M. Ihsan Karaman

Urodynamic findings in children with cerebral palsy

Abstract

Laser Acupuncture Therapy for Primary Monosymptomatic Nocturnal Enuresis

PURPOSE Monosymptomatic nocturnal enuresis is the nighttime bed-wetting that occurs among children without lower urinary tract symptoms or bladder dysfunction, and affects a considerable part of the population. In our study the effect of laser acupuncture therapy on patients with primary monosymptomatic nocturnal enuresis was evaluated in a prospective, randomized, placebo controlled, single-blind study. MATERIALS AND METHODS A total of 91 children with a mean age of 8.6 years who presented to our outpatient clinic with primary monosymptomatic nocturnal enuresis and had not received any medical therapy were included in the study. The children were randomized into 2 groups. In group 1 laser acupuncture was performed 3 times a week for 4 weeks, whereas the same program via a nonlaser light to the same points was performed on the children in group 2 (placebo group). The number of weekly bed-wetting episodes before therapy was recorded, and the children were reevaluated 15, 30, 90 and 180 days after treatment. RESULTS The mean number of bed-wetting episodes was 1.7 per week 6 months after laser therapy. In the placebo group the mean number of weekly bed-wetting episodes was 3.1. Laser acupuncture therapy was significantly more beneficial compared to placebo in terms of complete dryness, partial improvement and a decrease in the mean number of weekly bed-wetting episodes. CONCLUSIONS Laser acupuncture therapy, a noninvasive, painless, short-term therapy with a low cost, can be considered as an alternative therapy for patients with primary monosymptomatic nocturnal enuresis.

A rare case of an adult giant hydroureteronephrosis due to ureterovesical stricture presenting as a palpable abdominal mass.

The giant hydroureteronephrosis is a rare condition. We report a case of a unilateral giant hydroureteronephrosis in an adult patient presenting as palpable abdominal mass secondary to ureterovesical junction (UPJ) stricture. A 51-year-old man presented with a 2-year history of a palpable abdominal mass. Physical examination revealed a grossly distended abdomen that the upper margin of distension was at the level of the epigastrium and the lower one at the suprapubic region. Abdominal ultrasound and computerized tomography demonstrated a very large cystic mass in the right side of retroperitoneum involving all the space from superiorly right sub-diaphragmatic area to the bladder inferiorly. The patient underwent exploration and a right giant hydroureteronephrosis as involving all the retroperitioneal space crossing midline to the left with a liquid content of approximately 7 l caused by stricture at the ureterovesical junction was seen. The hydronephrotic sac was thin and right nephroureterectomy was performed by opening the sac and drainig-off the liquid. The literature was reviewed and the management of giant hydronephrosis was discussed.

Significance of atypical small acinar proliferation and high-grade prostatic intraepithelial neoplasia in prostate biopsy.

Purpose In clinical practice, atypical small acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) are two common findings on prostate biopsies. Knowing the frequency of a prostate cancer diagnosis on repeat biopsies would aid primary treating physicians regarding their decisions in suspicious cases. Materials and Methods One hundred forty-three patients in whom biopsies revealed ASAP or HGPIN or both were enrolled in the present study; prostate cancer was not reported in the biopsy specimens and at least one repeat biopsy was performed. Age, digital rectal examination findings, prostate volumes, and free and total prostate-specific antigen (PSA) levels and the biopsy results of the patients were recorded. Results Of the 97 patients with ASAP on the first set of biopsies, prostate cancer was diagnosed in the second and third biopsies of 32 and 6 patients, respectively. Prostate cancer was not detected in the second or third biopsies of the 40 patients with HGPIN in the first biopsy. Of the 6 patients with ASAP+HGPIN in the first biopsy, prostate cancer was detected in 3 patients in the second biopsy and in 1 patient in the third biopsy. Conclusions The diagnosis of ASAP is a strong risk factor for prostate cancer. A repeat biopsy should be performed for the entire prostate subsequent to the diagnosis of ASAP. In patients with HGPIN according to the biopsy result, the clinical decision should be based on other parameters, such as PSA values and rectal examination, and a repeat biopsy should be avoided if the initial biopsy was performed with multiple sampling.

