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Öğe Acquired Penile Epidermoid Cysts in Children(Cureus Inc, 2022) Yagmur, Ismail; Tekin, Ali; Bagci, Uygar; Yaman, Banu; Avanoglu, Ali; Ulman, IbrahimBackground In this study, we aim to present the experience of a tertiary center regarding penile epidermoid cysts over 15 years. Methodology Patient files of those who underwent surgical excision for penile epidermoid cysts between 2005 and 2019 were reviewed retrospectively. The demographics, clinical characteristics, etiological factors, cyst features, surgical techniques, complications, and follow-up data were analyzed. Results In total, 24 penile epidermoid cysts were excised in 21 boys. The median age at the time of surgery was 52 (15-204) months. The median duration between previous surgery and cyst excision was 40 (1-180) months. In total, 11 cases had a history of circumcision, and 10 had undergone hypospadias surgery. There was no significant difference between these two etiologic groups (p > 0.05). The main symptom was an asymptomatic penile mass. The average cyst size was 9.4 +/- 6.7 mm. All cysts were completely excised with incisions made over old scars, except one. No complications were observed during a median follow-up period of 50 (12-120) months, and only one recurrence was noted. Conclusions Acquired penile epidermoid cysts may present as an early or late complication after penile surgery. Complete excision with an incision along the existing scars seems to be an effective solution for preventing new scars.Öğe Benign prostatic hyperplasia: Case report of a 17-year-old(Elsevier Sci Ltd, 2016) Yagmur, Ismail; Turna, Burak; Tekin, Ali; Akincioglu, Emir; Sarsik, Bnu; Ulman, IbrahimIntroduction Benign prostatic hyperplasia (BPH) is generally common in men older than 50 years of age but is extremely rare in childhood. In the literature to date, fewer than five cases have been reported under 18 years of age. Owing to the limited number of cases, the etiology and management of BPH in the first two decades is not clear. Objective We herein report a 17-year-old boy who presented with acute urinary retention due to BPH and was treated with endoscopic transurethral resection of the prostate (TUR-P). Case report A 17-year-old male patient with a history of intermittent hematuria was admitted elsewhere with acute urinary retention. An increase in prostate size was detected on digital rectal examination. Pelvic ultrasound revealed a large mass arising from the prostate and filling the bladder lumen. Transrectal ultrasound-guided prostate biopsy (TRUS-Bx) was performed to exclude malignancy. After the documentation of benign prostate tissue in the histopathological analysis, the patient was referred to our clinic for further evaluation and management. Magnetic resonance (MR) imaging revealed a 48 x 55 x 68 mm mass arising from the middle lobe of prostate and filling the bladder lumen (Figure) with an initial diagnosis of a non-ductal malignant tumor because of his age. Enlarged lymph nodes or any sign of metastasis were not detected. Re-examination of the previous biopsy specimens confirmed the absence of malignancy; therefore he underwent endoscopic treatment with TUR-P. Histopathological examination reported BPH. The postoperative 1-year follow-up was uneventful. Discussion The patient was extensively evaluated with a suspicion of malignancy, especially rhabdomyosarcoma, which is more expected for this age group. Reviewing juvenile cases with BPH in the literature, two authors explained the possible etiologic factors of their cases as gonadotropin supplement therapy for undescended testes and the mother's utilization of a human chorionic gonadotropin-containing agent during pregnancy to prevent spontaneous abortion. Our case had no history of drug intake, endocrino-logic abnormality, or any other possible relevant factor. Owing to the limited number of cases, there is not enough data to understand the etiology and also no consensus on the treatment of BPH in the adolescents. Therefore, experiences gained from adult cases guide the pediatric treatment modalities. Conclusion Despite the fact that BPH is very rare in childhood, one should keep it in mind in the differential diagnosis of acute urinary retention and malignant prostate diseases. The endoscopic method is the treatment of choice in BPH.