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There are scanty data on the rate of abnormal Tc-99 m dimercaptosuccinic acid (DMSA) renal scintigraphy and associated factors in children older than 5 years with diagnosis of VUR. We do not have knowledge about which older children should undergo DMSA after VUR diagnosis. This study aims to assess the rate of abnormal DMSA findings and associated factors in children older than 5 years of age diagnosed with VUR. We retrospectively reviewed the medical records of 258 children with VUR diagnosed at or older than 5 year age. 179 children [42 (23.5%) males and 137 (76.5%) females] with complete data were included. 268 reflux units were compared according to gender, bilaterality, grade, reflux phase at voiding cystourethrography, febrile urinary tract infection (fUTI), lower urinary tract dysfunction (LUTD), and DMSA findings with uni- and multivariate analysis. The median age was 110 (60–216) months. VUR grades were I, II, and III in 197 (73.6%) units and IV–V in 71 (26.4%). 138 (51.5%) renal units had abnormal DMSA. VUR grade (p

Objective: Bladder wall thickness (BWTh) measurements and Nerve Growth Factor (NGF) /creatinine (Cr) values, as noninvasive tools, were found to predict daytime voiding problems in children with overactive bladder (OAB). The goal of this research was to examine if bladder wall thickness together with urine NGF/Cr could be a clinical utility in treatment outcome of OAB in children. Patients and Methods: A total of 60 children with OAB, (Group 1; n=40) and healthy normal controls (Group 2; n=20), aged 6-14 years old were involved in this prospective study. Children were evaluated with detailed history and physical examination, including neurologic examination, and were asked to complete a self-reported questionnaire and a 3-day bladder diary with the aid of their parents. Uroflowmetry was performed in all cases. Urinary nerve growth factor levels were measured by the ELISA and BWTh was measured trans-abdominally by one uro-radiologist specialized in pediatric ultrasonography. Urinary NGF levels were normalized by urinary creatinine levels and compared among all subgroups. Children with OAB received urotherapy as first line treatment at least for three months. 18 children refractory to urotherapy received anticholinergic therapy defined as group 3. Results: The median age of the study group was 10 (range 6 to 16). After urotherapy, 22 children had similar BWTh and NGF/Cr values compared to controls. (2.75 ± 1.15; 2.40 ± 1.00 mm; p=0.86 and 1.02 ± 0.10; 0.78 ± 0.15; p=0.12, respectively). After anticholinergic treatment, BWTh levels (2.25 ± 0.90; 2.40 ± 1.00 mm; p=0.94) and NGF/Cr values (0.95 ± 0.10; 0.78 ± 0.15; p=0.42, respectively) had no significantly difference compared to controls (Group 2). In receiver operating characteristic analysis, bladder wall thickness was found to have sensitivity of 85% and specificity of 84.2% (3,20 AUC, 913; 95 %) and NGF/Cr had sensitivity of 90% and specificity of 92.1% (1,595; AUC, 947; 95 %) in predicting treatment outcome in children with OAB. Conclusions: Bladder wall thickness measurements and NGF/Cr values, as noninvasive tools, could guide outcomes in the treatment of children with overactive bladder.

Introduction Placental insufficiency is one of the reasons for the reduction of hormone production. Thus, if one of the suspected causes of hypospadias is placental insufficiency, then the neurodevelopmental status of boys with hypospadias may be impaired. The aim of this study was to evaluate the neurodevelopmental status of boys with hypospadias and guide the parents of those who need support to related departments for early intervention. Materials and Methods Boys were divided into two groups, those with hypospadias (group H) and healthy children undergoing traditional circumcision (group C). The parents of the boys completed the Ages and Stages Questionnaire (ASQ) and ASQ–Social Emotional (SE), both of which are screening instruments for the early identification of developmental and social–emotional problems, respectively. Results Seventy-eight boys had hypospadias and 59 were admitted for traditional circumcision. The group H had statistically significant more impaired scores than group C in communication, gross motor, and personal–social skill sections. The multivariate logistic regression analysis revealed that hypospadias was the independent predictive factor for communication and personal–social skills. Conclusion Hypospadias and neurologic impairment may share common etiologic factors. Accordingly, physicians should keep in mind that if a boy presents with hypospadias, the possibility of having neurologic impairment is higher than normal population and early intervention has crucial importance. Every boy with hypospadias should be evaluated for neurodevelopmental status.

