Ahmet Sahan

Is 40 cm H2O detrusor leak point pressure cut-off reliable for upper urinary tract protection in children with myelodysplasia?

The purpose of this study, is to find out the most accurate cut‐off level for the detrusor leak point pressure (DLPP) in terms of upper urinary tract (UUT) protection in a cohort of children with myelodysplasia.

Safety and Efficacy of Retropubic or Transobturator Midurethral Slings in a Randomized Cohort of Turkish Women

Objective: The aim of this study was to evaluate the safety and efficacy of retropubic (RP) or transobturator (TO) midurethral slings (MUS) in a prospective randomized cohort of Turkish women. Patients and Methods: A total of 54 women with urodynamic stress urinary incontinence (SUI) were randomized to undergo either RP or TO MUS between August 2006 and February 2013 in a tertiary referral center by a single surgeon. All patients had history, physical examination, urodynamic evaluation and quality of life assessments. The validated Turkish versions of the SEAPI, ICIQ-SF and OAB-V8 questionnaires were used. The Advantage® RP and the Obtryx® TO MUS Systems were used for all RP and TO procedures. Results: Twenty-seven patients were randomized to each group. The median follow-up was 48.5 ± 21.8 months. The median hospital stay was 24.0 ± 4.8 h and median operative time was 35.0 ± 19.9 min. The overall objective and subjective cure rates were 92.6 and 79.6%, respectively. The quality of life of all patients significantly increased after the operation compared to their preoperative status. Patients with a poorer subjective cure rate were those with mixed urinary incontinence, whose preoperative SEAPI and OAB-V8 scores were significantly higher. Conclusion: MUS surgery is highly effective and could safely be performed in a cohort of Turkish women with SUI in subspecialty centers by experienced surgeons. There is no significant difference between RP or TO applications in terms of safety and efficacy. Further studies with long-term follow-up data are required.

MP43-15 PROTECTIVE EFFECT OF PLATELET RICH PLASMA ON EXPERIMENTAL ISCHEMIA/REPERFUSION INJURY IN TORSION OF RAT TESTIS

INTRODUCTION AND OBJECTIVES: Previous reports have suggested an association between cold temperatures and the prevalence of testicular torsion. We hypothesized there is no association, and we used large-scale national data to evaluate this hypothesis. METHODS: For testicular torsion cases, we used the Pediatric Health Information System (PHIS) database to determine the date and city of a case of testicular torsion from 9/2006 to 7/2015. Cases were identified using ICD-9 diagnosis codes for testicular torsion (608.2) occurring concomitantly with procedure codes for reduction of torsion (63.52). For weather data, we used data from the National Climatic Data Center at the National Oceanic and Atmospheric Administration. For all cities with hospitals in the PHIS database, we determined the maximum and minimum daily atmospheric temperature at the weather station closest to each hospital. We then built cumulative distribution functions and density graphs for the distribution of (a) median daily temperature (calculated from measured temperature maximum and minimum) for cases of testicular torsion, and (b) median daily temperature for all days. Cumulative distribution curves and density graphs were compared using the KolmogorovSmirnov (K-S) test. All analyses were completed using the R software package. RESULTS: 9,126 cases of testicular torsions were identified and 154,542 days of temperature data across all hospital cities over the time period of interest. Days at each temperature across all hospitals and time from 9/2006 to 7/2015 were calculated, as were number of torsions at each temperature. The relative distribution of each temperature is compared in Figure 1, with all days portrayed in red and torsions portrayed in blue. The K-S test for similarity of distribution showed a D statistic of 0.019 (p-value 0.005), indicating the maximum deviation between these two distributions was 1.9%, a nearly imperceptible change. CONCLUSIONS: We therefore concluded that there is no clinically significant difference between the distribution of temperature in the United States and the distribution of temperature related to testicular torsion. We have shown using more than 150,000 individual days in individual cities and more than 9,000 cases of testicular torsion that there is no association between temperature and the prevalence of this disorder. We suggest abandoning this premise. Source of Funding: none

Resistant pediatric priapism: A real challenge for the urologist

Priapism in pediatric patients is a rare entity. We present an 8-year-old boy with known cerebral palsy. He came to the emergency department with sustained painful erection for 12 hours. Physical examination showed rigid penis. Blood count and biochemical analysis were normal. Although penile Doppler ultrasound revealed normal arterial and venous flow, cavernosal blood gas was hypoxic. A total of 50 mL of dark blood was aspirated, and 2 mL of 0.001% adrenalin solution was applied to both corpus cavernosum, twice within 20 minutes, which eventually did not achieve detumescence. A distal Winter shunt was performed at the end of which the penis was semi-flaccid. By the 18th hour of surgery, the penis re-gained painful erection status, so an Al-Ghorab shunt was performed. After the Al-Ghorab shunt, the penis was still in the semi-flaccid state. The next day, an angiography was performed and an arteriovenous fistula was discovered and treated by embolization. The flaccid state was achieved and the patient was discharged the day after the embolization.