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Hazır B, Çak HT, Saruhan K, Tekgül S, Doğan HS. Factors affecting the postoperative quality of life and psychological well-being in pediatric urology patients. J Pediatr Urol 2023:S1477-5131(23)00158-4. [PMID: 37173198 DOI: 10.1016/j.jpurol.2023.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 04/18/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND While most studies in pediatric urology investigate the clinical results, very few explore the relationship between surgery and quality of life and psychosocial well-being in pediatric urology practice. The determination of the effects of the surgical method on the quality of life (QoL) is of increasing importance. INTRODUCTION This study investigated the effect of surgery type on the postoperative QoL and psychological well-being of pediatric urological surgery patients. METHODS A total of 151 children and adolescents (4-18 years old) undergoing elective urological surgery between September 2020 and July 2021 were evaluated preoperatively; those who currently had psychiatric disorders were excluded. Of the 98 patients undergoing subsequent detailed preoperative assessment using standardized instruments to evaluate QoL and depression and anxiety symptom levels, only 63 could be re-evaluated postoperatively at a 6-month follow-up. Additionally, preoperative parental psychiatric symptom load was assessed using standardized self-report forms. RESULTS The patients were classified into two categories for analysis-open versus endourological surgery and major versus minor surgery. In the latter category, there was a significant increase in the postoperative QoL in children undergoing minor urological surgery (p = 0.037). Furthermore, the table depicted the regression analysis indicating the predictors for lower postoperative QoL. Those predictors were higher parental preoperative psychiatric symptom load, a greater number of previous surgeries, and female gender (p < 0.001, adjusted R2 = 0.304). CONCLUSION Postoperative QoL of children/adolescents undergoing pediatric urology surgery is affected more by the patient's preoperative medical condition and the psychological status of the patient's parents, rather than the surgical method opted for.
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Affiliation(s)
- Berk Hazır
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey.
| | - Halime Tuna Çak
- Department of Child and Adolescent Psychiatry, Hacettepe University School of Medicine, Ankara, Turkey
| | - Kemal Saruhan
- Department of Child and Adolescent Psychiatry, Hacettepe University School of Medicine, Ankara, Turkey
| | - Serdar Tekgül
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hasan Serkan Doğan
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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Gasimov K, Jafarov R, Tatanis V, Bozacı AC, Ceyhan E, Mammadaliyev T, Doğan HS, Tekgül S. Children with Non-Neurogenic Lower Urinary Tract Dysfunction Require Less Frequent and Number of Botulinum Toxin Injections Than Neurogenic Ones. jus 2022. [DOI: 10.4274/jus.galenos.2022.2022.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Tekgül S, Çıtamak B, Doğan HS, Ceylan T. A Rational Solution for Megaureter in Infants with Solitary Kidney: Temporary Loop Cutaneous Ureterostomy. jus 2022. [DOI: 10.4274/jus.galenos.2022.2021.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Altan M, Kısıklı A, Baltacı KE, Shahsuvarlı P, Bozacı AC, Doğan HS, Tekgül S. Publication Rates and Publication Times of Studies Presented at the First Four Meetings of the Society of Urological Surgery in Turkey (MSUST). jus 2022. [DOI: 10.4274/jus.galenos.2021.2021.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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5
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Ceylan T, Doğan HS, Çıtamak B, Gasimov K, Bozacı AC, Tatanis V, Tekgül S. The Reliability of Bladder Volume Determination in Children Using Portable Ultrasonographic Scanner in Standing Position. jus 2022. [DOI: 10.4274/jus.galenos.2021.2021.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Ceylan T, Çıtamak B, Bozacı AC, Altan M, Gasimov K, Asi T, Doğan HS, Tekgül S. Endoscopic Treatment of Vesicoureteral Reflux: Changing Trends Over the Years. jus 2021. [DOI: 10.4274/jus.galenos.2021.0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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8
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Tekgül S, Stein R, Bogaert G, Nijman RJM, Quaedackers J, 't Hoen L, Silay MS, Radmayr C, Doğan HS. European Association of Urology and European Society for Paediatric Urology Guidelines on Paediatric Urinary Stone Disease. Eur Urol Focus 2021; 8:833-839. [PMID: 34052169 DOI: 10.1016/j.euf.2021.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/29/2021] [Accepted: 05/14/2021] [Indexed: 11/17/2022]
Abstract