Öğe Changing bulking agent may require change in injection volume for endoscopic treatment of vesicoureteral reflux(Brazilian Soc Urol, 2018) Tekin, Ali; Yagmur, Ismail; Tiryaki, Sibel; Dokumcu, Zafer; Ulman, Ibrahim; Avanoglu, AliIntroduction: Various bulking agents were utilized for endoscopic correction of VUR. A study reviewing multi-institutional data showed that the amount of injection material has increased over time with the purpose of improving success rates, which also resulted in costs. We noticed an opposite trend in our center since we started using a new bulking agent. The aim of this study was to evaluate evolution of our practice with different bulking agents. Patients and Methods: Records of VUR patients who underwent subureteric injection with polyacrylate polyalcohol copolymer (PPC) and dextronomere hyaluronic acide (DxHA) between 2005 and 2014 were reviewed. Variation of different parameters throughout the study period was evaluated along with the success rate. Success was defined as complete resolution of reflux. Results: A total of 260 patients with 384 refluxing units were included. The success rate was higher in PPC group compared to DxHA group. There was no statistically significant difference between years regarding distribution of VUR grade, body weight, patient height, and age in PPC group. Despite significant reduction in injection volume, success rate did not decrease through the years with PPC. Conclusion: Different bulking agents may require different injection volumes to achieve the same success rate in endoscopic treatment of vesicoureteral reflux. Habits gained with previous experience using other materials should be revised while using a new went.Öğe Çocuklarda üreter ve böbrek taşlarinda morbiditenin azaltilmasina dair altyapinin yenilenmesi(Ege Üniversitesi, 2016) Yağmur, İsmail; Avanoğlu, Ali; Tekin, AliÇocuklarda üriner sistem taş hastalığı, anatomilerine uygun küçüklükte enstrümantasyonun kısıtlılığı sebebiyle erişkinlere göre daha zorlayıcı olmaktadır. Lazer tekniklerindeki gelişmelerle beraber özellikle son on yılda bazı lazer tedavi teknikleri ürolojide standart tedavi yöntemleri haline gelmiştir. Komplikasyon oranlarının düşük olması, işlem süresinin, hastanede kalış süresinin kısa olmasıyla üriner sistemdeki taşların hızlı ve etkin bir şekilde tedavisini yapılabilmesini sağlamakta; hem etkin ve güvenilir cerrahiyi sağlamakta hem de hasta konforu üzerinde olumlu etkilere neden olmaktadır.;Urinary stone disease, Ho: Yag laser litotripsy, ureterorenoscopy;Üriner sistem taş hastalığı, Ho: Yag lazer litotripsi, üreterorenoskopiÖğe Çocuklarda video teleskop ile morbiditenin azaltılmasına dair cerrahi alt yapının belirlenmesi(Ege Üniversitesi, 2016) Yağmur, İsmail; Avanoğlu, Ali; Tekin, AliMagnification, surgical education;Magnifikasyon, cerrahi eğitimi;Optik magnifikasyon çocuk cerrahisinde birçok alanda gereklidir. En sık kullanılan görüntüyü 2.5-4 kat büyüten büyüteçli gözlüklerdir ancak yalnızca kullanan kişiye büyütme sağlarlar. Yakın zamanda teknolojik gelişmeler ekrana yansıtılabilir yüksek çözünürlüklü görüntüler elde edilmesini sağlayan kompakt video mikroskopları sağlamıştır.Öğe Comparing the efficacy of extracorporeal shock wave lithotripsy and ureteroscopic lithotripsy in the treatment of proximal ureteral stones in children: A retrospective study(Wiley, 2023) Bagci, Uygar; Dinckal, Mustafa; Tekin, Ali; Kizilay, Fuat; Nazli, Oktay; Ulman, IbrahimObjectives: Ureteroscopic lithotripsy and extracorporeal shock wave lithotripsy methods are commonly used in the treatment of proximal ureteral stones. There are no adequate studies showing which method is more effective in children. In our study, we aimed to evaluate and compare the efficacy of two treatment methods, commonly used for proximal ureteral stones in children.Methods: A total of 78 patients who underwent ureteroscopic lithotripsy (n = 38) and extracorporeal shock wave lithotripsy (n = 40) due to stones located in the proximal ureter between 2010 and 2021 were included in the study. Demographic data, clinical characteristics, and treatment outcomes