Can lockdown and homeschooling change the outcome of urotherapy for lower urinary tract dysfunction in children?

OBJECTIVE

Lower urinary tract dysfunction (LUTD) are still important for both children and pediatric urologists. Urotherapy is recommended in LUTD treatment management. In our country, all citizens under the age of 20 were banned from going out of their homes due to Covid-19 and the homeschooling system has been adopted The aim of this study is to investigate the effect of lockdown and homeschooling on the effectiveness of urotherapy used for LUTD treatment.

METHODS

83 patients were included in the study group. Besides 306 patients were determined as the control group (pre-Covid). The patients in the study group and the control group were compared in terms of improvement in Dysfunctional voiding and incontinence scoring system (DVISS), quality of life scores, bladder diary, Bristol stool scale, and treatment responses at 3rd and 6th months.

RESULTS

The study group and control group were compared in terms of DVISS, voiding frequency and incontinence in the voiding diary, quality of life score, and Bristol stool scale at admission visit and the group characteristics were similar. During the 6th month visit, the mean DVISS of the study group was found to be significantly lower (7.12 ± 3.48; 8.58 ± 4.06 respectively (p 0.002)). Daily voiding frequency was similar in the study group and the control group during the 2nd and 3rd visit. The study group's mean number of daily incontinence was significantly lower at visit 3 (0.57 ± 0.9; 0.94 ± 0.27, respectively (p 0.02).After six months of treatment, 13.3% of the study group patients had a complete response, 44.6% had a partial response, whereas 42.2% non-responders. In the control group, the response rates were as 5.9%, 39.2% and 54.9% respectively (p 0.02).

CONCLUSIONS

LUTD is still very common in pediatric urology. Standard urotherapy is widely used in treatment management. According to our results, the success of standard urotherapy increases with lockdown and homeschooling. We have shown that the success of standard urotherapy can be improved by regulating environmental conditions. In terms of LUTD management, environmental conditions can be regulated to provide a better quality of life and a better cure in a more economical way.

Is it necessary to have a guidewire down through the ureter during mini percutaneous nephrolithotomy? Single-centre experience with 1052 cases

OBJECTIVES

In this study, it is aimed to identify the rate of successful placement of a guidewire down through the ureter during PNL and to compare the outcomes of different locations of guidewires in the collecting system following renal puncture in terms of success and complications rates.

PATIENTS AND METHODS

Data of 1052 patients who underwent miniPNL in our institution between January 2014 and November 2020 were analysed. Patients were divided into three groups. Group I consisted of patients with the guidewire coiled within the punctured calyx, group II consisted of patients with the guidewire reaching the renal pelvis and group III consisted of patients with the guidewire passed down through the ureter. The groups were compared for successful tract creation and complication rates.

RESULTS

There were 303 (28.8%) patients in group I, 330 (31.4%) patients in group II and 419 (39.8%) patients in group III. Successful tract dilation at the first attempt was established in 298 (94.7%) patients in group I, 328 (99.4%) patients in group II and in all of the 419 (100%) patients in group III. Successful tract creation was established in a second attempt in all of the patients failed in the first attempt. The groups were similar for stone-free and complication rates.

CONCLUSIONS

Placement of guidewire down through the ureter could not be established in more than 60% of the cases. Location of guidewire prior to dilation did not affect the outcomes. Therefore, we suggest to proceed with tract creation even when the guidewire coils within the punctured calyx.

Effect of Active Aspiration and Sheath Location on Intrapelvic Pressure During Miniaturized Percutaneous Nephrolithotomy

OBJECTIVE

To evaluate the effects of location of the tip of percutaneous sheath and nephroscope in the collecting system together with active aspiration on the Intrapelvic pressure measurements (IPP) during miniaturized percutaneous nephrolithotomy (miniPNL).

MATERIALS AND METHODS

The data of 20 patients underwent miniPNL in supine position was collected prospectively. IPP measurements were done with an 8 Fr urodynamic pressure measurement catheter in 4 different settings with respect to location of tip of sheath and nephroscope. All 4 settings were repeated with active aspiration. Totally measurements were done and compared in 8 different settings for 90 seconds in each patient.