Methods and Rates of Punishment Implemented by Families to Enuretic Children in Turkey

PURPOSE Nocturnal enuresis is a serious health problem affecting a significant portion of the population. In this study, we investigated the frequency of punishment methods in nocturnal enuresis (NE) in Turkey and its relationship with other parameters. MATERIALS AND METHODS A total of 501 children (301 boys and 200 girls) who were admitted to our outpatient clinic due to nocturnal enuresis were included in the study. Mean age was 9.39 years (range 5-18). Prepared questionnaire form inquiring educational status of the family, frequency and implementation and duration of punishment methods was applied to patients and families. RESULTS At least one punishment method was applied to 291 (58.1%) of children with NE. Punishment methods of parents were detected as condemnation (257 patients, 51.3%), depriving desires of the child (120 patients, 23.9%), humiliating the child in the presence of other children (113 patients, 22.6%), reprimanding- threatening with punishment (203 patients, 40.5%). This application was found to continue for longer than 1 year in 52% of punished children. Families graduated of high school and above were found to use punishment methods significantly more than others. CONCLUSION According to the results of our study, a quite high proportion of enuretic children were detected to be exposed to punishment methods. Even, some parents consider that these methods are a part of nocturnal enuresis treatment. We, the doctors, should endeavor more for raising awareness of the community in order to diminish this worrisome behavior.

Case Report: A Case of Bladder Dysfunction due to Myasthenia Gravis

Detrusor underactivity, due to myasthenia gravis (MG) is extremely rare. Only 4 cases of de novo dysfunction have been reported. We report a case of detrusor underactivity and increased post-void residual urine in a woman with MG. The patient has been managed by clean intermittent catheterization 6 times a day.

Comparison of intravesical (Cohen) and extravesical (Lich–Gregoir) ureteroneocystostomy in the treatment of unilateral primary vesicoureteric reflux in children

INTRODUCTION Various intravesical and extravesical techniques have been described for the surgical correction of vesicoureteral reflux (VUR). Among those techniques Cohen (intra-vesical) and Lich-Gregoir (extra-vesical) are the most commonly used ones. However, there are limited studies that compare those two surgical techniques in the literature. OBJECTIVE In this study, we aim to compare the outcomes of the open intravesical and extravesical procedures for unilateral primary VUR in children. METHODS We analyzed the records of 118 consecutive children with primary VUR who underwent open ureteral reimplantation surgery by single surgeon from January 2011 to October 2015 at our institution. Among them, intravesical reimplantation was group A, and extravesical reimplantation procedure was group B. We retrospectively analyzed the clinical data of both groups, including age, sex, preoperative reflux grade, presence of lower urinary tract symptoms (LUTS), operative time, postoperative complications and hospitalization period. Success of surgery was defined as the resolution of the VUR as determined by voiding cystourethrography 6 -12 months after surgery. All the parameters were statistically compared. RESULTS A total of 58 patients were found eligible for the study. In 23 cases intravesical (group A) and in 35 cases extravesical (group B) procedure were performed. The operative time in group A was significantly higher than group B (110.3±16.9 and 87±29.8 min, respectively, p = 0.002). The mean hospital stay was also longer in group A (2.8±0.8 and 1.2±0.6 days, respectively, p = 0.007). The ureteral catheterization periods were 14.1±6.1 days for group A and there was no ureteral catheter placement in group B. The success rate of the two groups were comparable (100% vs 94.9%, p = 0.513). No intraoperative complications were detected in either group. The number of febrile urinary tract infections were similar between the groups after a mean follow up of 18.2 months (p = 0.746). DISCUSSION Our results confirmed that both Cohen and Lich-Gregoir procedures had equivalent success and complication rates. Lich-Gregoir technique was found superior to Cohen technique in terms of hospital stay and operative time. Moreover, it avoids the necessity of urethral and ureteral stenting which probably might increase the comfort of the patients postoperatively. The main limitations of our study are unrecorded pain scores and amount of analgesics taken the after surgery and retrospective analysis of the data. CONCLUSION Both the open intravesical and extravesical ureteroneocystostomy procedures are equally effective in the treatment of primary unilateral VUR. Any of the techniques can be opted by the surgeons depending on their surgical experience.