CONTEXT Paediatric stone disease is an important clinically entity and management is often challenging. Although it is known that the condition is endemic in some geographic regions of the world, the global incidence is also increasing. Patient age and sex; the number, size, location, and composition of the stone; and the anatomy of the urinary tract are factors that need to be taken into consideration when choosing a treatment modality. OBJECTIVE To provide a general insight into the evaluation and management of urolithiasis in the paediatric population in the era of minimally invasive surgery. EVIDENCE ACQUISITION A nonsystematic review of the literature on management of paediatric urolithiasis was conducted with the aim of presenting the most suitable treatment modality for different scenarios. EVIDENCE SYNTHESIS Because of high recurrence rates, open surgical intervention is not the first option for paediatric stone disease, except for very young patients with very large stones in association with congenital abnormalities. Minimally invasive surgeries have become the first option with the availability of appropriately sized instruments and accumulating experience. Extracorporeal shockwave lithotripsy (SWL) is noninvasive and can be carried out as an outpatient procedure under sedation, and is the initial choice for management of smaller stones. However, for larger stones, SWL has lower stone-free rates and higher retreatment rates, so minimally invasive endourology procedures such as percutaneous nephrolithotomy and retrograde intrarenal surgery are preferred treatment options. CONCLUSIONS Contemporary surgical treatment for paediatric urolithiasis typically uses minimally invasive modalities. Open surgery is very rarely indicated. PATIENT SUMMARY Cases of urinary stones in children are increasing. Minimally invasive surgery can achieve high stone-free rates with low complication rates. After stone removal, metabolic evaluation is strongly recommended so that medical treatment for any underlying metabolic abnormality can be given. Regular follow-up with imaging such as ultrasound is required because of the high recurrence rates.
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Affiliation(s)
- Serdar Tekgül
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey.
| | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Guy Bogaert
- Department of Urology, University of Leuven, Leuven, Belgium
| | - Rien J M Nijman
- Department of Urology and Pediatric Urology, University Medical Centre, Groningen, The Netherlands
| | - Josine Quaedackers
- Department of Urology and Pediatric Urology, University Medical Centre, Groningen, The Netherlands
| | - Lisette 't Hoen
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
| | - M Selcuk Silay
- Department of Urology, Istanbul Biruni University, Istanbul, Turkey
| | - Christian Radmayr
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hasan Serkan Doğan
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
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Ceyhan E, İleri F, Bozacı AC, Doğan HS, Canbay Ö, Ankay Yılbaş A, Tekgül S. Local Anesthetic Infiltration During Pediatric Percutaneous Nephrolithotomy Improves Postoperative Analgesia. jus 2019. [DOI: 10.4274/jus.galenos.2019.2441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Asi T, Doğan HS. Percutaneous Removal of a Broken Malecot Nephrostomy Tube. jus 2019. [DOI: 10.4274/jus.galenos.2019.2473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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11
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Ceyhan E, Bozacı AC, Doğan HS, Ergen A, Akdoğan B, Katipoğlu K, Kösemehmetoğlu K, Ertoy Baydar D, Tekgül S. Two Cases of Bladder Adenocarcinoma After Augmentation Cystoplasty. jus 2019. [DOI: 10.4274/jus.galenos.2018.2140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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12
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Çitamak B, Bozaci AC, Altan M, Haberal HB, Kahraman O, Ceylan T, Doğan HS, Tekgül S. Surgical outcome of patients with vesicoureteral reflux from a single institution in reference to the ESPU guidelines: a retrospective analysis. J Pediatr Urol 2019; 15:73.e1-73.e6. [PMID: 30472078 DOI: 10.1016/j.jpurol.2018.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/20/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Vesicoureteral reflux (VUR) is an anatomic or functional disorder, and it is a condition associated with renal scarring, hypertension, and end-stage renal disease. Renal damage can be prevented by appropriate medical and surgical intervention for selected patients. OBJECTIVES The objective of this study was to retrospectively analyze the surgically treated patient group of this study in reference to the risk analysis criteria used in European Association of Urology (EAU), European Society for Paediatric Urology (ESPU) guidelines to see the outcome of the study management protocol within the last 15 years in respect to this risk analysis. STUDY DESIGN A total of 686 patients who were operated upon in a single institution for VUR between 1997 and 2016 were retrospectively analyzed. According to the criteria in EAU/ESPU guidelines, the patients were classified into three groups: low, medium, and high risk. Risk factors were compared between the groups. RESULTS The patient numbers for low, medium, and high risk were 92 (13.4%), 485 (70.7%), and 109 (15.9%), respectively. In the high-risk group, surgeons tended to do more ureteroneocystostomy (UNC) (82.6%), whereas in the low-risk group, surgeons tended to do more subureteric injection (STING) (76.1%). The success rates for STING and UNC were found to be 75% and 93%, respectively. Although there was a difference in success rates among patients treated with STING or UNC, this difference was not statistically significant