Objectives:Some of the methods, which were routinely used in traditional open surgical techniques, have vanished nowadays as a result of technical and technological improvements. The aim of this study is to interrogate the responses of the surgeons who have different specialties but work on similar areas of the body to these technical alterations, and the feasibility of these methods in open surgery.Materials and Methods:The study included 90 pediatric surgeons, urologists and general surgeons. A questionnaire was developed asking about the changes that the surgeons faced since first performing endoscopic surgery.Results:The pediatric surgeons changed the accustomed surgical principles in six procedures (73%). Alterations of the urologists were in three pathologies (61%) and four pathologies (72%) in general surgeons. Eighty-six percent of pediatric surgeons, 27% of urologists and 40% of general surgeons were using these alterations of endoscopic techniques in open surgery as well.Conclusion:In this study minimal invasive surgery (MIS) techniques have changed some of the accustomed surgical principles of open surgery. MIS were misevaluated as being close techniques to open surgeries, yet they are in fact a separate branch of surgery, which have many unique technical features. This approach may cause additional changes in open techniques by developing supportive and innovative aspects of MIS.

The optimal management of lower pole kidney (LPK) stones in children is controversial. The aim of this study was to determine the outcomes of children with asymptomatic isolated LPK stones smaller than 10 mm during follow-up.A total of 242 patients with 284 stones presenting at our institution between June 2004 and December 2014 with an asymptomatic, single LPK stone with a diameter of 10 mm were enrolled in the study. All children were assigned to receive first-line therapy and then categorized according to the need for medical intervention. Age, gender, stone laterality, stone size and type, associated urinary tract problems, and uncontrolled metabolic status were assessed as predictive factors of medical treatment for small (10 mm) asymptomatic LPK stones. Stone-free rates were compared between interventions.The mean age and mean stone size were 9.4 ± 1.9 years and 7.4 ± 0.6 mm at admission, respectively. Stone progression rate was 61.2%, and the mean time for intervention was 19.2 ± 4.6 months. Flexible ureterorenoscopy (n = 68) or micro-percutaneous nephrolithotomy (n = 4) were performed for 72 stones (25.4%; group 1), and extracorporeal shock wave lithotripsy was performed for 102 stones (35.9%; group 2). The stone-free rates were 81.8 and 79.3% in group 1 and 2, respectively (p 0.05). The remaining asymptomatic stones (110, 38.8%; group 3) were managed by continued observation, and at the end of the observation time (mean 40.8 ± 20.8 months) the spontaneous passage rate was 9.1% in this group. In the multivariate analysis, stone size of7 mm, concurrent renal anomalies, and stones composed of magnesium ammonium phosphate (struvite) and cystine were statistically significant predictors of the need for intervention.Children with stones larger than 7 mm, renal anomalies, or stones composed of metabolically active cystine or struvite are more likely to require intervention, and those with asymptomatic LPK stones smaller than 10 mm can be managed by continued observation.

Urethral duplication is a rare congenital anomaly with several anatomical variations. Persistence of duplicated urethra and related sphincter mechanism are mainly the reasons for the symptoms. We here present a 9-month-old boy with a rare form of duplication with each portion of the duplicated bladder having its own urethral opening.

To discuss whether concealed penis after circumcision lowers perimeatal urethral and glanular sulcus uropathogenic bacterial colonization in healthy boys with no urinary tract problems and prevents attacks of febrile urinary tract infections in non-healthy boys with defined urinary tract abnormalities. Materials and Methods: This case-control study was conducted in Ibn-i Sina Hospital and retrospectively collected data of 471 boys were analyzed. All patients were scanned for any urinary tract abnormality and those with any defined abnormalities were classified as non-healthy group. (123 patients) Non-healthy patients were divided into two subgroups as concealed (n:31) and non-concealed (n:92) penis after circumcision. Healthy patients with no urinary problems were divided into three groups as circumcised without concealed penis (n:144), with concealed penis after circumcision (n:104) and uncircumcised control group (n:100). Bacterial cultures were obtained from both periurethral meatal and glanular sulcus areas by adhering strictly to the rules of obtaining bacterial culture to avoid false-positive or negative culture results. Also only uropathogenic bacterias were evaluated, irrelevant results were excluded. Results: Mean age was similar in healthy population. Comparison of three groups showed that there was a significant difference in both cultures.(P = .026 for periurethral meatal region, P = .039 for glanular sulcus region) In post hoc analysis, non-concealed group had a lower rate of culture positivity in both areas compared to other groups. Mean age was also similar in non-healthy population. Mean follow-up period was 18.2 months. Patients with concealed penis after circumcision had a significantly higher number of febrile UTI attacks (20 attacks in 8 patients vs 7 attacks in 5 patients) compared to non-concealed group. (P = .019) All febrile UTI attacks except one in this group occurred below the age of 12 months. A total of 10 patients in both healthy and non-healthy groups had postoperative hemorrhage after circumcision and only 1 patient had a wound infection. Conclusion: Concealed penis after circumcision does not lower perimeatal urethral and glanular sulcus uropathogenic bacterial colonization in healthy patients and does not protect unhealthy patients from febrile urinary tract infection attacks. If circumcision is planned, concealed penis should be avoided and also parents should be informed about the possible risks due to concealed penis before the procedure, particularly in patients with urinary tract abnormalities.

