurethral cystolithotripsy (TUCL) in treating bladder stones in preschool-aged children (≤6 years old). METHODS: Twenty-four patients treated with mPCL and 28 patients treated with TUCL for bladder stones were compared retrospectively. The operative and postoperative outcomes of both groups were analyzed. RESULTS: The mean age and gender distribution were similar between the groups. The mean stone size was 16.5 ± 0.5 mm for the mPCL group and 14.9 ± 5.7 mm for the TUCL group (p = 0.318). The mean operative time was 41.1 ± 9.9 min for the mPCL group and 39.0 ± 12.3 min for the TUCL group (p = 0.182). Catheterization times and hospitalization times were statistically significantly longer in the mPCL group (p = 0.000). The rate of urinary retention after urethral catheter removal was significantly higher in the TUCL group (p < 0.05). Reintervention was performed for one patient in Group 1 due to urinary leakage and for five patients in Group 2 due to urinary retention. The stone-free rate (SFR) after a single procedure was 100% in the mPCL group and 89.3% in the TUCL group (p = 0.099). After auxiliary procedures performed for three patients, the overall SFR also reached 100% for the TUCL group. DISCUSSION: Both mPCL and TUCL are effective methods in the treatment of bladder stones of <30 mm in the preschool age group. Although TUCL has some advantages over mPCL, such as shorter hospital stays and catheterization times, there is a risk of urinary retention with increased stone sizes. It may be more advantageous to apply mPCL for the reduction of complications and reintervention rates, especially in small children with bladder stones of >20 mm.

Acquired Penile Epidermoid Cysts in Children.

Background In this study, we aim to present the experience of a tertiary center regarding penile epidermoid cysts over 15 years. Methodology Patient files of those who underwent surgical excision for penile epidermoid cysts between 2005 and 2019 were reviewed retrospectively. The demographics, clinical characteristics, etiological factors, cyst features, surgical techniques, complications, and follow-up data were analyzed. Results In total, 24 penile epidermoid cysts were excised in 21 boys. The median age at the time of surgery was 52 (15-204) months. The median duration between previous surgery and cyst excision was 40 (1-180) months. In total, 11 cases had a history of circumcision, and 10 had undergone hypospadias surgery. There was no significant difference between these two etiologic groups (p > 0.05). The main symptom was an asymptomatic penile mass. The average cyst size was 9.4 ± 6.7 mm. All cysts were completely excised with incisions made over old scars, except one. No complications were observed during a median follow-up period of 50 (12-120) months, and only one recurrence was noted. Conclusions Acquired penile epidermoid cysts may present as an early or late complication after penile surgery. Complete excision with an incision along the existing scars seems to be an effective solution for preventing new scars.

Relationship between erectile dysfunction and Helicobacter pylori: A prospective controlled pilot study.

This study sought to investigate the correlation between Helicobacter pylori (Hp) and arteriogenic erectile dysfunction (ED). This study included 30 patients diagnosed with ED due to penile arterial insufficiency, in accordance with the International Index of Erectile Function scores and penile Doppler ultrasonography results, and 30 healthy individuals without ED in the control group. The levels of fasting blood glucose, serum lipid and C-reactive protein (CRP) were recorded. Enzyme-linked immunosorbent assay revealed that the levels of Hp-specific Immunoglobulin G (IgG) antibodies in the patient and control groups were 39.7 ± 23.2 and 21.0 ± 19.8 arbU/ml, respectively (p = .001); the mean CRP levels were 0.3 ± 0.2 and 0.1 ± 0.1 mg/dl, respectively (p = .01). A positive correlation was detected between ED and the levels of Hp-specific IgG and CRP. Further comprehensive studies supporting these preliminary results may facilitate the use of Hp seropositivity as an auxiliary marker in the diagnosis of ED. These findings may also guide future research on the clinical benefits of Hp eradication strategies for the prevention and treatment of ED.

Can Neutrophil-Lymphocyte Ratio in Complete Blood Count Help in the Differential Diagnosis Between Acute Appendicitis and Right Ureteral Stones in Pediatric Age Groups?