in success rates regarding risk groups for patients treated with STING or UNC. DISCUSSION The most recent guideline was that which was published by the EAU/ESPU organization in 2012. This guideline is established based on the risk analysis. The analysis revealed that patients in the low-risk group tended to undergo endoscopic surgery treatment method, whereas patients in the high-risk group tended to undergo open surgery. Therefore, the study management over the last 10 years has been mainly in line with the current recommendations. CONCLUSION The analysis shows that when the patients are classified according to the EAU/ESPU risk classification, surgeons tended to perform more endoscopic and more open surgery for the low- and high-risk groups, respectively. Although each surgical modality had similar success rates in each group, open surgical results were overall much higher than those of endoscopic surgery in each group. This was a specifically important finding in high-risk group where the endoscopically treated group of patients was small in number, and the need for a definitive correction is essential in this group because of increased risk of renal injury.
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Affiliation(s)
- B Çitamak
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey.
| | - A C Bozaci
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - M Altan
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - H B Haberal
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - O Kahraman
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - T Ceylan
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - H S Doğan
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - S Tekgül
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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Çitamak B, Mammadov E, Kahraman O, Ceylan T, Doğan HS, Tekgül S. Semi-Rigid Ureteroscopy Should Not Be the First Option for Proximal Ureteral Stones in Children. J Endourol 2018; 32:1028-1032. [DOI: 10.1089/end.2017.0925] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Burak Çitamak
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Emin Mammadov
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Oğuzhan Kahraman
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Taner Ceylan
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hasan Serkan Doğan
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Serdar Tekgül
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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Kaygısız O, Satar N, Güneş A, Doğan HS, Erözenci A, Özden E, Pişkin MM, Demirci D, Toksöz S, Çiçek T, Gürocak S, Kılıçarslan H, Nazlı O, Kefi A, İzol V, Beytur A, Sarıkaya Ş, Tekgül S, Önal B. Factors predicting postoperative febrile urinary tract infection following percutaneous nephrolithotomy in prepubertal children. J Pediatr Urol 2018; 14:448.e1-448.e7. [PMID: 29779995 DOI: 10.1016/j.jpurol.2018.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/08/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Predictive tables and scoring systems can predict stone clearance. However, there is a paucity of evidence regarding the prediction of complications during percutaneous nephrolithotomy (PCNL), particularly in children, which remains under-researched. To our knowledge, no studies have evaluated the risk factors for febrile urinary tract infection (FUTI) after pediatric PCNL. OBJECTIVES To assess the predictive factors of FUTI in prepubertal children after PCNL and determine whether any prophylactic cephalosporins are superior for decreasing the FUTI rate. STUDY DESIGN Data from 1157 children who underwent PCNL between 1991 and 2012 were retrieved from the multicenter database of the Turkish Pediatric Urology Society. Children >12 years of age were excluded, leaving 830 children (364 girls, 466 boys). Data were analyzed according to the presence of FUTI and compared between the FUTI and non-FUTI groups. RESULTS Mean age was 6.46 ± 3.38 years. Twenty-nine (3.5%) children had FUTI which was confirmed by urine culture. FUTI occurred more frequently in young children (5.5%) than school-age children (2.4%). In univariate analysis, there were significant differences between the FUTI and non-FUTI groups regarding age, cephalosporin subgroup (first, second and third generation cephalosporin), side of PCNL, staghorn stones, tract size, operative time, postoperative ureteral catheter usage, perioperative complications (SATAVA), and blood transfusion. Multivariate analysis revealed that age, side of PCNL, staghorn stones, tract size, operative time, and blood transfusion were independent predictors of FUTI. DISCUSSION The smaller tract size could cause FUTI with poor fluid drainage that may lead to elevate renal pelvic pressure and trigger bacteremia-causing pyelovenous backflow. Filling the calyx and renal pelvis by a staghorn stone and the resulting obstruction of fluid drainage may elevate intrarenal pelvis pressure. Longer operative time is likely to increase renal pelvic pressure over longer periods, which may account for FUTI after pediatric PCNL. CONCLUSIONS Younger age, right-sided PCNL, staghorn stones, mini-PCNL, longer operative time, and blood transfusion are risk factors for FUTI. First-, second-, and third-generation cephalosporins are equally effective for prophylaxis in prepubertal children undergoing PCNL.
