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Öğe Comparison of postoperative analgesic efficacy of bupivacaine and levobupivacaine for dorsal penile block(Bayrakol Medical Publisher, 2024) Esen, Hayruenisa Kahraman; Esen, Osman; Yildiz, Turan; Ilce, ZekeriyaAim: In this study, we aimed to evaluate the postoperative analgesic efficacy and side effects of bupivacaine and levobupivacaine for dorsal penile blockage in circumcised patients. Material and Methods: A total of 84 circumcised patients (age range: 7-11 years) were enrolled in this study. The patients were divided into two groups according to the dorsal penile block method: bupivacaine utilized Group B, levobupivacaine utilized Group L. Blocks were administered preoperatively with 1mL kg -1 of 0.25% bupivacaine and levobupivacaine. Postoperative pain scores and sedation were evaluated. Pain assessment was performed using the WongBaker faces Pain Scale (WBPS). The number of patients without pain within the first 6 hours, analgesia duration, time of first analgesia, and total paracetamol consumption were recorded. Results: Mean scores of WBPS were found statistically higher at the first, second and third hours in group B than in group L (p<0,05). The results showed no statistically significant differences between groups according to the WBAS assessment at 4, 5 and 6 hours, rates of rescue analgesic requirement and also rescue paracetamol dose between the groups. Discussion: Administration of levobupivacaine for dorsal penile blockage was found to be more efficient to provide postoperative analgesia and also to reduce postoperative analgesia utilization than bupivacaine in circumcised children under general anesthesia.Öğe Comparison of Urinary Tract Dilatation and Society of Fetal Urology systems in the detection of vesicourethral reflux and renal scar(Int Scientific Information Inc, 2021) Dogan, Gulec Mert; Sigirci, Ahmet; Cengiz, Aslinur; Tasolar, Sevgi Demiroz; Yildiz, Turan; Tabel, Yilmaz; Elmas, Ahmet TanerPurpose: The presence and degree of hydronephrosis is very important in the management of many diseases of the urinary tract. In this study, we aim to compare the sensitivity and specificity of 2 classification systems that are used for hydronephrosis grading in ultrasound, for reflux and scar detection. The classification systems were the Society of Fetal Urology (SFU) and Urinary Tract Dilatation (UTD). Material and methods: Ultrasounds and dimercaptosuccinic acid scintigraphies (DMSA) of all patients who underwent voiding cystourethrogram (VCUG) due to urinary tract infection were examined retrospectively. DMSA was accepted for scar detection and VCUG for reflux detection as reference methods. SFU classification was used for hydronephrosis in ultrasound reports, and UTD classification was made over the reports. Sensitivity, specificity, and positive and negative predictive values of UTD and SFU classification systems for reflux and scar detection were calculated, and these 2 systems were compared. Results: 103 (39%) of the patients were male and 162 (61%) were female. Pathologies were detected in 192 (35%) of 530 kidneys in ultrasound. In 110 (42%) of the children, reflux was detected in VCUG. Scars in DMSA were detected in only 16% (44) of 266 kidneys. Sensitivity, positive and negative predictive values of the UTD classification system were statistically significantly higher than the SFU system for scar and reflux detection (p < 0.01). Conclusions: If we use the UTD system in ultrasounds of patients with urinary tract infections, children reported as UTD 0 may not need VCUG, which reduces radiation exposure to children and the cost of the diagnostic interventions.Öğe Effect of catheter selection in hypospadias repair(2020) Arpacik, Mehmet; Yildiz, TuranAim: The effects of catheter use on postoperative complications in patients undergoing hypospadias repair remains controversial. The aim of this study was to evaluate the effectivity of silicone and feeding catheters on surgical outcomes in patients undergoing hypospadias repair.Material and Methods: The retrospective study included 169 patients with distal and midpenile hypospadias who were operatively treated with tubularized incised plate urethroplasty between July 2014 and July 2018. A feeding catheter was used in 79 patients (Group A) and a silicone catheter was in 90 patients (Group B). Postoperative complications including catheter-related complications (catheter occlusion, urine leak around the catheter, and spontaneous withdrawal) and hypospadias-related complications (urethrocutaneous