Yunus Söylet

Quo vadis? Ureteric reimplantation or ignoring reflux during augmentation cystoplasty.

To decide whether antireflux surgery should be used in the presence of vesico‐ureteric reflux (VUR) in children, in whom an augmentation procedure is needed, because secondary VUR in children with a neurogenic bladder, infravesical obstruction and primary VUR in the exstrophy‐epispadias complex is expected to resolve after augmentation, which decreases the intravesical pressure and increases capacity.

Extensive intestinal aganglionosis

Extensive aganglionosis very close to the ligament of Treitz and total intestinal aganglionosis are rare forms of Hirschsprungs disease. In these cases, nutrition, fluid, and electrolyte balance are a problem. Although the myectomy-myotomy technique of Ziegler appears hopeful, no effective surgical method has been put into the practice for the treatment of these rare forms of Hirschsprungs disease. We report four cases with extensive intestinal aganglionosis, one of which was total intestinal aganglionosis with involvement of the stomach.

The roles of extracellular matrix proteins, apoptosis and c-kit positive cells in the pathogenesis of ureteropelvic junction obstruction

AIM To investigate histopathological changes in ureteropelvic junction obstruction (UPJO) from an etiological perspective. PATIENTS AND METHODS Medical records of patients with UPJO were reviewed and pathological specimens collected. Nephrectomy materials from forensic autopsies were taken as controls. Specimens were assessed with light microscopy. Fibronectin, type 4 collagen, laminin, Bax and Bcl-2 expression for apoptosis, together with interstitial cells of Cajal determination with c-kit were determined immunohistochemically. Staining scores were evaluated semiquantitatively. Results were evaluated using Mann-Whitney U-test. RESULTS Control group comprised 14 children (median age, 3.5 years; 6 months-17 years). Study group comprised 22 children with UPJO (median age, 9 months; 1 month-10 years). Light microscopy revealed non-specific inflammation, epithelial proliferation and atrophy with fibrosis in the smooth muscle of the UPJ in all patients. Fibronectin, type 4 collagen and laminin were found to be significantly increased in UPJO at the intrafascicular space of smooth muscle and the matrix of stroma. Bcl-2 expression was increased in UPJO. c-Kit was unable to stain interstitial cells of Cajal, but staining for mast cells was significant. CONCLUSIONS High expression of fibronectin, laminin and type 4 collagen may indicate a relation to the pathogenesis of UPJO. Defective kidney morphogenesis, during branching and tubulogenesis of ureteric bud, may be responsible for this congenital pathology.

Comparison of urodynamic investigations before and after posterior sagittal anorectoplasty for anorectal malformations

METHODS The authors evaluated 21 patients (10 boys, 11 girls) who had anorectal malformations (ARM). Ten of them had infralevator (low-group I) and 11 of them had supralevator (high-group II) type ARM. All of the patients underwent urodynamic investigation before and after posterior sagittal anorectoplasty (PSARP) operation. RESULTS Sacral and spinal anomalies were found in 54% (6 of 11) patients who had supralevator type ARM. None of the patients with infralevator type ARM had additional sacral or spinal anomalies. Before PSARP operation urodynamic investigations of all infralevator type ARM patients were within normal limits, whereas 82% (9 of 11) of patients with supralevator type ARM showed neurovesical dysfunction (NVD). There was no significant difference between the preoperative and postoperative urodynamic findings. The possibility of additional sacral or spinal anomalies and NVD in supralevator type ARM was high. After PSARP operation no additional lower urinary tract dysfunction was detected in the urodynamic evaluation of ARM patients.

Emotional effects of hypospadias surgery on Turkish boys

PURPOSE The aim of this study is to investigate in Turkish boys the emotional effects of hypospadias repair before and after the optimal age for repair. MATERIALS AND METHODS Forty hypospadias patients treated in our department were included in this study. Group 1 consisted of 13 patients operated on at less than 30 months of age. Group 2 consisted of 27 patients operated on at over 30 months of age. Age at time of study, severity of hypospadias, age at repair and number of operations were evaluated for both groups retrospectively. Socio-economic and socio-demographic characteristics of these patients including place of residence, educational level of their parents and parental occupations were determined. The Turkish versions of the Childrens Depression Inventory and the State-Trait Anxiety Inventory for Children A-State scale were used to evaluate the emotional effects of hypospadias surgery. For statistical analysis, the Mann-Whitney U test, Students t test and Chi-squared test were used. RESULTS There was a significant difference in the age at repair between Groups 1 and 2. No significant differences existed in severity of hypospadias and number of operations between the two groups. All 40 patients had the same socio-economic and socio-demographic characteristics. Group 1 did not significantly differ from Group 2 in regard to the educational level of their parents and parental occupations. Age at repair, which was the only difference between the two groups, did not affect the level of depression and anxiety-state symptoms. CONCLUSIONS There is a close relationship between emotional effect of hypospadias surgery and age at repair. Possibility of depression and anxiety, which were dominating emotional symptoms among boys operated on for hypospadias, was found not to be high after the recommended age. It is concluded that, as hypospadias surgery creates a circumcised penis, the degree of emotional trauma is lower in Turkish boys than in other nationalities.