Aim:The primary goal of urologic management in children with neurogenic bladder is to reduce the risk of urinary tract infection (UTI) and associated renal injury. We aimed to evaluate the use of antibacterial-coated clean intermittent catheterization (CIC) catheters for neurogenic bladder patients in comparison with standard catheters.Material and Methods:We performed a retrospective study of 144 neurogenic bladder patients aged 6-16 years old, who received CIC at two major centers between January 2007 and June 2016. Group 1 consisted of children used antibacterial coated (chitosan) catheter (n=55), group 2 of children used standard CIC without antibacterial (n=42) and group 3 of children used standard CIC returned into antibiotic coated CIC mimimum 6 months (n=29). Febrile urinary tract infection and asymptomatic bacteriuria were evaluated among patients with antibacterial coated or standard catheters. We also focused on a subgroup of patients with high risk of urinary tract infection (grade 3> vesicoureteral reflux, previously scar formation in renal scintigraphy).Results:Totally 126 patients (89 female, 37 male) were involved in this study. The mean age of the study group was 9.6±2.6 years (range 6 to 16) and the mean follow-up 58±14 months (min: 22, max: 69). There was no significant difference between three groups for asymptomatic bacteriuria and febrile UTI frequencies. However, febrile UTI frequencies and de nova scar formation in renal scintigraphy were higher in previously defined subgroup of patients with high risk of urinary tract infection in group 2 than group1 and 3.Discussion:Both antibiotic coated and standard CIC can be used in children with neurogenic bladder with similar complication rates. Patients with high risk of urinary tract infection (higher than grade 3 vesicoureteral reflux, dilated ureter, previously de nova scar formation in renal scintigraphy) will benefit from antibacterial-coated catheters rather than standard ones.

Vesicoureteral reflux (VUR) which is associated with bladder dysfunction and increased risk of urinary tract infection (UTI), is a common and important urinary system abnormality seen in children. Although VUR spontaneously resolves in most of the cases, it might lead to severe complications including reflux nephropathy, hypertension, UTI and bladder dysfunction. The continuous antibiotic prophylaxis (CAP) in the management of VUR is first choice of therapy. However, controversy exists on CAP in the current studies and some questions have not been properly answered yet. In this paper the recent trends of CAP in VUR is reviewed under current guidelines.

We evaluated whether stress levels in children and parents during radiological evaluation after febrile urinary tract infection are really lower using the top-down approach, where (99m)technetium dimercaptosuccinic acid renal scintigraphy is used initially, than the bottom-up approach, where voiding cystourethrography is initially performed and repeated examinations are easier for all.We prospectively evaluated 120 children 3 to 8 years old. Pain ratings were obtained using the Faces Pain Scale-Revised, and conversation during the procedure was evaluated using the Child-Adult Medical Procedure Interaction Scale-Revised by 2 independent observers. To evaluate parental anxiety, the State-Trait Anxiety Inventory form was also completed. Following a documented febrile urinary tract infection children were randomized to the top-down or bottom-up group. A third group of 44 children undergoing repeat voiding cystourethrography and their parents were also evaluated.Child ratings of pain using the Faces Pain Scale-Revised were not significantly different between the top-down group following (99m)technetium dimercaptosuccinic acid renal scintigraphy (2.99 on a scale of 10) and the bottom-up group following voiding cystourethrography (3.21). Also the Faces Pain Scale-Revised was not significantly different in the repeat voiding cystourethrography group (3.35). On the Child-Adult Medical Procedure Interaction Scale-Revised there was negative correlation between child coping and child distress, as well as rate of child distress and adult coping promoting behavior. Parental state anxiety scores were significantly less in the top-down and repeat voiding cystourethrography groups than in the bottom-up group.Although the top-down approach and repeat voiding cystourethrography cause less anxiety for caregivers, these values do not correlate to pain scale in children. This finding might be due to lack of appropriate evaluation tools of pediatric pain and anxiety. However, the theory that the top-down approach is less invasive, and thus less stressful, requires further research. The Child-Adult Medical Procedure Interaction Scale-Revised data indicate that influences in adult-child interaction are bidirectional.