were retrospectively analyzed. Kolmogorov-Smirnov, Chi-square, and Mann-Whitney U tests were used for statistical analysis.Results: There was no statistical difference between the demographic characteristics of the groups, except for the mean age values (p = 0.008). A statistically significant difference was found in favor of the extracorporeal shock wave lithotripsy group in terms of stone-free rates after the first intervention, complication rates requiring intervention, re-intervention rates, and the average number of anesthesia sessions per patient until stone-free status (p = 0.043, p = 0.009, p = 0.017, and p < 0.001, respectively).Conclusions: The results of this retrospective study suggest that extracorporeal shock wave lithotripsy is the primary treatment option for single, non-complicated proximal ureteral stones.Öğe The consistency between Assigned Gender and Individual Gender Identity in Disorder of Sex Development Cases: Long-Term Results from a Single Center(Karger, 2023) Jalilova, Arzu; Ozen, Samim; Yuluğ Taş, Begüm; Kızılay Özalp, Deniz; Solmaz, Aslı Ece; Balkı, Hanife Gül; Tekin, Ali[No abstract available]Öğe Diffusion tensor imaging in anorectal malformations: a pilot study for the evaluation of lumbosacral plexus(Springer, 2022) Tiryaki, Sibel; Celtik, Ulgen; Eraslan, Cenk; Divarci, Emre; Tekin, Ali; Ozok, Geylani; Ergun, OrkanIntroduction Neurogenic bladder with anorectal malformations (ARM) is a well-known yet understudied topic. Diffusion tensor imaging (DTI) is a special usage of MRI that can evaluate peripheric nerves. The aim of this study is to evaluate the lumbosacral plexuses of patients with ARM using DTI. Patients and methods Patients with ARM willing to participate were included. Patient files were reviewed, a questionnaire was made, and DTI was performed. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were computed for the right and left lumbosacral plexuses. Results There were 18 patients and 12 controls. Groups were similar in terms of sex (p = 0.232) and age (p = 0.853). There was a significant difference only for ADC of the left plexus. There was visible asymmetry in tractographies and DTI parameters of two patients with severely deformed pelvises (image 1) but also in another patient with a normal sacrum. In addition, despite asymmetry, FA and ADC were similar to controls also in these patients. Conclusion This is the first study presenting quantitative data about the lumbosacral plexus in ARM. We think the most interesting finding of this study was observing the normal values even in the patients with severely malformed sacrum which is yet to be validated with further studies.Öğe Distribution of interstitial cells of Cajal in the bladders of fetal rats with retinoic acid induced myelomeningocele(Aves, 2016) Tekin, Ali; Karakus, Osman Zeki; Hakguder, Gulce; Ates, Oguz; Ozer, Erdener; Olguner, Mustafa; Akgur, Feza MiracObjective: Myelomeningocele (MMC) is one of the most common reason of neurogenic bladder dysfunction in children. Although neurogenic bladder dysfunction occurrence is related with bladder innervation, also there are some changes seen in the smooth muscle and neural cells of the bladder. Interstitial cells of Cajal (ICC) are the pacemaker cells found in organs with peristaltic activity. Although it has been shown that ICC are diminished in the rat urinary bladder with traumatic spinal cord injury, there is no data about ICC in fetal rat bladders with MMC. This study has been conducted to investigate the ICC in the bladders of fetal rats with retinoic acid induced MMC. Materials and methods: Time dated pregnant Wistar albino rats were divided into 3 groups. In MMC group, dams were fed with gavage solution containing 60 mg/kg all-trans retinoic acid dissolved in olive oil on 10. embryologic day. Sham group animals were fed only olive oil. Control group dams were fed with standard rat chow. Fetuses were delivered by cesarean section and harvested on 22. embryologic day. MMC was identified by observing MMC sacs at the back of the fetuses. Distribution of ICCs were evaluated using immunohistochemical staining. Results: ICCs were found in all groups, which have the same morphological features that had been described earlier in the gastrointestinal tract and the bladder. The density of the ICC in the MMC group was found to be significantly decreased when compared with the control and the sham groups (p<0.05). Conclusion: The density of the ICC in the urinary bladder decreased in the neurogenic bladder developed in MMC.