A therapeutic method for failed bladder augmentation in children : re-augmentation

To investigate the causes leading to the deterioration of previously successful bladder augmentation and to evaluate the efficacy of re‐augmentation.

Experience with Laparoscopy in Nonpalpable Testis

Aim: The aim of this study was to investigate the feasibility and benefits of diagnosis and interventional laparoscopy in those paediatric patients with nonpalpable testes (NPT). Patients and Method: Between 1992 and 1999, 75 patients with NPT (mean age 3 years, range 6 months to 14 years) were treated. 86 testes were evaluated. Results: According to the laparoscopic findings, 4 groups of testes were identified: Vanishing testis (n = 32), low abdominal testis (!2 cm to the internal ring) (n = 26), high abdominal testis (12 cm to the internal ring) (n = 24) group and intersex patients (n = 4). Of the first group, 19 testes (one bilateral) had blind ending spermatic cord and vessels and if an atrophic testicular tissue was identified, it was removed laparoscopically. For those with spermatic cord and vessels beyond the internal ring (13 testes), atrophic testes were removed through a high scrotal incision. 19 testes of the second group had a laparoscopy-assisted orchiopexy. In the same group a laparoscopic orchiopexy was performed on 7 testes. 24 testes in the 3rd group had a Fowler Stephens (FS) stage I and 18 testes had a laparotomy performed for FS stage II procedure (laparotomy and orchiopexy) after 6 months. At laparotomy there was no evidence of testicular atrophy in all but one testis which was removed and the FS stage II procedure was completed in 17 testes. The follow-up period is between 6 months and 4 years, and two more testicular atrophies were noted after FS stage II. The results were satisfactory in 15 testes among 18 (83%). In the intersex group, the patient with testicular feminization had laparoscopic orchiectomy. The other patient with bilateral nonpalpable testis was identified to have a uterus and two intra-abdominally located gonads on laparoscopy and gonadal biopsies were obtained for diagnosis. Histology demonstrated bilateral ovotestes confirming the diagnosis of a true hermaphrodite. Conclusion: We think that laparoscopy decreases the number of laparotomies in NPT, allows a single stage procedure in low abdominal testis and facilitates clip ligation of the testicular artery in high abdominal testis. Also laparoscopy provides diagnostic and therapeutic options in vanishing testis and intersex patients.

A case of wandering spleen causing urinary symptoms after correction of a posterolateral diaphragmatic hernia.

Abstract A 12-year-old girl who had had an operation for a posterolateral diaphragmatic hernia was admitted to the hospital because of enuresis. Physical examination and radiologic studies revealed the spleen behind the urinary bladder, left-sided hydronephrosis, and a high volume of residual urine. The hydronephrosis and residual urine resolved immediately following splenectomy.

Testis sparing surgery for Leydig cell pathologies in children

OBJECTIVE The aim was to analyze testis-sparing surgical procedures in boys with Leydig cell pathologies. STUDY DESIGN The hospital records of four boys with Leydig cell hyperplasia who underwent testis-sparing surgery for testicular masses between 2000 and 2012 were analyzed retrospectively. Tumor markers were evaluated and all boys underwent scrotal ultrasonography preoperatively. The hormonal profile was also analyzed for symptoms of precocious puberty. The testis was delivered through a high transverse inguinal incision and the tumor was excised by enucleation. After confirming the benign nature of the tumor with frozen-section examination, the testis was reinserted and fixed into the scrotum with absorbable sutures. All cases were followed-up with physical examination, scrotal ultrasonography, and measurement of β-human chorionic gonadotropin (HCG), α-fetoprotein, and hormone levels. RESULTS The mean age of the patients was 9.4 years (1.5-15 years). Testicular mass and scrotal asymmetry were detected in all cases. Ultrasonography was the main initial diagnostic modality for detecting testicular masses (Table). β-HCG and α-fetoprotein levels were normal. Three cases had Leydig cell hyperplasia and one patient was diagnosed to have a Leydig cell tumor. Signs of precocious puberty were detected in the four patients. The mean follow-up period was 4.8 years (2-8 years). Neither recurrence nor testicular atrophy developed in the follow-up. Findings of precocious puberty continued in one patient with Leydig cell hyperplasia, in whom a 2-mm contralateral metachronous lesion was detected and enucleated successfully. DISCUSSION Testis-sparing surgery with its potential long-term psychological, cosmetic, and functional advantages should be used in pediatric patients in whom a benign Leydig cell pathology is confirmed histopathologically. CONCLUSION This intervention with good long-term results can easily be applied through a proper dissection plane in the testicle. Since testicular Leydig cell tumors in childhood have small rates of recurrence, this choice of treatment is efficient in patients with salvageable testicular tissues and normal levels of tumor markers.

Üç yaşında saptanmış bir laringosel olgusu Olgu Sunumu

Laryngocele is a rare cervical lesion of childhood that may present either with a mass or respiratory distress Therefore other causes such as thyroglossal cyst or dermoid cyst are primarily suspected in a case with a midline cervical mass and the diagnosis of laryngocele is usually made after surgical exploration and histopathologic analysis Herein a three year old boy in whom the diagnosis of an external laryngocele was achieved after surgical intervention and histopathological analysis is presented and the differential diagnosis is overviewed Key words: cervical mass children laryngocele