fistula, meatal stenosis, urethral stenosis, and glans dehiscence) were recorded for each patient.Results: The age of the patients ranged between 6 months and 15 years. The incidence of catheter-related complications was significantly higher in Group A compared to Group B (p0.021). The overall incidence of hypospadias-related complications was 5.1% in Group A as opposed to 3.3% in Group B and no significant difference was found between the two groups with regard to postoperative complications.Conclusion: Although catheter selection had no effect on hypospadias-related complications, the use of feeding catheters led to a higher incidence of catheter-related complications, which is likely to increase the anxiety levels of the parents.Öğe Efficacy and safety of Hyadex for treatment of vesicoureteral reflux: a multicenter experience(Sage Publications Ltd, 2023) Oguz, Fatih; Yildiz, Turan; Gecit, Ilhan; Gungor, Hasan; Ciftci, Halil; Aksoy, Yilmaz; Yagmur, IsmailObjectiveThis study was performed to evaluate the efficacy and safety of dextranomer/cross-linked hyaluronic acid (Hyadex) in patients with a clinical diagnosis of vesicoureteral reflux (VUR).MethodsIn this cross-sectional multicenter observational study, Hyadex was used in four different centers for the endoscopic treatment of VUR from 2020 to 2022. The study involved 74 patients (93 renal units) who were diagnosed with VUR according to voiding cystourethrography (VCUG) findings and were considered suitable for subureteric endoscopic treatment. The follow-up time (control VCUG time) was 3 months.ResultsIn the VCUG evaluation, grade I VUR was found in 13 renal units, grade II in 23 renal units, grade III in 42 renal units, and grade IV in 12 renal units. The success rates of Hyadex treatment according to the degree of VUR were as follows: 84.6% for grade I, 82.6% for grade II, 71.4% for grade III, and 66.0% for grade IV. No major complications were observed.ConclusionEndoscopic subureteric Hyadex injection had high success rates in appropriately selected patients with VUR and may be used as the first-line treatment for children with VUR.Öğe External hemorrhoidal disease in child and teenage: Clinical presentations and risk factors(Professional Medical Publications, 2019) Yildiz, Turan; Aydin, Dilek Bingol; Ilce, Zekeriya; Yucak, Aysel; Karaaslan, ErolObjective: Hemorrhoidal disease (HD), though mostly seen in adults, has recently emerged as a common problem among children. However, the diagnosis and treatment of HD in children is mostly based on the data obtained in adult studies. In this study, we aimed to evaluate risk factors, diagnostic and treatment modalities in the children diagnosed with external HD. Methods: The study was conducted at Sakarya University Medical School Pediatric Surgery Department between January 2012 and July 2018. We reviewed children who were diagnosed as having HD at Pediatric Surgery clinic. Age, gender, presenting symptoms, physical examination findings, risk factors, and treatment outcomes were evaluated for each patient. Results: The study included 56 patients with a mean age of 140.8 +/- 45.2 months. The patients comprised 48 (85.7%) boys and 8 (14.3%) girls. Constipation and a positive family history were the most common risk factor (n=33; 58.9%, n=29; 51.8%, respectively). Conservative treatment was performed in 53 (94.6%) patients. Recurrence was observed in 5 (8.9%) and skin tag was detected in 6 (10.7%) patients. Conclusions: External HD mostly occurs in boys in their second decade of life. Positive family history and constipation were the most common risk factors in our patients. Conservative treatment is sufficient for the management of external HD in children because of its low recurrence rates.Öğe Glial Cell Line-Derived Neurotrophic Factor, S-100 Protein and Synaptophysin Expression in Biliary Atresia Gallbladder Tissue(Korean Soc Pediatric Gastroenterology & Nutrition, 2021) Gurunluoglu, Semra; Ceran, Canan; Gurunluoglu, Kubilay; Kocbiyik, Alper; Gul, Mehmet; Yildiz, Turan; Bag, Harika GozukaraPurpose: Biliary atresia (BA) is a disease that manifests as jaundice after birth and leads to progressive destruction of the ductal system in the liver. The aim of this study was to investigate histopathological changes and immunohistochemically examine the expression of glial cell line-derived neurotrophic factor (GDNF), synaptophysin, and S-100 protein in the gallbladder of BA patients. Methods: The study included a BA group of 29 patients and a control group of 41 children with cholecystectomy. Gallbladder