Introduction: The aims of this study were to investigate the effect of varicocelectomy on DNA fragmentation index and semen parameters in infertile patients before and after surgical repair of varicocele. Materials and Methods: In this prospective study, 72 men with at least 1-year history of infertility, varicocele and oligospermia were examined. Varicocele sperm samples were classified as normal or pathological according to the 2010 World Health Organization guidelines. The acridine orange test was used to assess the DNA fragmentation index (DFI) preoperatively and postoperatively. Results: DFI decreased significantly after varicocelectomy from 34.5% to 28.2% (P = 0.024). In addition all sperm parameters such as mean sperm count, sperm concentration, progressive motility and sperm morphology significantly increased from 19.5 × 10 6 to 30.7 × 10 6 , 5.4 × 10 6 /ml to 14.3 × 10 6 /ml, and 19.9% to 31.2% (P < 0.001) and 2.6% to 3.1% (P = 0.017). The study was limited by the loss to follow-up of some patients and unrecorded pregnancy outcome due to short follow-up. Conclusion: Varicocele causes DNA-damage in spermatozoa. We suggest that varicocelectomy improves sperm parameters and decreases DFI.

Intraprostatic cysts are usually asymptomatic and uncommon. In this kind of cysts, lower urinary tract symptoms are unexpected. Due to similar embryological structure and radio - logical imaging, the differential diagnosis of intraprostatic cysts is difficult. However, clinical aspects can be useful in differential diagnosis. Herein, we report a case of intraprostatic median cyst with lower urinary tract symptoms in fourth decade of his life. We also discuss the differential diagno - sis of median intraprostatic cysts on the based on this case.

Background: To determine association between urine pH and OAB symptoms and to determine if urinary alkalization improves overactive bladder (OAB) symptoms. Methods: 659 patients with OAB were enrolled in this study between June 2012 and May 2014. 329 patients (group 1) were included in the final analysis. 201 adults were used as a control group (group 2). 24-hour urinary pH and the validated Turkish version of the OAB-V8 questionnaire were performed in patients. A 24-hour urine pH Results: Acidic urinary pH was determined in 61.4% of patients with OAB. There was a significant association between the presence of acidic urine and OAB. Also, the OAB-V8 scores of patients were significantly higher in patients with acidic urine than nonacidic urine. OAB-V8 scores of patients showed statistically significant improvement after diet therapy (17.87 ± 6.52 vs. 10.43 ± 7.17; p < 0.001). Conclusions: We found that acidic urinary pH was closely associated with OAB, and alkalization of urine improved lower urinary tract symptoms. We suggest that urinary pH should be considered as a parameter in treatment planning of patients with OAB.

Objective To determine preoperative predictive factors of postoperative complications of ureteric re-implantation in children by using the modified Clavien classification system (MCCS), which has been widely used for complication rating of surgical procedures. Patients and Methods In all, 383 children who underwent ureteric re-implantation for vesico-ureteric reflux (VUR) and obstructing megaureters between 2002 and 2011 were included in the study. Intravesical and extravesical ureteric re-implantations were performed in 338 and 45 children, respectively. Complications were evaluated according to the MCCS. Univariate and multivariate analyses were used to determine predictive factors affecting complication rates. Results In all, 247 girls and 136 boys were studied. The mean (sd) age was 46 (25) months and the mean (sd) follow-up was 49.4 (27.8) months. The mean (sd) hospitalisation time was 4.7 (1.6) days. Complications occurred in 76 (19.8%) children; 34 (8.9%) were MCCS grade I, 22 (5.7%) were grade II and 20 (5.2%) were grade III. Society of Fetal Urology (SFU) grade 3–4 hydronephrosis, obstructing megaureters, a tailoring-tapering and folding procedure, refractory voiding dysfunction and a duplex system were statistically significant predictors of complications on univariate analysis. Prior injection history, paraureteric diverticula, stenting, gender, age, operation technique (intra vs extravesical) were not significant predictors of complications. In the multivariate analysis refractory voiding dysfunction, a tailoring-tapering and folding procedure, obstructing megaureters (diameter of >9 mm) and a duplex system were statistically significant predictors of complications. Conclusion Ureteric re-implantation remains a valid option for the treatment of certain patients with VUR. Refractory voiding dysfunction, a tailoring-tapering and folding procedure, obstructing megaureters (diameter of >9 mm) and associated duplex systems were the main predictive factors for postoperative complications. Use of a standardised complication grading system, such as the MCCS, should be encouraged to allow the valid comparison of complication rates between series.