Background and objective Abdominal pain is one of the most common problems in children presenting to the pediatric emergency departments and is often a diagnostic challenge for the physician. Clinical studies have been carried out on adult patients to differentiate between ureteral stones and acute appendicitis (AA) in which neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were analyzed in the complete blood count, and it was found that NLR and PLR could help in the differential diagnosis. In this study, we investigated whether complete blood count parameters in pediatric patients could be helpful in the differential diagnosis between AA and right ureteral stones. Methods The files of pediatric patients who were followed up and treated for AA and right ureteral stones between January 2019 and March 2021 were reviewed retrospectively. The demographic characteristics of the patients and their WBC, NLR, PLR, and red cell distribution width (RDW) values were evaluated to determine whether there was a difference between the two groups. Results In this study, 77 patients with AA and 48 patients with right ureteral stones were included. Univariate regression analysis revealed that age, gender, WBC, PLR, and NLR were factors likely responsible for AA. As per multivariate linear regression analysis, NLR level (odds ratio: 0.407; 95% CI: 0.293-0.566; p<0.001) was an independent predictor of AA. Conclusion Based on our findings, NLR can help in establishing the diagnosis in pediatric patients who present to the emergency department with right lower quadrant pain, and in whom physical examination, routine laboratory tests, and imaging methods cannot help distinguish between AA and ureteral stones.

Antegrade placement of JJ catheter in the treatment of malignant ureteral obstruction: Retrospective analysis of a single centre.

OBJECTIVE: The aim of the present study was to examine the results of antegrade JJ stent placement in upper urinary tract obstruction in patients where retrograde placement was not possible. METHODS: In this retrospective study, patients who underwent antegrade JJ stent placement for malignant ureteral obstruction in the urology clinic of a university hospital between January 1, 2018 and December 31, 2020 were included in the study. JJ stent was placed under local or general anaesthesia guided by ultrasonography and fluoroscopy. Age, gender, kidney function values, pathologies causing obstruction, and complications of the patients were examined. RESULTS: In this study, 40 patients (16 men, 24 women) who underwent antegrade JJ stent placement were included. The mean ages of the women and men included were 51 (31-91) years and 62.5 (26-81) years, respectively. In all, antegrade JJ stenting was performed in 61 renal units of these patients. Of these, 21 were bilateral, 11 in the right collecting system and 8 in the left collecting systems. Clinical and technical success was achieved in 59 of the 61 procedures (96.6%). Arteriovenous fistula developed in only one patient, whereas no serious complications such as massive bleeding, resistant hematuria or pseudoaneurysm occurred in the remaining patients. The procedure was completed in a mean time of 15-30 minutes. CONCLUSIONS: Antegrade JJ stent placement is a procedure with a high success rate and low risk of complications that can be used in patients with severe ureteral obstruction owing to malignant or benign aetiologies. This method should be applied in centres experienced in malignant ureteral obstruction and on patients where retrograde placement was not possible. Furthermore, it should be considered as an alternative treatment option to open surgery as it can be performed under local anaesthesia in patients at a high risk of anaesthesia.

Malignant Glomus Tumor of the Ureter.

Although glomus tumour is usually seen in the subungual region of the extremities, it may rarely occur in visceral organs. Approximately 1% of all glomus tumours are malignant. Malignant glomus tumours of the urinary system are extremely rare. This paper presents a case of malignant glomus tumour of the left ureter in a 41-year male patient who had undergone a simple left nephrectomy 4 years ago and presented with recurrent macroscopic haematuria. Uretectomy and mass excision were performed. No progression was observed during the 6-month post-operative follow-up. The tumour can be differentiated from other tumours by pathological and immunohistochemical examination following surgical excision. Because there are very few cases, the treatment protocol is not entirely clear. However, complete removal of the tumour is an effective treatment and can prevent local recurrence. Key Words: Malignant glomus tumour, Ureter, Treatment, Urogenital system.

Is there a relationship between renal scarring and neutrophil-to-lymphocyte ratio in patients with vesicoureteral reflux?

