Berk Burgu

Approach to newborn priapism: A rare entity

Priapism is a rare entity with a different aetiology in newborns than in childhood and adult life. Due to its rarity, management can be challenging. The possible consequences of improper treatment make management of this condition clinically relevant. Preservation of normal erection is the major goal. Although the majority of cases are idiopathic, prolonged erection may be associated with polycythemia. As spontaneous detumescence occurs in the majority of cases, conservative non-surgical treatment is advocated initially. We report the case of a newborn presenting with priapism on the 1st day of life. Detumescence was achieved on the 4th day of life with conservative management.

Significance of age-specific creatinine levels at presentation in posterior urethral valve patients

OBJECTIVE Determination of prognostic factors is of great importance in decision making on therapies and informing parents about the probable outcome of disease. The present study aims to evaluate and assess the prognostic factors in posterior urethral valve (PUV) patients. MATERIALS AND METHODS The data of 68 patients treated between 1996 and 2004 were evaluated retrospectively. The mean age at diagnosis was 36.4 months. The serum creatinine levels were standardized using the age-specific creatinine reference (ASCR) levels. The age at diagnosis, clinical presentation, initial serum creatinine, method of treatment, presence of vesicoureteral reflux (VUR) and hydroureteronephrosis (HUN), all of which may effect the prognosis, were evaluated. RESULTS The analysis revealed that, of the 36 patients whose initial serum creatinine levels were within ASCR, only one (2.8%) had a final serum creatinine higher than ASCR values. In contrast, of the 32 patients whose initial serum creatinine levels were not within ASCR, 19 (59.4%) had final serum creatinine levels higher than ASCR (P<0.001). The distribution of final serum creatinine according to treatment method, presence of UTI before treatment and age at diagnosis was not statistically significant; however, the difference in distribution for initial serum creatinine (P<0.001), mode of clinical presentation (0.016), presence of HUN (0.019) and state of VUR (0.037) before treatment was statistically significant. CONCLUSION Final outcome with regard to renal function in PUV patients is affected by bilateral VUR and most significantly by serum creatinine levels higher than ASCR.

Time between First and Second Transurethral Resection of Bladder Tumors in Patients with High-Grade T1 Tumors: Is It a Risk Factor for Residual Tumor Detection?

Purpose: We evaluated the risk factors for residual tumor detection after transurethral resection of bladder tumors (TURBT) in patients with newly diagnosed high-grade T1 transitional cell carcinoma of the bladder. Patients and Methods: Overall 132 patients underwent TURBT for primary bladder tumors and were diagnosed as high-grade T1 bladder cancer. Patients with incomplete resections were excluded from the study. Clinical and pathologic characteristics of the patients were compared and multivariate analysis was performed to determine independent prognostic factors. Results: Residual tumor was demonstrated in 57 (43.1%) of the patients. The residual tumor rate was significantly lower in patients with solitary tumors, tumors <3 cm in diameter, muscle presence in the initial TURBT pathologic sample and treated by an expert surgeon. In patients with solitary bladder tumors, tumors at the dome and posterior wall of the bladder exhibited higher rates of residual tumor (p < 0.0001). The time elapsed between first and second TURBT was significantly shorter in patients without residual tumor compared to patients with residual tumor at second TURBT (32.6 ± 9.1 vs. 39.3 ± 10.9 days, respectively, p = 0.001). Multivariate analysis demonstrated that time elapsed between first and second TURBT is the most important parameter for residual tumor detection. Conclusion: Our study revealed that multiple tumors, tumors >3 cm in size, absence of detrusor muscle in the initial TURBT specimen, TURBT performed by trainees and finally, as a new finding, prolonged interval between first and second TURBT are independent predictors for residual tumor detection in patients with high-grade T1 tumors.

An unusual cause of infantile gynecomastia: sertoli cell tumor.

Prepubertal testicular masses are relatively rare. Sertoli cell tumors account for 2% of prepubertal testicular tumors and very few have occurred in the first decade of life. Gynecomastia can be seen in approximately 5% of patients with testicular mass. We present an 8-month-old boy admitted with bilateral gynecomastia and unilateral testicular mass.

Inflammatory Myofibroblastic Tumor of the Bladder in a 10-Year-old Girl

Inflammatory myofibroblastic tumors (IMTs) of the bladder are rarely encountered bladder tumors during the pediatric age. The unknown malignant potential of these tumors causes controversy for their treatment and follow-up. We report a 10-year-old girl who was referred to our clinic with dysuria and enuresis. The clinicopathological evaluation was compatible with IMT and a bladder preserving approach was used. There was no recurrence in the first year of follow-up examinations.

Mayer-Rokitansky-Küster-Hauser syndrome accompanied by renal cell carcinoma: a case report.

Mayer-Rokitansky-Küster-Hauser anomaly originates from agenesis of the Müllerian duct including agenesis of the uterus and the vagina because of abnormal development of the uterine ducts. This syndrome may be accompanied by the upper urinary tract anomalies such as unilateral renal agenesis, ectopia of 1 or both kidneys, renal hypoplasia, horseshoe kidney, and hydronephrosis. We report a 16-year-old girl, with unilateral renal agenesis, herniating ovary, and renal cell carcinoma in her solitary kidney, associated with Mayer-Rokitansky-Küster-Hauser syndrome—the first case in the literature to our knowledge.