Objective To determine the relationship between postcircumcisional mucosal cuff length due to performance of circumcision and premature ejaculation (PE). Materials and methods 180 circumcised men were enrolled in the study, including 60 men with PE circumcision performed by doctors (Group 1), 60 men with PE circumcision performed by non-medical personnel (Group 2) and 60 men without PE. Data considered for analysis consisted of age, circumcision age, education, smoking, penile length, mucosal cuff, penile skin lengths and Intravaginal Ejaculation Latency Time (IELT). Results The mean age of study group was 32.7 ± 10.4 (range 24–56). The mean of IELT was 0.6 ± 0.1 min (min) in group 1, 0.5 ± 0.1 min in Group 2 and 4.3 ± 0.3 min in healthy group. The mean of penis length was 123.2 ± 12.8 mm in group 1, 124.6 ± 11.7 mm in group 2 and 124.8 ± 13.4 mm in healthy group. The mean of penile mucosa was 11.7 ± 1.7 mm in group 1, 14.8 ± 3.1 mm in group 2 and 12.8 ± 3.1 mm in healthy group. There was no difference between the three groups regarding the length of the penile mucosal cuff (p = 0.89). Patients circumcised by doctors in group 1 had significantly shorter postcircumcisional mucosal cuff length than group 2 patients circumcised by personnel except doctors (p = 0.42); but there was no statistical difference in IELT between group 1 and group 2. Conclusions The result of this study is that circumcisions performed by doctors have shorter mucosal cuff but the length of mucosa is not a risk factor in premature ejaculation.

The purpose of this study was to evaluate the features of prostate cancer that have been incidentally detected in radical cystoprostatectomy specimens of bladder cancer patients. The researchers of the current study retrospectively evaluated the data from 119 men who underwent radical cystoprostatectomy at four referral institutions in Ankara, Turkey. Of the 21 prostate cancer patients, 17 (81%) were aged >= 60 years; 10 (47.6%) had clinically significant diseases; three had a Gleason score of 6, three had a Gleason score of 7, three had a Gleason score of 8, one had a positive surgical margin along with extracapsular invasion of the tumor and a high Gleason score, and three patients had a tumor volume of >= 0.5 cm(3), of which two also had a high Gleason score. Patients were followed-up for a mean of 29 +/- 10.2 months; the overall survival was 96.6% (n = 115) during that period. Preoperative digital rectal examination and prostate-specific antigen values did not differ between the benign and prostate cancer groups. There was no survival advantage in the insignificant prostate cancer and benign prostate groups. No additional benefit for predicting prostate cancer was found with digital rectal examination and prostate-specific antigen tests, although some clinicians advised such. In patients aged < 60 years, organ-sparing cystectomy seems reasonable. In prostate-sparing surgery, candidates who are aged >60 years, the preoperative work-up may routinely include prostate biopsy, especially the apex. Preoperative findings of multifocality of bladder cancers and the presence of carcinoma in situ have the risk of prostatic involvement. Copyright (C) 2014, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. All rights reserved.

Purpose: It is debated whether treatment delay worsens oncologic results in localized prostate cancer (PCa). Few studies have focused on the role of a delay between the time of biopsy and the time of surgery. Thus, we aimed to investigate the effect of the time period between biopsy and surgery on Gleason score upgrading (GSU). Materials and Methods: A total of 290 patients who underwent radical retropubic prostatectomy in Ankara Training and Research Hospital were included in the study. The biopsy Gleason score, age, total prostate-specific antigen (PSA) value, prostate volumes, and PSA density (PSAD) were analyzed in all patients. The patients were divided into two groups: patients with GSU (group 1) and patients without GSU (group 2). Variables having a p-value of ≤0.05 in the univariate analysis were selected and then evaluated by use of multivariate logistic regression models. Results were considered significant at p＜0.05. Results: GSU occurred in 121 of 290 patients (41.7%). The mean age of the patients was 66.0±7.2 years in group 1 and 65.05±5.60 years in group 2 (p=0.18). The mean PSA values of groups 1 and 2 were 8.6±4.1 and 8.8±4.3 ng/dL, respectively. The mean prostate volumes of groups 1 and 2 were 43.8±14.1 and 59.5±29.8 mL, respectively. The PSAD of group 1 was significantly higher than that of group 2 (0.20 vs. 0.17, p=0.003). The mean time to surgery was shorter in group 2 (group 1, 52.2±22.6 days; group 2, 45.3±15.5 days; p=0.004). According to the logistic regression, time from biopsy to surgery is important in the prediction of GSU. Conclusions: We suggest that the time period between biopsy and surgery is a significant factor that affects GSU in patients with clinically localized PCa.