OBJECTIVES: Vesicoureteral reflux (VUR) exacerbates the risk of renal scarring by establishing a ground for pyelonephritis. It is known that the inflammatory process is more influential than the direct damage caused by bacterial infection in the development of renal scars after pyelonephritis. Therefore, the present study aims to investigate the relationship between renal scarring and systemic inflammatory markers in patients with VUR. MATERIAL AND METHODS: Hundred and ninety-two patients (116 females, 76 males) diagnosed with VUR were divided into two groups based on the presence or absence of renal scarring and into three groups according to the grade of VUR (low, moderate and high). Neutrophil count, lymphocyte count, mean platelet volume (MPV) and neutrophil-to-lymphocyte ratio (NLR) were compared among the groups. RESULTS: Of the 192 patients, 102 had renal scarring. The age and gender distribution did not differ significantly between the groups with and without renal scarring (p > 0.05). However, the grade of reflux and lymphocyte count were significantly higher in the group with renal scarring (p < 0.05), and the NLR was significantly lower in the group with renal scarring (p < 0.05). The lymphocyte count was significantly higher (p < 0.05) and NLR was significantly lower in the high-grade VUR group (p < 0.05). However, MPV values did not differ significantly (p > 0.05) between the groups. CONCLUSIONS: NLR can be used to predict renal scarring in patients with VUR, especially in the period of 3-6 months after the first attack of infection, and may even serve as a candidate marker for treatment selection. However, larger series and prospective studies are needed.

Do we have a limit for retrograde intrarenal surgery for solitary kidney stone?

OBJECTIVE: The management of urolithiasis in patients with a solitary kidney is challenging for urologists. This study aimed to evaluate the safety of retrograde intrarenal surgery (RIRS) in the treatment of stones in patients with solitary kidney and to reply to the question if there is any limit for this surgery. METHODS: Between January 2016 and December 2019, we enrolled 52 patients who had a solitary kidney and underwent RIRS. We collected data on preoperative patient characteristics, stone dimensions, and postoperative outcomes. Stone size, duration of operation, duration of fluoroscopy, type of anesthesia, and degree of surgical complication were evaluated retrospectively. Surgeries performed in less and more than 60 minutes and with and without complications were compared. RESULTS: A total of 52 patients with a kidney stone and a solitary kidney were evaluated. The mean stone size was 14 ± 0.4 cm and surgical success rate was 87.3%. In our study, 13 patients (24.5%) had grade 1 minor complications, and none required a blood transfusion. The mean operation time was 51.9 ± 17.3 minutes. The postoperative creatinine value increased in 6 patients. The duration of operation in the group with complications was significantly higher than that in the group without complications. In patients who underwent an operation lasting ≥ 60 minutes, stone size, fluoroscopy time, and complication rate were significantly higher than in patients who underwent an operation lasting ≤ 60 minutes. CONCLUSION: Our opinion is to be careful in patients with a solitary kidney with a big stone and we recommend assigning these procedure to experienced hands for not exceeding 60 minutes in one session.

Comparison of Conservative and Surgical Treatments in Symptomatic Pregnancy Hydronephrosis.

OBJECTIVES: This study aimed to evaluate the factors affecting the treatment choice in pregnant women with symptomatic hydronephrosis. METHODS: Hospital records of pregnant women who visited our clinic due to symptomatic hydronephrosis between December 2010 and December 2020 were analysed retrospectively. Patients were divided into 2 groups: conservative and surgical (JJ stent) treatment groups. Age, gestational week, primipara, trimester, visual analogue scale (VAS), and preterm birth rates as well as clinical, laboratory, and ultrasonography findings were compared between the groups. RESULTS: The study included 227 pregnant women (conservative treatment group, 133; JJ stent group, 94). Age, gestational week, primipara, trimester, hydronephrosis side, fever, pyelonephritis, pyuria, preterm labour and abortion, as well as blood urea nitrogen, creatinine, C-reactive protein, and white blood cell levels did not differ significantly between the groups (p > 0.05). In the JJ stent group, VAS, creatinine value, culture positivity rate, degree of hydronephrosis, and renal pelvis anterior-posterior (AP) diameter were significantly higher than those in the conservative treatment group (p < 0.05). The cut-off value for renal pelvis AP diameter was 16.5 mm in the first 2 trimesters and 27.5 mm in the third trimester. CONCLUSIONS: Surgical treatment should not be delayed in pregnant women who do not respond to conservative treatment and have impaired renal function and grade 3-4 hydronephrosis. Early surgical intervention is necessary in patients with a renal pelvis AP diameter of >16.5 mm in the first 2 trimesters and >27.5 in the third trimester.