tissue removed during surgery was obtained and examined immunohistochemically and histopathologically. Tissue samples of both groups were immunohistochemically assessed in terms of GDNF, S-100 protein, and synaptophysin expression. Expression was classified as present or absent. Inflammatory activity assessment with hematoxylin and eosin staining and fibrosis assessment with Masson's trichrome staining were performed for tissue sample sections of both groups. Results: Ganglion cells were not present in gallbladder tissue samples of the BA group. Immunohistochemically, GDNF, synaptophysin, and S-100 expression was not detected in the BA group. Histopathological examination revealed more frequent fibrosis and slightly higher inflammatory activity in the BA than in the control group. Conclusion: We speculate that GDNF expression will no longer continue in this region, when the damage caused by inflammation of the extrahepatic bile ducts reaches a critical threshold. The study's findings may represent a missing link in the chain of events forming the etiology of BA and may be helpful in its diagnosis.Öğe Impact of COVID-19 pandemic on pediatric appendicitis hospital admission time and length of hospital stay(Turkish Assoc Trauma Emergency Surgery, 2022) Tasci, Aytac; Gurunluoglu, Kubilay; Yildiz, Turan; Arslan, Ahmet Kadir; Akpinar, Necmettin; Cin, Ecem Serbest; Demircan, MehmetBACKGROUND: Appendicitis is one of the most common surgical emergencies among children. In this retrospective clinical study, we attempted to determine the effects of the COVID-19 pandemic period on hospital admission time and length of hospital stay (LOS) in pediatric appendicitis cases. METHODS: We retrospectively compared pediatric appendectomies from the date of the first reported COVID-19 case to June 1, 2020, which is considered as the start of the normalization process, with pre-pandemic pediatric appendectomies of the same number of days in terms of age, gender, hospital admission time, LOS, parental educational level, laboratory values, and histopathological findings. RESULTS: There was an average increase of 2 days in the time from the onset of symptoms to hospital admission in pediatric appendicitis patients in the COVID-19 period (p=0.001). Furthermore, C-reactive protein value was statistically significantly higher in the COVID-19 period (p=0.018). Given the LOS, it was calculated as an average of 5 days in the pre-pandemic period and 4 days in the COVID-19 period, and this difference was statistically insignificant (p=0.273). There was no significant difference between the groups in terms of histopathological findings (p=0.176). The parental educational level had no effect on the admission time. CONCLUSION: The hospital admission time of pediatric appendicitis patients is significantly prolonged in the COVID-19 pandemic, but this prolongation had no histopathological effect. During the pandemic, the recovery of patients who required urgent treatment during the stay-at-home period was also negatively affected. Notwithstanding, we are of the opinion that the absence of an increase in the LOS may be due to the willingness of both families and physicians to keep the LOS as short as possible. Despite the increase in hospital admission time in pediatric appendicitis during the Covid 19 pandemic process, the lack of increase in the rate of complicated appendicitis may be an indicator of the importance of other factors in the development of complicated appendicitis.Öğe Management of anesthesia and complications in children with Tracheobronchial Foreign Body Aspiration(Professional Medical Publications, 2019) Karaaslan, Erol; Yildiz, TuranObjectives: Delayed diagnosis and treatment of tracheobronchial foreign body aspiration (FBA) in children may lead to morbidity and mortality. Our objective was to evaluate the anesthetic management, periand post-operative complications, and predisposing factors for postoperative intensive care unit (ICU) admission in children undergoing rigid bronchoscopy due to tracheobronchial FBA. Methods: This retrospective study included 81 children who underwent rigid bronchoscopy between January 2010 to July 2018 at Inonu University, Department of Pediatric Surgery, Turkey. Data regarding demographic characteristics, anesthetic management, length of ICU and hospital stays, and peri- and postoperative complications were retrieved from the hospital database. Results: The patients included 54 (66.7%) boys and 27 (33.3%) girls with a mean age of 29.6 +/- 31.2 months. The most common presenting symptom was the