Öğe The effect of tai-chi on internal-external locus of control levels in primary school students with attention deficit hyperactivity disorder(2011) Dereceli, Çağatay; Dorak, Remzi Ferudun; Tekin, Ali…Öğe Endoscopic Management of Complicated High-grade Vesicoureteral Reflux in the First Year of Life(Galenos Yayincilik, 2021) Tekin, Ali; Tiryaki, Sibel; Yagmur, Ismail; Kilic, Ozge; Avanoglu, Ali; Ulman, IbrahimAim: The treatment of vesicoureteral reflux (VUR) in infants is controversial. Subureteric injection is considered by some to be a popular alternative to long-term antibiotic prophylaxis. In this study, we reviewed our experience in endoscopic subureteric injection to correct high-grade reflux in infants with documented indications for antireflux surgery. Materials and Methods: The hospital records of patients with grade 4-S VUR and breakthrough urinary tract infections who had undergone endoscopic subureteric injection in the first year of life between 2009 and 2016 were reviewed retrospectively. Radiologic success was defined as complete resolution of reflux determined via voiding cystourethrogram obtained at least three months after the injection, and clinical success was defined as the downgrading of reflux grade to below three and the absence of urinary infection. Results: A total of 23 patients (5 girls, 18 boys) with 34 high-grade refluxing units were included in this study. The mean age at first injection was 6.3 +/- 1.8 months (1-11 months). The radiologic success rate with initial injection was 61.7%, and it was 85.2% after repeated injections. The overall clinical success rate after first injection was 70.6% and 97.1% after repeated injections. The mean injected material volume was 0.34 +/- 0.27 (0.1-1) mL per ureter. Conclusion: The management of high-grade infantile reflux is still controversial with insufficient data. Published studies comparing endoscopic treatment and antibiotic prophylaxis have inconclusive results due to their wide range of success rates. Although it needs to be supported by prospective studies, endoscopic treatment is a successful alternative in high-grade VUR infants with breakthrough infection.Öğe Endoscopic Management of Vesicoureteral Reflux in Duplex Renal Collecting Systems(Galenos Yayincilik, 2022) Cayirli, Hasan; Tekin, Ali; Kilic, Ozge; Arusoglu, Ilker Zeki; Avanoglu, Ali; Ulman, IbrahimAim: Standardization of an optimal treatment protocol for vesicoureteral reflux (VUR) correlated with duplex kidney systems remains controversial. In this study, we reviewed our experience in endoscopic subureteric injection to correct reflux in duplex systems with documented indications, in an aim to confirm its position as an alternative means of open surgery. Materials and Methods: The hospital records of complete renal duplex system patients who had experienced endoscopic subureteric injection for VUR between 2009 and 2018 were reviewed. The indications for the amelioration of VUR included breakthrough urinary tract infection (UTI) along with the presence of renal scarring. Results: A total of 24 patients (18 girls, 6 boys) with refluxing renal duplex systems were included in the study. The mean age at first injection was 46.4 +/- 28.8 months (5-160) and the mean duration of follow-up was 47.25 +/- 27.7 months. The success rate with the initial injection was 83.3% (20/24). The mean volume of material injected was 0.68 +/- 0.49 mL per duplex system. Conclusion: Management of reflux in duplex systems is still controversial with insufficient data. Our results suggest that endoscopic management should be considered as an alternative to open ureteral reimplantation in refluxing duplex renal collecting systems. Major open surgery and accompanying discomfort can be avoided by an endoscopic injection which can be performed as an outpatient procedure in most of the reflux patients with duplex system who have an indication for surgical management.