Urolithiasis and Its Treatment in Pregnant Women: 10-Year Clinical Experience From a Single Centre.

INTRODUCTION: Urolithiasis during pregnancy is an important health concern that can affect maternal and foetal health. If left untreated, it can cause obstetric complications, such as spontaneous abortion and preterm delivery. In this study, we aimed to evaluate urolithiasis and its treatment in pregnant women. METHODS: We analysed data of 57 patients diagnosed with urolithiasis during pregnancy between January 2010 and December 2020. Patients' age, gestational age, urolithiasis history, physical examination findings, laboratory findings, location and size of the stone and applied treatment methods were examined. The effectiveness and complications of the applied treatment methods were evaluated. RESULTS: The mean age of 57 patients included in our study was 27 (27.8 ± 5.6) years and their mean gestational age was 20 (20.3 ± 9.2) weeks. The mean stone size was 9 mm (9.09 ± 4.37). The most common symptom at the time of presentation to the hospital was flank pain (93%). Kidney stones were detected in 34 patients and ureteral stones in 23 patients. Although conservative treatment was sufficient in 26 (45.6%) patients, 31 (54.4%) patients required surgical intervention. Major obstetric complications, such as preterm delivery and abortion, did not occur in any of the patients. CONCLUSION: The diagnosis and treatment of pregnant women with urolithiasis should be managed in a multidisciplinary manner. While determining the treatment options, foetal and maternal health should be considered.

Usability of shear wave elastography to predict the success of extracorporeal shock-wave lithotripsy: prospective pilot study.

The present study is intended to investigate the usability of shear wave elastography (SWE) in predicting the success of extracorporeal shock-wave lithotripsy (ESWL) used in kidney stone treatment. ESWL was performed on a total number of 52 patients diagnosed with kidney stones between May 2019 and July 2020. The presence of a residual stone greater than 4 mm was accepted as failure. The patients were divided into two groups as ESWL success and ESWL failure. SWE and Hounsfield unit (HU) measurements of stones were performed in all patients before ESWL. The two groups were compared in terms of age, gender, stone localisation, stone size, body mass index (BMI), skin-to-stone distance, HU, and SWE values of the stones. ESWL was successful in 30 of the 52 patients included in the study, while it failed in 22 of them. While the mean SWE value was 7.3 (7.9 ± 2.2) kPa in patients with success in ESWL, it was 14.6 (17.9 ± 10.2) kPa in those with failed ESWL. The mean HU was 883.5 (841.4 ± 191.1) in patients with success in ESWL and 1078 (1115.5 ± 183) in those with failed ESWL. Both SWE and HU values of the stones were found to be statistically significantly lower in the successful group (p < 0.05). It was seen that SWE and HU values were correlated to each other. The groups of successful and failed ESWL did not differ significantly in terms of age, gender distribution, stone size, BMI, and skin-to-stone distance (p > 0.05). With SWE, the hardness of the stone can be measured and its suitability for ESWL can be evaluated. It can be used as an alternative parameter to HU before ESWL treatment, since it has a lower cost compared to computed tomography (CT) and does not contain radiation.

Isolated Renal Hydatid Cyst in a 6-Year-Old Boy: A Case Report.

Hydatid cyst (HC) is a parasitic infection transmitted by oral ingestion of Echinococcus granulosus eggs. Isolated kidney involvement is extremely rare. It is even less common in children. We present a case of isolated renal HC in a 6-year-old boy from Sanliurfa, southeast Turkey who complained of abdominal pain and distension. Cystectomy was performed with a flank incision using the extraperitoneal approach. No recurrence was detected in the postoperative 6-month follow-up. There are not enough data about the efficacy of medical treatment in renal HC. Therefore, medical treatment should be considered pre- and post-operatively to prevent dissemination, rather than being used as a primary treatment. Kidney-sparing surgery should be the first choice in patients with isolated renal HC. However, nephrectomy is recommended for nonfunctioning kidneys, large cysts thought to be connected with the collecting system, and cysts with suspicious tumor. In societies where HC disease is endemic, renal HC should be considered in children with cysts located in kidney, even if the indirect hemagglutination test is negative.

