Seyhmus Kerem Ozel

Objectives: The aim of this study was to compare the effectiveness of biofeedback (BF) treatment, parasacral transcutaneous electrical nerve stimulation (PTENS), and dual combination in pediatric dysfunctional voiding (DV). Patients and methods: Between July 2018 and July 2021, a total of 42 participants diagnosed with DV were included in the prospective phase and divided into three groups: the BF group (1 male, 12 females; mean age: 9 ± 3.28 years; range, 6 to 13 years), the PTENS (PT) group (2 males, 12 females; mean age: 8.85 ± 2.14 years; range, 6 to 11 years), and the biofeedback and PTENS (BFPT) group (2 males, 13 females; mean age: 9.6 ± 2.29 years; range, 5 to 16 years). Patients with DV were randomly selected for BF, PT, and BFPT. Standard urotherapy was applied to all patients. Patients were evaluated with uroflowmetry, residual urine levels, and an objective symptom scoring system, the International Consultation on Incontinence Questionnaire Pediatric Lower Urinary Tract Symptoms, before and after treatment. Late follow-up evaluations were also done. Results: No difference was observed in uroflowmetric data. Although the symptom scores decreased significantly in all groups after treatment (p for BF: 0.005, p for PT: 0.0001, p for BFPT: 0.001), the posttreatment score after PT was significantly lower when compared to the score after BF (17.46 ± 3.23 vs. 14.5 ± 3.59, p = 0.018). Long-term follow-up was 23.11 ± 0.78 months for the BF group and 17.6 ± 1.51 months for the PT group. These scores remained similar in long-term follow-up. Conclusion: Parasacral TENS seems to be more effective as a primary treatment in patients with DV in the short and long-term compared to BF treatment. It may be more advantageous in patients who cannot cooperate, have inadequate motivation, or have mental retardation. Thus, PT should be kept in mind in patients with DV.

Matrix metalloproteinases (MMPs) and their endogenous inhibitors, tissue inhibitors of metalloproteinases, regulate extracellular matrix remodeling and neural tissue homeostasis. Transforming growth factor β1 modulates inflammation, ECM deposition, and tissue repair. Dysregulation of these pathways may contribute to congenital spinal dysraphism. This study quantified cerebrospinal fluid MMP-9, TIMP-1, and TGF-β1 in neonates with myelomeningocele and evaluated their potential as pathogenic mediators or biomarkers. Preoperative CSF samples were collected from 48 neonates with isolated myelomeningocele (Group 1) and 24 age-matched controls with sterile CSF (Group 2). MMP-9, TIMP-1, and TGF-β1 concentrations were measured via ELISA. Intergroup differences were analyzed, and Pearson correlation assessed relationships among biomarkers. CSF MMP-9 levels were significantly elevated in neonates with myelomeningocele compared to controls (57.12 ± 64.19 ng/mL vs. 11.29 ± 6.79 ng/mL; p < 0.05). TIMP-1 (368.78 ± 220.08 ng/mL vs. 450.04 ± 390.22 ng/mL) and TGF-β1 (2.32 ± 1.44 ng/mL vs. 2.524 ± 1.07 ng/mL) did not differ significantly. MMP-9 correlated positively with TIMP-1 across all subjects (p < 0.05) and with TGF-β1 within the myelomeningocele group (p < 0.05), indicating coordinated regulation of ECM degradation and fibrogenic signaling. Elevated CSF MMP-9 in neonates with myelomeningocele suggests dysregulated ECM remodeling may be associated with neural tube malformation. MMP-9 may serve as a biomarker of ECM dysregulation, providing insights into the pathogenesis of congenital spinal dysraphism and identifying possible targets for future therapeutic interventions.

