An alternative method for determining daily bladder perception.

OBJECTIVES: To avoid the unphysiologic nature of cystometry, we searched a new tool for evaluating bladder perceptions. METHODS: The study group consisted of 25 (14 girls and 11 boys) primary monosymptomatic enuretic children with a mean age of 11 (range 8-16). Four children were excluded due to neuromuscular dysfunctions of the bladder, which was demonstrated with the help of cystometry. All children filled a voiding chart 3 times daily to record the duration elapsed till normal desire (ND(daily)) and strong desire (SD(daily)). During cystometry, the amounts of infused medium (cystometric ND(ml) and cystometric SD(ml)) and the duration (cystometric ND(sec) and cystometric SD(sec)), till ND and SD were perceived and recorded. RESULTS: Mean cystometric ND(ml) was 209.9 +/- 107.2 and ND(sec), 318.1 +/- 135.5, whereas mean cystometric SD(ml) was 273.0 +/- 103.1 and SD(sec), 415.7 +/- 136.8. To evaluate the reliability of elapsed time instead of milliliters, as a parameter, cystometric ND/SD values were calculated and a strong correlation was found between the 2 (ND/SD(sec) = 0.77 +/- 0.19 and ND/SD(ml) = 0.77 +/- 0.19, r = 0.9795, P = .000). Although there was a strong correlation between 3 ND(daily) (r = 0.9576, P = .000), between 3 SD(daily) (r = 0.9706, P = .000), and 3 ND/SD(daily) (r = 0.8706, P = .000), no significant correlation was determined between mean ND(daily) and cystometric ND(sec) (r = 0.3410, P = .2032), and also between mean SD(daily) and cystometric SD(sec) (r = 0.2740, P = .2402). CONCLUSIONS: Daily durations of sensations do not correlate with those perceived during cystometry. However, as the results of 3 consecutive daily recordings have a strong correlation, comparison of the reliability of these methods is still needed.

Comparison of bladder perceptions during cystometry in pediatric and adult patients.

OBJECTIVES: This study was designed to evaluate the reliability of bladder perception in children and compare it with that in adults. METHODS: A total of 30 children were included in the study. The average patient age was 11 years (range 7-16). In the first phase of the study, a catheter was fixed to the skin without introducing it through urethra. After the children were told that the test had begun, they were asked to report any sensations. In the second phase, although an 8F urodynamics catheter had been introduced, nothing was infused. In the third phase, regular filling cystometry was performed. The final phase of the study was performed using the same method as for the second phase. The intervals that elapsed until each sensation was perceived were recorded in seconds and were used to compare the perceptions. RESULTS: Of the 30 children, 4 were excluded because of sensation defects in the cystometric evaluation. In the first phase, none of the children reported any first sensation, first desire, normal desire, or strong desire. In the second phase, 3 of the children reported a first sensation and 2 reported a first desire. In the third phase, all 26 children reported sensations and the first sensation/normal desire percentage was 41% and the first desire/normal desire percentage was 52%. In the fourth phase, none of the children reported sensations. CONCLUSIONS: In our previous studies, we reported that an important percentage of adults perceived false sensations in the fake phases. The children had no significant perceptions in the fake phases (first, second, and fourth phases). Thus, the sensations reported by children during urodynamics studies are more reliable than those reported by adults.

Adolescent varicocele repair: long-term results and comparison of surgical techniques according to optical magnification use in 100 cases at a single university hospital.

PURPOSE: We review the long-term results of varicocele repair, and compare the complication rates of varicocelectomy techniques according to optical magnification use in adolescents with varicocele at a single university hospital. MATERIALS AND METHODS: We prospectively studied 100 males 7 to 19 years old with clinical palpable varicocele. Of the patients 52 (52%) underwent left unilateral varicocelectomy and 48 (48%) underwent bilateral varicocelectomy. Varicocelectomy was performed using a microscope in 49 patients (79 sites), loupe magnification in 25 (35 sites) and no magnification in 26 (34 sites) using either a subinguinal or inguinal approach. Postoperative complications were compared in all patients based on technique. Preoperative and postoperative serum hormone values and semen parameters were compared in 33 patients. RESULTS: Mean postoperative followup was 30.4 +/- 13.06 months (12 to 65). Total motile sperm count increased from 22.6 million +/- 5.16 million to 64.53 million +/- 12.3 million postoperatively, which was statistically significant (p = 0.002). Postoperative recurrence rates were 0% in cases managed by microsurgical varicocelectomy, 2.9% in those where loupe magnification was used and 8.8% in those where no magnification was used. Postoperative hydrocele rates in these cases were 0%, 2.9% and 5.9%, respectively. The highest rates of recurrence and hydrocele were observed in cases where no magnification was used, compared to those managed by microsurgery (p = 0.03 and p = 0.116, respectively). CONCLUSIONS: Adolescent varicocele repair improves semen parameters and is a safe method with low recurrence and low complication rates. Our study suggests that the postoperative complication rate significantly decreases with use of higher magnification, such as microscopy. Microsurgical varicocele repair is the best technique with the lowest postoperative rates of recurrence and hydrocele in the treatment of adolescent varicoceles.