Carotid artery intima-media thickness can predict the response of patients with erectile dysfunction to phosphodiesterase 5 inhibitors.

This study investigated the role of carotid artery intima-media thickness (IMT) as a morphological marker of the response of vasculogenic erectile dysfunction (ED) patients to tadalafil, one of the phosphodiesterase 5 inhibitor (PDE5-I). Through March-December 2016, 51 men with vasculogenic ED aged over 30 years were enrolled in this prospective study. Vasculogenic ED was accepted as a normal testosterone level, with penile colour Doppler ultrasonography showing arteriogenic ED, venogenic ED or mixed arteriogenic and venogenic ED. All patients underwent biochemical and hormonal blood tests, ultrasonographic evaluation of the common carotid artery (CCA) IMT and penile colour Doppler ultrasonography. On-demand tadalafil (10 mg or 20 mg in cases of a non-response to 10 mg) was administered to each patient for 2 months. ED was assessed using the short form of International Index of Erectile Function (IIEF-5) before and after the drug therapy. According to the patients' responses to the medication, they were grouped as non-responders or responders. Thirty-one of the 51 patients responded to tadalafil. The mean CCA IMT of the non-responders and responders was 0.9 ± 0.2 mm and 0.6 ± 0.2 mm, respectively (P = 0.000). The IMT of 90% of the non-responders was >0.67 mm, whereas it was >0.67 mm in 40% of the responders. The data were analysed using the Kolmogorov-Smirnov test, Chi-square test, t-test, Mann-Whitney U test and receiver operator characteristic (ROC) curves. Measurement of CCA IMT may offer an alternative and simple method to predict the response of vasculogenic ED patients to PDE5-Is.

Excision of the atrial Wilms` tumor thrombus without sternotomy, atriotomy and cardiovascular By-pass.

Tekin A, Yagmur I, Ergün O, Ayik MF, Atay Y, Ulman I, Avanoglu A. Excision of the atrial Wilms` tumor thrombus without sternotomy, atriotomy and cardiovascular By-pass. Turk J Pediatr 2019; 61: 436-439. The treatment of atrial-extention Wilms` tumor thrombus is surgical excision after chemotherapy. Atriotomy with cardiovascular by-pass is the one of the most common method for this procedure. Herein, we aimed to present a case of Wilms` tumor with a tumor thrombus extending into the right atrium totally excised with retrohepatic cavatomy. A 3.5 year-old girl was admitted with the symptom of dysuria. The examinations revealed a mass consistent with Wilms` tumor in the middle and lower poles of the left kidney. Doppler ultrasound and Echocardiographic examinations showed a tumor thrombus extending into the right atrium and some pulmonary nodules which were interpreted to be metastasis. Wilms` tumor was histopathologically diagnosed by an open biopsy. After three courses of chemotherapy imaging studies revealed that the atrial axtention of the tumor thrombus persisted. The tumor thrombus was found to be fibrotic on the magnetic resonance imaging scan of the patient. Therefore, nephroureterectomy along with the excision of the tumor thrombus from the inferior vena cava was done with intraoperative continuous trans-esophageal echocardiography (TEE). The suprarenal and retrohepatic vena cava were exposed by dissecting and ligating all short hepatic veins and completely mobilizing the right lobe of the liver. The thrombus was dissected out via Vertical cavatomy at the retrohepatic level. TEE confirmed complete removal of the thrombus from the atrium; Vena cava was then repaired. There was no need for a blood transfusion, or cardiovascular by-pass (CPB) during the operation. Total exposure of the retrohepatic and subdiaphragmatic vena cava using transplantation techniques is an effective method for the excision of a tumor thrombus without sternotomy, atriotomy and CPB, avoiding possible intra- and postoperative complications in selected cases of Wilms` tumor with intraatrial thrombus extension. The case emphasises the importance of multidisciplinary communication and collaboration.