Objectives: The aim of this study was to investigate the prevalence of renal anomalies in a large cohort of children with spina bifida and review the information in the literature. Patients and methods: Between January 2005 and February 2025, a total of 1,039 children (499 males, 540 females; mean age: 4.7±3.1 years; range, 4 days and 17 years) with the diagnosis of spina bifida and spina bifida occulta who were under follow-up within the last 20 years were included in the study. These patients were evaluated for the presence of congenital anomalies of kidney and urinary tract (CAKUT). Age, sex, any urinary anomaly detected with ultrasonography and scintigraphy were noted. English literature was also reviewed the studies reporting the association of spina bifida and CAKUT. Results: Of all patients, 17 had renal rotational anomaly and 13 had horse-shoe kidney. Nine patients had renal agenesis. Three patients had cross-renal ectopia, while one patient had ureterocele and another patient had ureteropelvic junction obstruction. The total number of patients with congenital renal anomalies associating with spina bifida was found to be 44 with a prevalence of 4.23% in this cohort. Conclusion: This cohort seems to have the largest patient population reported in a single center on this subject. The prevalence of CAKUT is increased in patients with spina bifida compared to general population. The cause of this increase may be the close embryological background of two systems. Awareness of such a clinical entity may promote the renal protective approach in patients with spina bifida.

Introduction: Children with spina bifida (SB) experience a reduced quality of life due to neurogenic bladder dysfunction and the risk of renal failure later in life. Pelvic floor rehabilitation (PFR) and transcutaneous electrical nerve stimulation (TENS) have gained prominence in recent years due to their positive effects in treating different types of bladder issues in both adults and children. Our study aims to investigate the effects of using these two methods together in children with SB and to delineate their potential value for clinical practice.Materials and Methods: Children with neurogenic bladder dysfunction due to SB who admitted to our spina bifida center were enrolled. Those patients, between 5 and 15 years of age, with only neurogenic detrusor overactivity (NDO) were randomly divided into two groups using an online computer application. While only the PFR was applied to Group PFR (n = 14), TENS was used in addition to this therapy in Group PFR + T (n = 14). The PFR sessions included abdominal massage, strength exercises, diaphragmatic breathing exercises, and contracting pelvic floor muscles. TENS was used in a standard fashion as previously described in patients with SB. Before and after treatment, patients' clinical data, dysfunctional voiding symptom score (DVSS), lower urinary tract symptoms, and quality of life scores due to urinary incontinence were evaluated. Urodynamic outcomes such as detrusor pressure, bladder capacity, contractility, and residual urine amount were also evaluated.Results: Twenty eight children out of 750 SB patients were enrolled in our center. Children with only NDO due to SB were included in the study (Group PFR, mean age 8.3 ± + 2.7 years, 10 boys, four girls; Group PFR + T, 7.86 ± 2.03 years, eight boys, six girls). Treatment duration was 6 weeks (18 sessions). There was a decrease in voiding and lower urinary tract symptoms in both groups regardless of the use of TENS (p < 0.05). Maximum detrusor pressure significantly decreased only in the TENS group after treatment (from 82.143 ± 58.069 cmH2O to 58.077 ± 39.872 cmH2O) (p < 0.05). The difference in clinical parameters, quality of life scores and other urodynamic parameters were not found to be significant between groups.Discussion: PFR and TENS may be effective in SB with NDO to reduce voiding symptoms, and protect bladder from increased pressures. PFR seems to be a useful conservative approach in patients with NDO, adjunt to standard treatment. Further studies are needed in delineation of a personalized holistic treatment approach in these patients.Conclusion: Addition of TENS to standard PFR in NDO may be effective in reducing maximum detrusor pressures, however, it does not seem to specifically contribute for improving incontinence and incontinence‐related quality of life.