Öğe Evaluation of Factors Affecting Surgical Success in Megameatus Intact Prepuce Cases(Galenos Publ House, 2024) Bagcl, Uygar; Tekin, Ali; Birol, Sibel Tiryaki; Ulman, IbrahimAim: Megameatus intact prepuce (MIP) is a rare form of hypospadias. Different meatal/urethral advancement and urethroplasty techniques are used in the treatment of MIP. This study aimed to evaluate the success of various surgical methods for the treatment of MIP. Materials and Methods: Patients who underwent circumcision, meatoplasty, and urethroplasty techniques due to MIP between 2011 and 2022 were included in this study. Surgical success was accepted as the absence of complications and/or the need for additional treatment. The statistical significance level was accepted as 0.05. Results: This study included 100 patients with a median age of 33 months. Of these, 94 patients were admitted to our center with untreated MIP, 5 presented after circumcision and 1 after MIP repair in another center. The urethral stent placement rate was significantly lower in those patients with a glanular meatus location as in patients who underwent the meatoplasty technique (p<0.001). The complication rate was significantly higher in the Duplay with Posterior Meatal Incision (DPMI) technique when compared to the other techniques (p=0.033). There were no significant differences between the meatoplasty, Duplay urethroplasty, Pyramid urethroplasty, and DPMI techniques in terms of the need for additional surgical intervention (p=0.102). None of the five previously circumcised patients who underwent Duplay urethroplasty experienced any complications. When the complication rates were compared between the patient group presenting with untreated MIP and those who underwent Duplay urethroplasty, no statistically significant difference was detected (p=0.534). Conclusion: According to the conclusions of this MIP series, prior circumcision or the preference for any specific surgical technique that preserves the urethral plate did not affect the success of MIP treatment.Öğe Excision of the atrial Wilms’ tumor thrombus without sternotomy, atriotomy and cardiovascular By-pass(2019) Tekin, Ali; Yağmur, İsmail; Ergün, Orkan; Ayık, Mehmet Fatih; Atay, Yüksel; Ulman, İbrahim; Avanoğlu, AliThe treatment of atrial-extention Wilms’ tumor thrombus is surgical excision after chemotherapy. Atriotomy with cardiovascular by-pass is the one of the most common method for this procedure. Herein, we aimed to present a case of Wilms’ tumor with a tumor thrombus extending into the right atrium totally excised with retrohepatic cavatomy. A 3.5 year-old girl was admitted with the symptom of dysuria. The examinations revealed a mass consistent with Wilms’ tumor in the middle and lower poles of the left kidney. Doppler ultrasound and Echocardiographic examinations showed a tumor thrombus extending into the right atrium and some pulmonary nodules which were interpreted to be metastasis. Wilms’ tumor was histopathologically diagnosed by an open biopsy. After three courses of chemotherapy imaging studies revealed that the atrial axtention of the tumor thrombus persisted. The tumor thrombus was found to be fibrotic on the magnetic resonance imaging scan of the patient. Therefore, nephroureterectomy along with the excision of the tumor thrombus from the inferior vena cava was done with intraoperative continuous trans-esophageal echocardiography (TEE). The suprarenal and retrohepatic vena cava were exposed by dissecting and ligating all short hepatic veins and completely mobilizing the right lobe of the liver. The thrombus was dissected out via Vertical cavatomy at the retrohepatic level. TEE confirmed complete removal of the thrombus from the atrium; Vena cava was then repaired. There was no need for a blood transfusion, or cardiovascular by-pass (CPB) during the operation. Total exposure of the retrohepatic and subdiaphragmatic vena cava using transplantation techniques is an effective method for the excision of a tumor thrombus without sternotomy, atriotomy and CPB, avoiding possible intra- and postoperative complications in selected cases of Wilms’ tumor with intraatrial thrombus extension. The case emphasises the importance of multidisciplinary communication and collaboration.