suspicion of FBA, followed by acute-onset cough, cyanosis, wheezing and respiratory distress. Mean duration of anesthesia was 44.40 +/- 14.72 min. Of the 81 patients, 18 (22.2%) were transferred to ICU and 63 (77.8%) patients were transferred to the ward postoperatively. Of the patients transferred to the ICU, 5 of them required mechanical ventilation. Some peri and postoperative complications, desaturation (n=16; 19.7%; p=0.001), mucosal bleeding (n=6; 7.4%; p=0.02), laryngeal edema (n=11; 13.6%; p<0.001), laryngospasm (n=13; 16.3%; p<0.001), were affected the frequency of intensive care transfer. Conclusion: Bronchoscopy with general anesthesia remains the golden standard for the management of tracheobronchial FBA. In such patients, a combination consisting of a detailed preoperative clinical evaluation of the patient, selection of short-acting anesthetic agents with minimal side effects for the induction and maintenance of anesthesia, and the administration of controlled ventilation can be recommended. Additionally, early diagnosis of peri- and post-operative complications, prediction of postoperative ICU requirement, and a close cooperation of anesthesiologists and surgeons are highly important.Öğe The new therapeutic option for female stress and stress-predominant mixed urinary incontinence: Periurethral hypertonic saline (10%) injection(Wiley, 2022) Tahtali, Ibrahim Nuvit; Yildiz, Turan; Dincer, Muhammed MuratObjectives We aimed to evaluate the safety and efficacy of periurethral hypertonic saline (10% NaCl) injection in the treatment of stress urinary incontinence (SUI) and stress-predominant mixed urinary incontinence (S-MUI) in women. Methods This was a prospective study conducted between January 2014 and April 2018 with 64 women (44 SUI and 21 S-MUI). Patients with SUI and S-MUI were evaluated using the Urinary Distress Inventory 6. Quality of life was evaluated with the Incontinence Quality of Life Scale and lower urinary tract symptoms of the women were evaluated with the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules. Incontinence status and treatment success were assessed via the Stamey incontinence grade and pad test. Results The subjective success rate was 58.5%, and the objective success rate was 81.5%. The rate of reinjection was 21.5%, and the mean duration of reinjection was 8.92 months (3-19 months). Minor adverse effects were observed in 30.4% of the 79 injections. International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules and Incontinence Quality of Life Scale scores improved remarkably starting from the first month. Urinary Distress Inventory 6 scores in the S-MUI group also improved. Conclusions The results indicate that hypertonic saline injection is an effective and safe method in the treatment of SUI and S-MUI. Since hypertonic saline is a much cheaper and more accessible substance compared to bulking agents, it seems to be a viable alternative for urinary incontinence treatment in women.Öğe Place of Cholecystectomy in Children with Uncomplicated Gallstones(Kowsar Corp, 2019) Yildiz, Turan; Ilce, Zekeriya; Turan, Gupse; Yucak, Aysel; Elmas, Bahri; Alan, CumaliBackground: The incidence of gallstones in children has increased in recent years. Risk factors that increase the formation of bile duct stones have been described in children, and discussions are ongoing about surgical indications of uncomplicated gallstones. Objectives: This study aimed to investigate the impact of risk factors on gallstone-induced complications and identify surgical indications for uncomplicated gallstones in children. Methods: Patients who had a cholecystectomy in the pediatric surgery clinic between October 2011 and January 2018 were evaluated. Data including age and sex, body mass index (BMI), associated risk factors, gallstone-induced complications, postoperative complications, postoperative complaints, and pathological results were recorded. Results: Seventy-two patients were included in the study. The mean age was 13.2 years with a female-to-male ratio of 2.27:1. Obesity was the most common risk factor (25%). A total of 44% of the patients experienced a complication on admission. The risk factors had no effect on the development of complications. The patients underwent cholecystectomy, but some symptoms persisted in thirteen patients postoperatively (18.1%). Ten of these patients did not have any risk factors; however, chronic cholecystitis findings were not identified in six specimens of those with uncomplicated gallstones. Conclusions: The risk factors have no influence on the development of gallstone-induced complications in children. Gallstones were cured with cholecystectomy; however, some complaints persisted in risk-free and uncomplicated gallstones. We think that if there are no risk factors in patients with uncomplicated gallstones, the patients should not receive surgerybut be closely monitored.