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Affiliation(s)
- Onur Kaygısız
- Department of Urology, Uludağ University Faculty of Medicine, Bursa, Turkey.
| | - Nihat Satar
- Department of Urology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ali Güneş
- Department of Urology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Hasan Serkan Doğan
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Erözenci
- Department of Urology, Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ender Özden
- Department of Urology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Mehmet Mesut Pişkin
- Department of Urology, Necmetin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - Deniz Demirci
- Department of Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Serdar Toksöz
- Department of Urology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Tufan Çiçek
- Department of Urology, Baskent University Faculty of Medicine, Konya, Turkey
| | - Serhat Gürocak
- Department of Urology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hakan Kılıçarslan
- Department of Urology, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Oktay Nazlı
- Department of Urology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Aykut Kefi
- Department of Urology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Volkan İzol
- Department of Urology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ali Beytur
- Department of Urology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Şaban Sarıkaya
- Department of Urology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Serdar Tekgül
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bülent Önal
- Department of Urology, Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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Söğütdelen E, Yildirim T, Haberal HB, Canpolat U, Hazirolan T, Doğan HS, Yilmaz ŞR, Erdem Y, Aki FT. Donor Nephrectomy May Compromise the Cardiovascular System: A Retrospective, Single-Center Study. EXP CLIN TRANSPLANT 2018; 19:237-243. [PMID: 30084761 DOI: 10.6002/ect.2018.0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Our goal was to determine the short-term effects of donor nephrectomy on the cardiovascular system and to gain a better understanding of the recently recognized long-term increased risk of end-stage renal disease and cardiovascular mortality. MATERIALS AND METHODS Living kidney donors who underwent donor nephrectomy between January 2010 and January 2015 at the Hacettepe University Transplantation Unit were retrospectively screened. Echocardiographic parameters, kidney volumes, and renal functions before nephrectomy were compared with measurements after nephrectomy. Flow-mediated dilatation values of living kidney donors were compared with healthy individuals. RESULTS The study included 73 female and 31 male living kidney donors with a mean age of 46.1 ± 10.8 years. In the comparative analysis of donors versus 35 healthy individuals, the changes in flow-mediated dilatation were 12.3 ± 5.7% and 15.4 ± 6.3%, respectively (P = .016). In the comparative analysis of preoperative versus the last visit transthoracic echocardiographic results, left ventricular end-systolic and end-diastolic diameters decreased and left ventricular posterior wall thickness and septum thickness increased (P = .025, P = .002, P = .026, and P = .019, respectively). CONCLUSIONS Nephrectomy may cause several hemodynamic changes in living kidney donors, which may exacerbate cardiovascular risks in this population.