Öğe Excision of the atrial Wilms’ tumor thrombus without sternotomy, atriotomy and cardiovascular By-pass(2019) Tekin, Ali; Yağmur, İsmail; Ergün, Orkan; Ayık, Mehmet Fatih; Atay, Yüksel; Ulman, İbrahim; Avanoğlu, AliThe treatment of atrial-extention Wilms’ tumor thrombus is surgical excision after chemotherapy. Atriotomy with cardiovascular by-pass is the one of the most common method for this procedure. Herein, we aimed to present a case of Wilms’ tumor with a tumor thrombus extending into the right atrium totally excised with retrohepatic cavatomy. A 3.5 year-old girl was admitted with the symptom of dysuria. the examinations revealed a mass consistent with Wilms’ tumor in the middle and lower poles of the left kidney. Doppler ultrasound and Echocardiographic examinations showed a tumor thrombus extending into the right atrium and some pulmonary nodules which were interpreted to be metastasis. Wilms’ tumor was histopathologically diagnosed by an open biopsy. After three courses of chemotherapy imaging studies revealed that the atrial axtention of the tumor thrombus persisted. the tumor thrombus was found to be fibrotic on the magnetic resonance imaging scan of the patient. Therefore, nephroureterectomy along with the excision of the tumor thrombus from the inferior vena cava was done with intraoperative continuous trans-esophageal echocardiography (TEE). the suprarenal and retrohepatic vena cava were exposed by dissecting and ligating all short hepatic veins and completely mobilizing the right lobe of the liver. the thrombus was dissected out via Vertical cavatomy at the retrohepatic level. TEE confirmed complete removal of the thrombus from the atrium; Vena cava was then repaired. There was no need for a blood transfusion, or cardiovascular by-pass (CPB) during the operation. Total exposure of the retrohepatic and subdiaphragmatic vena cava using transplantation techniques is an effective method for the excision of a tumor thrombus without sternotomy, atriotomy and CPB, avoiding possible intra- and postoperative complications in selected cases of Wilms’ tumor with intraatrial thrombus extension. the case emphasises the importance of multidisciplinary communication and collaboration.Öğe Extracorporeal shock wave lithotripsy in infants less than 12-month old(Springer, 2016) Turna, Burak; Tekin, Ali; Yagmur, Ismail; Nazli, OktayThere is a lack of literature on children compared to adults regarding the long-term effects of extracorporeal shock wave lithotripsy (SWL), specifically in infants. The aim of the present study was to analyze the efficacy and safety of SWL in infants and also evaluate its potential adverse effects in the mid-term. Between May 1999 and December 2013, 36 infants with 39 renal units underwent SWL treatment for kidney stones with an electrohydraulic lithotripter (Dornier MPL 9000/ELMED Multimed Classic). All children were less than 12-month old. The mid-term effects of SWL were examined at the last follow-up by measuring arterial blood pressure, random blood glucose level and ipsilateral kidney size. Evaluation of treatment and its consequences was based on clinical examination, blood tests and conventional imaging (plain abdominal radiography and ultrasound). Overall stone-free rate was 84.6 % after 3-month follow-up without any major complications. Mid-term follow-up was available in 20 of 36 children with a mean follow-up of 3.2 +/- 2.8 years (range 0.5-15.3). None of the infants were found to develop new onset of hypertension or diabetes. All treated infant kidneys' sizes were in the normal percentile range. SWL for management of infant kidney stones is effective and safe in the mid-term.Öğe Hipospadiyas Onarımı Sonrası Fistül Tedavisinde “Tübülarize İnsize Plak” Üretroplasti Yöntemi(2008) Tekin, Ali; Hakgüder, Faika Gülce; Ateş, Oğuz; Akgür, Feza; Olguner, Mustafa…Öğe Is the Reference Electrode Location Important for the Electromyography Evaluation of the Pelvic Floor in Urodynamic Studies?