Purpose This study aimed to investigate the prevalence of nocturia according to the International Continence Society (ICS) definition in Turkish women and to determine the associated risk factors and the correlation of other voiding symptoms with nocturia. Materials and Methods A prospective epidemiological study was carried out by use of self-reported questionnaires in 4,250 reproductive-aged women from January 2013 to May 2013. The International Consultation on Incontinence Questionnaire-Short Form and a questionnaire developed by the researchers according to the ICS were administered to define nocturia and other lower urinary tract symptoms. Other physical, reproductive, and health characteristics were also recorded concurrently. Results Overall, 1,636 women were included in the final analyses. The women had an average age of 34.4±5.26 years. The overall prevalence of nocturia was 34.7% (567 of 1,636 women). Women with nocturia were older (p40 years were significant risk factors for nocturia. We also found that other lower urinary tract symptoms correlated significantly (p

Lymphangioma circumscriptum (LC) is an uncommon type of microcystic lymphatic malformation involving the skin and mucosa caused by saccular dilatation of lymphatic channels. Patients may suffer from edema, vesiculopustular lesions and lymphatic leakage. There are many treatment methods for the management of lymphangioma circumscriptum. In this paper, we present a 10-year-old patient who had penile edema treated with split-thickness skin grafting technique.

Objective In this study we aimed to identify the effect of three different modalities (stenting, doxazosin and conservative follow-up) on stone free rates and complication rates for 10–20mm renal pelvic stones in pediatric patients who underwent shock wave lithotripsy. Patients and methods In this study data from 241 renal units (RUs) of 195 consecutive patients with 10–20mm renal pelvis stones were analyzed retrospectively. There were 3 groups in the study; 56 (23.2%) RUs with ureteral stenting were categorized as group 1, and 39 (16.2%) RUs that received doxazosin were categorized as group 2. The remaining 146 (60.6%) RUs without history of ureteral stenting or alpha-blockers usage were categorized as group 3. Patient demographics, stone characteristics, stone free rates (SFRs), time to stone expulsion and complications were documented and compared in each group. Results Mean age of the population was 6.6years and mean stone size was 13.8±2.9mm. Demographic characteristics of the 3 groups were not significantly different. SFRs of the three groups were 89.2%, 87.1% and 82.1% (p=0.275). Mean time to stone expulsion for groups 1 and 2 were 17.4 and 21.8days respectively and significantly lower than that in group 3 (31.3days). Conclusions Ureteral stenting or doxazosin for shockwave lithotripsy (SWL) is not superior to watchful waiting in terms of SFR and complications however both modalities shorten the stone expulsion time for 10–20mm renal pelvis stones in the pediatric population.

Urethral calculi are extremely rare in pediatric population and are usually presented with dysuria, hematuria, lower urinary tract obstruction, and rarely as a scrotal mass. We here report a giant primary urethral stone presenting as a scrotal mass that developed in the penile urethra resulting from a postsurgical complication of exstrophy-epispadias repair. A 7-year-old boy was admitted with the complaint of scrotal mass and dysuria. Computerized tomography confirmed giant urethral stone impacted to diverticulum of urethra. Cystoscopy revealed a nonobstructed stone in the urethra related to a posterior diverticulum. After scrotal incision, stone was removed with open diverticulectomy.

In this study, we aimed to investigate the effect of prestenting on success and complication rates of pediatric ureterorenoscopy (URS) procedures.We retrospectively analyzed the data of 251 pediatric URS cases. Forty-seven of the patients were prestented. Success and complication rates of the prestented and nonprestented groups were compared and further analysis was performed with respect to stone location (renal vs ureteral) and size (7-mm cutoff). Multivariate analysis was performed to define factors associated with success rates.Mean age of the population was 8.9 years. Success rate of the entire population was 80.5% and significant difference between prestented and nonprestented groups was detected (91.5% vs 77.9%, p = 0.04). Higher success rates of the prestented group were also observed in ureteral stones (94.1% vs 79.5%, p = 0.04) and stones7 mm (84.6% vs 74.1%, p = 0.72). Prestented group showed higher success rates in kidney stones, but the difference was insignificant (84.6% vs 74.1%, p = 0.72). Prestenting was also identified as an independent predictor of success in multivariate analysis. Complication rate in the prestented group was also lower, but the difference was not significant (8.5% vs 14.7%, p = 0.347).Prestenting was found to increase the success rate of URS in cases of larger stones and ureteral stones in pediatric population. Prestenting also provides lower, but insignificant, complication rates. However, this procedure also has significant disadvantages. Based on the results of current study, we cannot recommend routine prestenting in pediatric cases. Instead, we recommend an attempt to treat the stone in the first session and place a stent in case of failed procedure to utilize potential benefits of prestenting while avoiding disadvantages.

Horseshoe kidney is a relatively common congenital anomaly. In 95% of the cases, lower poles are connected to each other. In a small subset, an isthmus connects both upper poles (reverse horseshoe kidney). Almost always, the fusion of kidney poles occurs anterior to the aorta and vena cava. The fusion of renal poles posterior to both aorta and vena cava is extremely rare. Herein, we present a case with multiple rare congenital anomalies—retroaortic variant of reverse horseshoe kidney, retroaortic left renal vein, and butterfly vertebrae.