RESPONSE TO THE ANASTROZOLE TREATMENT IN A CASE WITH PEUTZ-JEGHERS SYNDROME WHO WAS DETECTED TO HAVE LARGE CELL CALCIFYING SERTOLI CELL TUMOR AND DEVELOPED PRE-PUBERTAL GYNECOMASTIA.

Peutz-Jeghers syndrome (PJS) is inherited as an autosomal dominant trait characterized by multiple gastrointestinal hamartomatous polyps, mucocutaneous pigmentation, and an increased risk of neoplasm. Large-cell calcifying Sertoli cell tumor (LCCSCT) is a kind of sex cord-stromal tumor which may co-exist with PJS and which is characterized radiologically by calcification foci within the testes. Surgical treatment options for this tumor range from testis-preserving surgery to radical orchiectomy. Not with standing this invasive approach, recently, there are some case reports demonstrating the efficacy of aromatase inhibitors in avoiding orchiectomy and its associated complications. In this paper, we have presented a LCCSCT case diagnosed in a boy with PJS and his response to anastrozole treatment.

A Rare Case of Penile Lymphangioma Circumscriptum Treated with the Split-Thickness Skin Grafting Technique

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.

196 DOES STRUCTURED WITHDRAWAL OF DESMOPRESSIN IMPROVE RELAPSE RATES IN MONOSYMPTOMATIC ENURETICS: PRELIMINARY RESULTS OF A PROSPECTIVE RANDOMIZED MULTICENTRE PLACEBO CONTROLLED STUDY?

Parviz Hajiyev*, Berk Burgu, Evren Suer, Yusuf Kibar, Ankara, Turkey; Mesrur Selcuk Silay, Istanbul, Turkey; Serhat Gurocak, Hasan Serkan Dogan, Hasan Cem Irkilata Irkilata, Ankara, Turkey; Tayfun Oktar, Bulent Onal, Istanbul, Turkey; Erim Erdem, Mersin, Turkey; Yuksel Cem Aygul, Ankara, Turkey; Cem Balcý, Ahmet Ruknettin Aslan, Istanbul, Turkey; Tarkan Soygur, Ankara, Turkey; Þaban Sarýkaya, Samsun, Turkey; Serdar Tekgul, Ankara, Turkey

Endoscopic management of patients with complicated vesicoureteral reflux

Özet Amaç: Vezikoüreteral reflüde (VUR) açık cerrahi sonrası görülebilecek sorunların yaşanmadığı subtrigonal enjeksiyon tedavisinin anatomik ya da fonksiyonel nedenlere bağlı komplike vakalardaki yerini ve başarı oranlarını sorguladık. Gereç ve yöntem: Komplike vaka kriterlerine uyan ve ortalama yaşı 3.1 (dağılım 1.2-16) olan 45 hastada (33 kız, 12 erkek) toplamda 64 reflülü üretere tecrübeli iki pediatrik ürolog tarafından endoskopik subtrigonal enjeksiyon uygulandı. Ortalama takip süresi 33 (dağılım 9-60) ay olan hastaların tümüne postoperatif 3. ayda voiding sistoüretrogram çekildi. Üreter başına ortalama 1.2 (dağılım 0.7-2.1) mL enjeksiyon materyali (dekstranomerhiyaluronik asit kopolimer) uygulandı. Bulgular: Toplam 64 reflülü üreterin 39’unda (%61) yaş, cinsiyet ve tanıdan bağımsız olarak ilk enjeksiyon sonrası başarı sağlandı. On hastaya uygulanan reenjeksiyon sonrasında başarı oranı %78’e yükseldi. Biri hariç paraüreteral divertikülün eşlik ettiği ve tek orifisli ‘Y/V’ duplike sistemlere olan reflülerin tümünde ilk ya da ikinci enjeksiyon sonrası kür sağlandı. Ekstravezikal üreteroneosistostomi sonrası reflüsü devam eden 6 hastada toplam 7 reflülü üretere endoskopik tedavi uygulandı ve 3 üreterde ilk enjeksiyon sonrasında ve 1 üreterde ise ikinci enjeksiyondan sonra reflü olmadığı izlendi. Dirençli işeme disfonksiyonu olan ve nörojen mesane tanısı ile izlenen 3’er hastada ilk ya da ikinci enjeksiyon sonrasında başarı sağlandı. Bu iki hasta grubunda yer alan toplam 5 hasta ise enjeksiyon sonrası reflü derecesinin azalması ve klinik sorun yaratmaması nedeniyle reimplantasyon uygulanmadan profilaksi kesilerek takibe alındı. Takip süresince hastaların hiçbirinde rekürren idrar yolu enfeksiyonu görülmedi. Sonuç: Komplike VUR’lu olgularda uygun enjeksiyon materyali ve tekniği ile tecrübeli ellerde, subtrigonal enjeksiyon kabul edilebilir bir tedavi seçeneğidir. Bununla birlikte bu hastalarda reimplantasyonun yeri göz ardı edilemez.