Öğe Primary Omental Torsion in Children(Aves, 2012) Yildiz, Turan; Ates, MustafaPrimary Omental Torsion (POT) is a very rare cause of acute abdomen mimicking acute appendicitis in children. In the pediatric age group the clinical presentation and laboratory findings are similar to those of acute appendicitis, and it is extremely difficult to diagnose preoperatively. We would like to share our experiences here. We retrospectively reviewed the medical records of children diagnosed for POT, from September 2005 to September 2010 at our department. Among 768 children operated on for acute appendicitis, four patients were diagnosed with POT. We discussed the POT patient's clinical presentation, laboratory findings, diagnostic imaging results as well as surgical and pathologic findings in this study. The mean age of patients was 10.2 years (8-12 years). All patient weight percentages were over 90% for their age group and all of them were obese. These patients were operated on with the diagnosis of acute appendicitis, the appendix was normal and ischemic omental torsion was seen in the lower right quadrant. In this retrospective study, we present our experience in four children with POT and discuss the diagnostic and therapeutic implications of this entity.Öğe Simple patch closure for perforated peptic ulcer in children followed by Helicobacter pylori eradication(Professional Medical Publications, 2014) Yildiz, Turan; Iice, Huri Tilla; Ceran, Canan; Ilce, ZekeriyaObjective: Peptic ulcer disease in children is rare. Therefore, the diagnosis can be missed until complications such as perforation or hemorrhage occur. Few reports have investigated the procedures and outcomes of children who have undergone operations for perforated duodenal ulcers. We report our experience with the modified Graham technique for perforated duodenal ulcers in nine children and review the literature. Methods: The records of patients operated on for a perforated duodenal ulcer in the last 8 years in two pediatric surgery centers were evaluated retrospectively. Patient demographics, symptoms, time to admission to hospital, operative findings, and postoperative clinical course were evaluated. Results: Nine children (mean age 13.2 years, range 6-170 years) were included. All patients were admitted in the first six hours after their abdominal pain started. In three patients, there was free air on plain x-rays, while the x-rays were normal in six. All perforations were located on the anterior surface of the first part of the duodenum and repaired with primary suturing and Graham patch omentoplasty. The recovery was uneventful in all patients. In five patients, urea breath tests were performed postoperatively for Helicobacter Pylon, and the results were positive. All patients underwent triple therapy with lansoprazole, amoxicillin, and clarithromycin. The mean follow-up time was 58 (range 3-94) months. Conclusions: Peptic ulcer perforation should be suspected in children who have acute abdominal pain and peritoneal signs, especially when their suffering is intense. The simple patch repair and postoperative triple therapy for Helicobacter Pylori are safe and satisfactory for treating peptic ulcer perforation in children.Öğe Türkiye’de Vergilendirmede Dijital Dönüşüm(2022) Demiroz Tasolar, Sevgi; Sigirci, Ahmet; Dogan, Gulec Mert; Cengiz, Aslinur; Subasi, Vedat; Yildiz, Turan; Tabel, YilmazAim: It is aimed to evaluate the effect of reflux time in primary VUR in terms of predicting endoscopic treatment success and treatment timing in VUR management. Vesicoureteral reflux (VUR) is an important cause of urinary tract infection and chronic renal disease. Voiding cystourethrography (VCUG) is the gold standard diagnostic test in the diagnosis of VUR. In recent years, new parameters related to VCUG have been more objectively studied to evaluate the clinical prognosis. Materials and Methods: In our study, the records and imaging findings of children with primary VUR who underwent VCUG examination between 2012 and 2019, who were treated with endoscopic injections, were retrospectively reviewed. Forty-one children (67 renal units) were included in our study. Patients with preoperative VCUG, urinary ultrasonography, dimercaptosuccinic