Introduction: To evaluate possible factors that can guide the clinician to predict potential cases refractoriness to medical treatment for giggle incontinence (GI) and to examine the effectiveness of different treatment modalities. Material and methods: The data of 48 children referred to pediatric urology outpatient clinic between 2000 and 2013 diagnosed as GI were reviewed. Mean age, follow-up, GI frequency, associated symptoms, medical and family history were noted. Incontinence frequency differed between several per day to less than once weekly. Children were evaluated with uroflowmetry-electromyography and post-void residual urine. Clinical success was characterized as a full or partial response, or nonresponse as defined by the International Children's Continence Society. Univariate analysis was used to find potential factors including age, sex, familial history, GI frequency, treatment modality and dysfunctional voiding to predict children who would possibly not respond to treatment. Results: Mean age of the patients was 8.4 years (range 5 to 16). Mean follow-up time and mean duration of asymptomatic period were noted as 6.7±1.4 years and 14.2±2.3 months respectively. While 12 patients were treated with only behavioral urotherapy (Group-1), 11 patients were treated with alpha-adrenergic blockers and behavioral urotherapy (Group-2) and 18 patients with methylphenidate and behavioral urotherapy (Group-3). Giggle incontinence was refractory to eight children in-group 1; six children in-group 2 and eight children in-group 3. Daily GI frequency and dysfunctional voiding diagnosed on uroflowmetry-EMG were found as outstanding predictive factors for resistance to treatment modalities. Conclusions: A variety of therapies for GI have more than 50% failure rate and a standard treatment for GI has not been established. The use of medications to treat these patients would not be recommended, as they appear to add no benefit to symptoms and may introduce severe adverse effects.

Purpose To date, laparoscopy has gradually become the gold standard for treatment of non-palpable testicles (NPT) with different success and complication rates. In this study, we aimed to evaluate outcomes of laparoscopic approaches for NPT. Materials and Methods We reviewed data of 82 consecutive patients who underwent laparoscopic treatment for unilateral NPT at two institutions by two high volume surgeons from 2004 January to 2014 December. Laparoscopic-assisted orchidopexy (LAO) and two-stage Fowler–Stephens technique (FST) was performed for 45 and 37 patients, respectively. Age (at surgery), follow-up time, laterality of testes, and postoperative complications were analyzed. Modified Clavien classification system (MCCS) was used for evaluating complications. Results The median age (at surgery) and median follow-up time were 18 (range: 6–56) and 60 (range: 9–130) months, respectively. Overall success rate for two laparoscopy techniques was 87.8% during the maximal follow-up time. We observed wound infection in two, hematoma in one, testicular atrophy in five, testicular re-ascending in two patients at follow-up period. There was no statistical difference between two laparoscopic techniques for grade I (five vs. two patients, p = 0.14) and grade IIIb MCCS complications (five vs. two patients, p = 0.44). Conclusion Our results have shown that two laparoscopic approaches have low complication rates.

Objective To evaluate preoperative predictive factors for postoperative complications of augmentation cystoplasty in children by using the modified Clavien classification system (MCCS). Patients and Methods A retrospective review of medical records between 1994 and 2014 identified 117 children (64 males and 53 females) who underwent augmentation cystoplasty. Complications were evaluated according to the MCCS. Univariate and multivariate analyses were used to determine predictive factors affecting complication rates. Results The mean (SD) age was 9.3 (1.9) years and the mean (SD) hospitalization time was 9.7 (3.6) days. Patients with an adverse or unexpected event within 30 days of surgery were identified. Complications occurred in 29 (24.7%) children; 13 (11.1%) were MCCS grade I, 8 (5.1%) were grade II, 5 (4.2%) were grade III, and 3 (2.5%) were grade IV. Antireflux surgery, outlet resistance increasing procedures, Society of Fetal Urology (SFU) grades 3-4 hydronephrosis, posterior urethral valves, scoliosis, and serum creatinine greater than 1.0 mg/dL were statistically significant predictors of complications on univariate analysis. In the multivariate analysis, SFU grades 3-4 hydronephrosis, bladder neck reconstruction, and serum creatinine greater than 1.0 mg/dL were statistically significant independent predictors of complications. Conclusion Augmentation cystoplasty remains a valid method of treating severe bladder dysfunction in children. SFU grades 3-4 hydronephrosis, outlet resistance increasing procedures, and serum creatinine greater than 1.0 mg/dL were the main predictive factors for postoperative complications. Use of a standardized complication grading system, such as the MCCS, should be encouraged to allow the valid comparison of complication rates between series.