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Affiliation(s)
- Emrullah Söğütdelen
- From the Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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Haberal HB, Çıtamak B, Altan M, Bozacı AC, Ceylan T, Doğan HS, Tekgül S. Positioning the Instillation of Contrast Cystography: Does It Provide Any Clinical Benefit? Urology 2018; 112:164-168. [DOI: 10.1016/j.urology.2017.10.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 10/24/2017] [Accepted: 10/28/2017] [Indexed: 10/18/2022]
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Altan M, Çitamak B, Bozaci AC, Güneş A, Doğan HS, Haliloğlu M, Tekgül S. Predicting the stone composition of children preoperatively by Hounsfield unit detection on non-contrast computed tomography. J Pediatr Urol 2017; 13:505.e1-505.e6. [PMID: 28427913 DOI: 10.1016/j.jpurol.2017.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/01/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Many studies have been performed on adult patients to reveal the relationship between Hounsfield unit (HU) value and composition of stone, but none have focused on childhood. OBJECTIVE We aimed to predict stone composition by HU properties in pre-intervention non-contrast computed tomography (NCCT) in children. This could help to orient patients towards more successful interventions. MATERIALS AND METHODS Data of 94 children, whose pre-intervention NCCT and post-interventional stone analysis were available were included. Stones were grouped into three groups: calcium oxalate (CaOx), cystine, and struvite. Besides spot urine PH value, core HU, periphery HU, and Hounsfield density (HUD) values were measured and groups were compared statistically. RESULTS The mean age of patients was 7 ± 4 (2-17) years and the female/male ratio was 51/43. The mean stone size was 11.7 ± 5 (4-24) mm. There were 50, 38, and 6 patients in the CaOx, cystine, and struvite groups, respectively. The median values for core HU, periphery HU, and mean HU in the CaOx group were significantly higher than the corresponding median values in the cystine and struvite groups. Significant median HUD difference was seen only between the CaOx and cystine groups. No difference was seen between the cystine and struvite groups in terms of HU parameters. To distinguish these groups, mean spot urine PH values were compared and were found to be higher in the struvite group than the cystine group (Table). DISCUSSION The retrospective nature and small number of patients in some groups are limitations of this study, which also does not include all stone compositions. Our cystine stone rate was higher than childhood stone composition distribution in the literature. This is because our center is a reference center in a region with high recurrence rates of cystine stones. In fact, high numbers of cystine stones helped us to compare them with calcium stones more accurately and became an advantage for this study. CONCLUSIONS NCCT at diagnosis can provide some information for determination of stone composition. While CaOx stones can be discriminated from cystine and struvite stones using HU parameters, a simple spot urine pH assessment must be added to distinguish cystine stones from struvite stones.
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Affiliation(s)
- Mesut Altan
- Hacettepe University School of Medicine, Department of Urology, Ankara, Turkey
| | - Burak Çitamak
- Hacettepe University School of Medicine, Department of Urology, Ankara, Turkey
| | - Ali Cansu Bozaci
- Hacettepe University School of Medicine, Department of Urology, Ankara, Turkey.
| | - Altan Güneş
- Hacettepe University School of Medicine, Department of Radiology, Ankara, Turkey
| | - Hasan Serkan Doğan
- Hacettepe University School of Medicine, Department of Urology, Ankara, Turkey
| | - Mithat Haliloğlu
- Hacettepe University School of Medicine, Department of Radiology, Ankara, Turkey
| | - Serdar Tekgül
- Hacettepe University School of Medicine, Department of Urology, Ankara, Turkey
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Altan M, Çitamak B, Bozaci AC, Mammadov E, Doğan HS, Tekgül S. Is There Any Difference Between Questionnaires on Pediatric Lower Urinary Tract Dysfunction? Urology 2017; 103:204-208. [DOI: 10.1016/j.urology.2016.12.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/26/2016] [Accepted: 12/28/2016] [Indexed: 10/20/2022]
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Altan M, Çıtamak B, Haberal HB, Söğütdelen E, Bozaci AC, Baydar DE, Doğan HS, Tekgül S. Invasive Squamous Carcinoma and Adenocarcinoma of an Unreconstructed Exstrophic Bladder with HPV Infection. Curr Urol 2016; 9:109-12. [PMID: 27390585 DOI: 10.1159/000442863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/02/2015] [Indexed: 11/19/2022] Open
Abstract
Bladder exstrophy is a complex abnormality and is traditionally treated within the early years of life. It is associated with an increased risk of bladder cancer, with 95% of the arising tumors being adenocarcinomas and 3 to 5% being squamous cell carcinomas. HPV infections are also associated with an increased risk of bladder cancer. This case represents a patient with bladder exstrophy that gave rise to coinciding squamous cell carcinoma and adenocarcinoma. Final pathology results showed an infection with HPV. We presented the management of the case and discussed the diagnosis and treatment methods for this patient.