acid (DMSA) renal scan, and post-operative control VCUG were included in this study. Results: Patients with preoperative VUR grade 1-2 were divided into two groups as “low grade” and patients with stage 3-4-5 as “high grade”. In the general patient pop- ulation, endoscopic success rates in terms of renal unit deficit were found to be 46.3% (31/67). When the subgroup was analyzed, the endoscopic treatment success rate was 72.2% (13/18) in the low-grade group, versus 36.7% (18/49) in the high-grade group (p = 0.010). In the multivariate logistic regression analysis performed to identify indepen- dent predictors of scarring, reflux degree and reflux time were found to be independent predictors of scarring. Conclusion: In our study, we found that in VCUG evaluated preoperatively, VUR time as well as VUR grade were effective on endoscopic success rate and scar development. Based on these results, it could be thought that VUR time may be effective in selecting the best candidates for surgery and in the management and timing of treatment of VUR patients.Öğe Use of angiographic embolization in trauma-induced pediatric abdominal solid organ injuries(Turkish Assoc Trauma Emergency Surgery, 2019) Gurunluoglu, Kubilay; Ceran, Canan; Yildirim, Ismail Okan; Kutlu, Ramazan; Sarac, Kaya; Yildiz, Turan; Bayrakci, ErcanBACKGROUND: Knowledge of the utility of angiographic embolization (AE) in pediatric cases of blunt abdominal solid organ trauma injuries is limited. The current study is an examination of AE as an effective and reliable method to control bleeding in patients with persistent bleeding due to blunt trauma-induced abdominal solid organ injury. METHODS: This was a retrospective examination of patients < 17 years of age who had experienced blunt abdominal solid organ injury and who presented at a single institution within 4 years. A statistical analysis of the data was performed. RESULTS: The mean length of intensive care unit stay was 4 days for those who underwent embolization (n= 11), and the mean length of hospital stay was 12 days. The average pre-AE blood loss, as measured by the decrease in hematocrit (%) from admission to embolization, was -7.33 +/- 5.3% (p< 0.001). The average post-AE blood loss, as measured by the change in hematocrit 72 hours post AE, was 2 +/- 0.97% (p> 0.05). All of the patients were discharged with a full recovery. CONCLUSION: AE was a safe and effective method to control solid organ hemorrhage in pediatric patients with blunt abdominal injuries.Öğe Wandering spleen torsion resulted as intestinal obstruction(2020) Tasci, Aytac; Yildiz, TuranWandering spleen is a very rare condition with an estimated incidence of 0.2%. Clinical presentation of wandering spleen can vary from asymptomatic to an abdominal emergency. In this report, we present a two-year-old girl with acute intestinal obstruction due to the torsion of wandering spleen. We successfully performed the splenopexy procedure in a 2-year-old patient who came with an acute intestinal obstructionÖğe Whole exome sequencing analysis for mutations in isolated type III biliary atresia patients(Termedia Publishing House Ltd, 2020) Gurunluoglu, Kubilay; Koc, Ahmet; Durmus, Kubra; Bag, Harika Gozukara; Ceran, Canan; Gurunluoglu, Semra; Yildiz, TuranAim of the study: Biliary atresia is an idiopathic, destructive disease that affects both extrahepatic and intrahepatic bile ducts with severe inflammation and manifests as progressive jaundice within the first few months of life. In this study, we aimed to investigate the significance of genetic mutations in the onset of biliary atresia disease. Material and methods: With the approval of the ethics committee and parental consent, blood was taken from patients to obtain their DNA, and the study commenced. In this prospective study, we examined the DNA of 10 patients with no disease other than biliary atresia, and an exome sequence analysis was performed with the new-generation DNA sequencing method. The genetic structure of biliary atresia disease was examined by statistical analysis of the mutations, which were determined according to the reference DNA sequencing. Results: In the exome sequence analysis, the number of mutations detected among the patients changed significantly; the lowest number was 12,591, and the maximum was 19,863. By examining these mutations, we identified the mutated genes that were common to all patients. Conclusions: In this study, the highest mutation rates were detected in the PRIM2 and MAP2K3 genes. These genes have not previously been associated with biliary atresia.