RESULTS

Highest mean IPP measurements were recorded in setting II (35.3 ± 11.8 cm H2O) where the sheath was located in the calyx and the tip of the nephroscope was in the renal pelvis. When active aspiration was applied, the mean pressure measurements were significantly lower than the counterpart settings without aspiration (all P values <.0001). When the active aspiration was applied, intrarenal pressure measurements did not exceed 40 cm H2O in any settings in any of the patients.

CONCLUSION

Location of the tip of the sheath and the nephroscope has significant effect on IPP measurements. Active aspiration significantly lowers the IPP and keeps it <40 cm H2O. Endourologists should be aware of possible alterations in IPP during miniPNL and active aspiration should be kept in mind as an effective solution to decrease the risk of complications related to high IPP.

Characteristics and medical management of patients with rheumatoid arthritis and ankylosing spondylitis

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic, progressive, systemic inflammatory rheumatic diseases that lead to serious disability. The objective of this study was to investigate the demographic and clinical characteristics of the patients with RA and AS who were treated in tertiary hospitals in Turkey and to analyze their current medical management. A total of 562 RA and 216 AS patients were evaluated. The mean age of RA patients was 52.1 +/- 12.6 years. The female to male ratio was 3.7:1. Of the RA patients, 72.2% had positive rheumatoid factor (RF), 62.9% had high C-reactive protein, and 75.2% had radiological erosion. The ratio of patients with Disease Activity Score (DAS) 28 >3.2 was 73.9% and of those with Health Assessment Questionnaire (HAQ) > or =1.5 was 20.9%. There was a statistically significant increase in RF positivity and HAQ scores in the group with higher DAS 28 score. Frequency of extraarticular manifestations was 22.4%. The ratio of the patients receiving disease modifying antirheumatic drugs (DMARD) was 93.1%, and 6.9% of the patients were using anti-tumor necrosis factor (TNF) blocking agents. In AS, the mean age of the patients was 38.1 +/- 10.6, and the female to male ratio was 1:2.5. The time elapsed between the first symptom and diagnosis was 4.3 years. The ratio of peripheral joint involvement was 29.4%. Major histocompatibility complex, class I, B 27 was investigated in 31.1% of patients and the rate of positivity was 91%. In 52.4% of the patients, Bath AS Disease Activity Index (BASDAI) was > or =4. The erythrocyte sedimentation rate, Bath AS Functional Index, and peripheral involvement were significantly higher in the group with BASDAI > or =4. Frequency of extraarticular involvement was 21.2% in AS patients. In the treatment schedule, 77.5% of AS patients were receiving sulphasalazine, 15% methotrexate, and 9.9% anti-TNF agents. Despite widespread use of DMARD, we observed high disease activity in more than half of the RA and AS patients. These results may be due to relatively insufficient usage of anti-TNF agents in our patients and therefore these results mostly reflect the traditional treatments. In conclusion, analysis of disease characteristics will inform us about the disease severity and activity in RA and AS patients and could help in selecting candidate patients for biological treatments.

Dynamic postural stability in blind athletes using the biodex stability system

Three systems affect the upright standing posture in humans - visual, vestibular, and somatosensory. It is well known that the visually impaired individuals have bad postural balance. On the other hand, it is a well documented fact that some sports can improve postural balance. Therefore, it is aimed in this study to evaluate the dynamic postural stability in goal-ball athletes. Twenty blind goal-ball players, 20 sighted and 20 sedentary blind controls were evaluated using the Biodex Stability System. Three adaptation trials and three test evaluations (a 20-second balance test at a platform stability of 8) were applied to the blind people, and to the sighted with eyes open and closed. Dynamic postural stability was measured on the basis of three indices: overall, anteroposterior, and mediolateral. Means of each test score were calculated. The tests results were compared for the blind athletes, sighted (with eyes open and closed) subjects, and sedentary blind people. There were significant differences between the results of the blind people and the sighted subjects with regards to all of the three indices. Although the stability of goal-ball players was better than sedentary blinds', only ML index values were statistically different (4.47 +/- 1.24 in the goal-ball players; 6.46 +/- 3.42 in the sedentary blind, p = 0.04). Dynamic postural stability was demonstrated to be affected by vision; and it was found that blind people playing goal-ball 1 - 2 days per week have higher ML stability than the sedentary sighted people.