Objective To identify the incidence and associated factors of the postoperative hydronephrosis in pediatric patients who underwent ureterorenoscopy (URS) for renal or ureteral stones. Patients and methods We evaluated the results of 116 patients who underwent semirigid or flexible URS retrospectively. Primary end points of the study were to determine the incidence of postoperative hydronephrosis and factors associated with the development of postoperative hydronephrosis. Logistic regression analysis was used to define factors associated with the presence of hydronephrosis. Results Mean age of the population was 9.5 years and mean stone size was 9.4 mm. Hydronephrosis was detected in 32 (27.6%) patients. Stone-free status was achieved in 101 (87%) patients. Univariate analysis revealed history of ipsilateral URS, duration of operation, presence of impacted stone, development of ureteral injury during operation, and presentation with a renal colic episode as the parameter associated with increased risk of hydronephrosis. History of ipsilateral URS (odds ratio: 1.664, P = .027), presence of impacted stones (odds ratio: 1.788, P = .014), and development of ureteral injury during operation (odds ratio: 1.106, P = .039) were found to be the independent markers of developing postoperative hydronephrosis in a multivariate analysis. Conclusion Ipsilateral hydronephrosis following URS develops in a significant portion of patients. In patients with history of ipsilateral procedure and those with an impacted stone and had ureteral injury, the risk of postoperative hydronephrosis is higher; therefore, physicians should keep these parameters in mind in the decision-making process of selective imaging postoperatively.

We report a 13-month-old girl with primary intrarenal neuroblastoma initially diagnosed as Wilms' tumor. Intrarenal neuroblastoma is exceedingly rare in pediatric age that may masquerade as Wilms' tumor clinically and radiographically and it is important to differentiate for management.

Objective To investigate the efficacy of near infrared spectroscopy (NIRS) and an algorithm on the diagnosis of bladder outlet obstruction in men with lower urinary tract symptoms (LUTS). Methods Male patients with LUTS were recruited and underwent uroflowmetry and urodynamic pressure flow study (PFS) with simultaneous transcutaneous NIRS monitoring. Next, the postvoid residual urine volume was measured using ultrasonography. Data analysis first classified each subject as obstructed or unobstructed using the standard pressure flow data and nomogram and compared these results with the NIRS algorithm, which analyzed the pattern of change of the NIRS data plus the measurements of the postvoid residual urine volume and peak flow rate on uroflowmetry. Results A total of 65 patients were enrolled in the present study. Of these patients, 10 with equivocal PFS findings and 2 with concurrent urinary tract infection were excluded. Of the 53 patients, 29 and 24 were classified as obstructed and unobstructed according to the PFS outcomes, respectively. The International Prostate Symptom Score and uroflowmetry peak flow rate demonstrated significant differences between the obstructed and unobstructed patients. The NIRS algorithm correctly identified 25 patients diagnosed as obstructed (86.2%) and 21 diagnosed as unobstructed (87.5%) according to the PFS findings. Conclusion The NIRS algorithm could be a noninvasive option for the diagnosis of bladder outlet obstruction in men with LUTS, with 86.2% and 87.5% sensitivity and specificity, respectively.

In this study, we aimed to investigate the relation of testicular torsion and weather conditions, and to report results from Turkey, a country located between temperate and sub-tropical climate zones.A total of 56 patients that had surgery with the diagnosis of testicular torsion in Ankara Education and Research Hospital Urology Clinic between 2005 and 2014 were included in the study. Age of the patient, side of torsion, date and time at onset of pain, scrotal exploration time, ischemia duration, degree of cord torsion, the surgical procedure performed, and scrotal Doppler ultrasound (USG) findings at the time of diagnosis and 1 month after surgery were retrospectively analyzed. The web archives of Turkish Republic Meteorology General Directorate was used to determine the seasonal and mean temperatures at the time of diagnosis. The data were analyzed with SPSS v. 16 statistical package program using Chi-square, Mann- Whitney U and Wilcoxon tests.The mean age of 56 males included in the study was 18.88 ± 0.73 years. Right testicular torsion was seen in 23, and left testicular torsion was seen in 33 patients. Testicular arterial flow was absent in 37, arterial flow was moderately decreased in 12, and significantly decreased in 7 patients on Doppler USG. Detorsion procedure was performed in 46 patients while 10 patients had orchiectomy. Nine patients were admitted in summer, 14 in fall, 15 in winter, and 18 in spring. The mean air temperature at the time of admittance was 9.31 ± 1.05 °C. The prevalence of testicular torsion was not found different among the seasons (p=0.39). The analysis of air temperature at the time of admittance of the patients revealed that it was below 15 °C in 40 patients while it was above 15 °C in 16 patients, with a significant difference in between (p=0.002).The prevalence of testicular torsion did not change in relation with the seasons. However, it was determined that its prevalence was directly proportional to the air temperature, and increased particularly below 15 °C.