(Korean Continence Soc, 2022) Tekin, Ali; Pehlivan, Murat; Tiryaki, Sibel; Yucel, Omer Baris; Bagci, Uygar; Cayirli, Hasan; Arusoglu, Ilker ZekiPurpose: Perineal electromyography (EMG) is a crucial part of urodynamic studies. Many researchers focused on the standardization of techniques in urodynamics, but no study has yet evaluated the differences with various reference electrode placements. The aim of this study was to determine the optimal placement of the reference electrode for recording pelvic floor activity in urodynamic studies.Methods: Children over 6 years of age without anatomic or neurological abnormalities were invited to participate in the study. Four reference electrodes were placed on the right kneecap, the inner surface of the right inner thigh, the right anterior iliac spine (AIS), and the skin over the left gluteal muscles for simultaneous recording. The EMG signal formed by pelvic contraction during forceful straining was recorded both in the supine and sitting positions. The root mean square (RMS) value of each muscle contraction signal was calculated.Results: Twenty-one participants (10 boys and 11 girls) were included. The mean age was 10.19 +/- 3.20 years. The highest RMS values were obtained with the reference electrode on the thigh in the supine position and the AIS in the sitting position. Significant differences were found between the mean RMS values of the knee and other locations of reference electrodes in the supine position, as well as between mean RMS values in all regions except the thigh and gluteus in the sitting position. The minimum mean RMS values in both positions were obtained with the reference electrode on the knee.Conclusions: During urodynamic studies, reference electrodes shall be placed on AIS in the sitting and on the inner thigh in the supine position. The knee is not a suitable option for reference electrode placement. This information may help improve EMG recordings in the evaluation of pelvic floor muscles.Öğe Laparoskopik Nefrektomi ve Heminefrektomi(2009) Tekin, Ali; Ateş, Oğuz; Hakgüder, Faika Gülce; Akgür, Feza; Olguner, Mustafa…Öğe Long-term Outcome of Infants with Spina Bifida Through Assessment of the Prognostic Value of Hostile Bladder Parameters(Galenos Yayincilik, 2021) Tekin, Ali; Tiryaki, Sibel; Tanil, Ezgi Altun; Ulman, IbrahimAim: In 2016, the Centers for Disease Control and Prevention published a management algorithm for Spina Bifida (SB) cases from birth and started collecting data prospectively. They designated risk factors from urodynamic studies as end filling pressure or detrusor leak point pressure (DLPP) >= 40 cm H2O or neurogenic detrusor overactivity (NDO) with detrusor sphincter dyssynergia (DSD), and categorized this type of bladder dysfunction as hostile bladder (HB). They recommended the immediate start of clean intermittent catheterization and anticholinergics in these patients. Having similar concerns regarding this patient population, we designed a retrospective study to identify and reveal the long-term outcomes of SB patients with HB. Materials and Methods: All urodynamic studies and hospital records of SB patients admitted and followed between 1994-2014 were reviewed retrospectively. The demographic data, the presence of DLPP, DSD and NDO in the first urodynamic examination, bladder compliance, first and last radiologic and scintigraphic imagings, and surgical interventions were evaluated. Upper tract damage was defined as new scars in dimercaptosuccinic acid scans. Results: A total of 58 patients were included in this study. The mean follow-up was 12.17 +/- 5.17 years. The presence of a scar in the first scintigraphy (p=0.01) and the presence of hydronephrosis in the first and last ultrasonography (p=0.03) were found to be independent risk factors for new scar development. When DLPP values were evaluated with receiver operating characteristic curve analysis, 50 cm H2O was observed as a significant threshold value with 73% sensitivity and 60% specificity. Conclusion: Our study confirmed the detrimental effects of high pressure and detrusor-sphincter dyssynergia; however, HB parameters were not sufficient to distinguish high-risk group patients. The presence of scars in the first scintigraphic evaluation, DLPP above 50 cm H2O, and the presence of hydronephrosis in the first ultrasound were found to be risk factors for renal deterioration. More frequent monitoring and detailed evaluation may be necessary for patients with these risk factors.