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Affiliation(s)
- Mesut Altan
- Department of Urology, Hacettepe University, Ankara, Turkey
| | - Burak Çıtamak
- Department of Urology, Hacettepe University, Ankara, Turkey
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- Department of Urology, Hacettepe University, Ankara, Turkey
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Karakurt N, Beşbaş N, Bozacı AC, Bilginer Y, Doğan HS, Tekgül S. Antenatal hydronephrosis: a single center's experience and follow-up strategies. Turk J Pediatr 2015; 57:560-565. [PMID: 27735793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study was performed to evaluate the role of postnatal ultrasonography (US) in predicting the final diagnosis and need of surgery of antenatal hydronephrosis patients. One hundred and twenty six renal units (RUs) of 76 patients with diagnosis of antenatal hydronephrosis (ANH) were studied. An early postnatal US no later than the first week of life was requested. Voiding cystourethrography (VCUG) and/or diuretic renogram (MAG3) was performed in children who had persistent or worsening hydronephrosis to make a certain diagnose of etiology. US findings of different etiologies, and operated/nonoperated groups are compared. Regarding the renal pelvic anteroposterior diameter in the first week postnatal US; mild, moderate, severe, and no HN was detected in 48 (38.1%), 31 (24.6%), 24 (19.0%), and 23 (18.3%) RUs respectively. Eight RUs with a normal first postnatal US were found to have renal anomaly during follow up and 63% of these were vesicoureteral reflux (VUR). Kidneys with mild or moderate HN were likely to have transient dilatation while severe HN was likely to have obstruction. Postpartum follow-up of AHN is a dynamic process. Follow-up must be planned with optimum period of intervals according to clinic and US findings, to select the right patient for surgery or close follow-up.
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Affiliation(s)
- Neslihan Karakurt
- Division of Pediatric Hematology and Oncology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey.
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Doğan HS, Yazıcı Z, Aytaç B, Sevinir B, Erdoğan H, Çiçek Ç. Pediatric Multilocular Cystic Nephroma Extending into the Renal Pelvis and Ureter. jus 2014. [DOI: 10.4274/jus.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Abstract
OBJECTIVE We report our experience with percutaneous nephrolithotomy (PNL) therapy for staghorn or complex pediatric renal calculi. PATIENTS AND METHODS We retrospectively analyzed the case records of 105 patients younger than 17 years who underwent PNL. The cases included 53 complex calculi analyzed in 51 patients. We defined complex calculi as either staghorn or those with a stone bulk larger than 300 mm(2), involving more than one calix, the upper ureter or stone in anomalous kidney. RESULTS Mean age of patients with complex calculi was 9.7+/-0.7 years and stone burden was 654+/-92.4mm(2). The median duration of PNL was 90+/-4.7 (30-220) min. Complete clearance was achieved in 39 patients (73.6%). Of these, 32 (60.4%) required a single tract, while 21 (39.6%) required multiple tracts. With subsequent shock wave lithotripsy and PNL, the clearance rate increased to 86.8%. The average hemoglobin drop was 1.6+/-0.16 g/dL. Assessing the factors affecting the hemoglobin drop, the number of tracts (P=0.01) and size of tracts (P=0.002) were found to be significant. The mean change in serum creatinine concentration between preoperative and postoperative measurements was -0.01+/-0.02 mg/dL, for both patients with a single tract and those with multiple tracts. CONCLUSIONS PNL is safe and effective in the management of staghorn and complex renal calculi in children. Tract dilatation and number of tracts are important factors in reducing blood loss.
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Affiliation(s)
- Ender Ozden
- Department of Urology, Hacettepe University, Ankara, Turkey
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