Background: Spina bifida’s prevalence and incidence vary across geographical regions with sociodemographic characteristics and socioeconomic status of the populations having a significate influence over its epidemiology. This study aimed to outline the socioeconomic profile of families with spina bifida children, based on sociodemographic characteristics. Methods: Between August and December 2022, 86 surveys completed by parents of children that underwent spina bifida repair in our institution were included in this analysis. The first part of the survey included questions based on sociodemographic characteristics. The second part of the survey was based on care provided by the families, regular follow-ups, participation in rehabilitation programs, and type of burdens perceived by the caregivers. Results: A close look at the highest level of parent education showed that more than half of them were only middle school graduates. Occupational status in the perioconceptional period revealed that 77% of mothers were housewives/unemployed. 23% had a history of induced or spontaneous abortion. A high number of consanguine marriages were registered with 58% of the subjects being biologically related. 53% of the spina bifida children came from families with low household income. Only 15% of the spina bifida children had access to physiotherapy and 18% to rehabilitation programs. Conclusions: Children with spinal dysraphism were more likely to come from families resulted from consanguineous marriages, with at least two children, low level of parent education and household income. Emotional and financial burden perceived by caregivers should be addressed in order to diminish the numerous challenges that this group of families encounter.

Background: Chronic constipation is a common symptom of myelomeningoceles. TENS has been proven to be effective in treating constipation in different populations and parameters. Physiotherapy is a relatively recent treatment for constipation and has not been extensively studied in pediatrics and spina bifida. This study aimed to examine the role of TENS in myelomeningocele and to increase the number of studies on physiotherapy for pediatric constipation. Aims: To determine a new treatment approach that can be applied in chronic constipation in children with spina bifida using physical therapy techniques. Study Design: Randomized Controlled Trial Methods: Constipation symptoms, stool pattern, bladder and bowel dysfunction, muscle strength involved in defecation, pressure pain thresholds (ppt) in these muscles, severity of fecal incontinence, and quality of life were assessed prior to treatment. Physical Therapy (PT) group received manual physical therapy techniques and dietary therapy for six weeks while the Physical Therapy and TENS (PT+T) group also received TENS. The post-treatment evaluations were repeated. Results: A total of 28 children, 14 in each group, were included in the treatment plan. The stool form in both groups of children was constipated. There was a significant difference in stool pattern only PT+T group (p<0.05). Myofascial trigger points (MTrPs) were significantly reduced in both groups (p<0.05). Ppt and muscle strength increased significantly in PT group (p<0.05). Severity of fecal incontinence, constipation symptoms, and bladder-bowel dysfunction decreased significantly in both groups, but satisfaction with treatment increased (p<0.05). Only PT group had a statistically significant improvement in quality of life (p<0.05). Conclusions: TENS and physical therapy are safe and effective approaches that can be executed in clinical practice to reduce the symptoms of chronic constipation in myelomeningoceles.

Introduction: Tibial somatosensory evoked potentials (SEP) are used to identify the neurological status and tethered cord (TC) in patients with spina bifida (SB). Its significance in contributing to the interpretation of urodynamics to determine bladder status is unknown. This study aimed to determine the correlation between SEP and urodynamics in children with SB.Material and Methods: SEP and urodynamic results, for differential diagnosis of TC, were evaluated. SEP scores were correlated with urodynamic findings. SEP results were scored from 1 to 6, with 1, denoting a favorable score and 6, an unfavorable score. Age, gender, detrusor, and sphincter activities in urodynamics were noted. Results were analyzed using the χ² test and logistic regression analysis. Receiver operating characteristic (ROC) curve was formed to get a valid threshold for the SEP score to predict the urodynamic condition.Results: There were 44 SB patients for whom SEP was done for differential diagnosis of TC. Fifteen patients who did not meet the inclusion criteria were excluded from the study. SB aperta was present in 17 patients and occulta in 12, respectively. The patients had a mean age of 6.6 ± 3.2 years. There were 13 boys and 16 girls. A strong correlation was found between high SEP scores and detrusor sphincter dyssynergia (p < 0.001). A SEP score over 3.5 was found to be 93% sensitive and 73% specific to predict this correlation. There was no relationship between detrusor activity and SEP scores (p = 0.18).Discussion: Tibial SEP is an important noninvasive adjunct tool for the diagnosis of TC in patients with SB. Urodynamic studies are the gold standard in the evaluation of bladder status in neurogenic bladder dysfunction due to SB. Detrusor sphincter dyssynergia may be regarded as a sign of severe spinal cord injury in these patients.Conclusion: Our findings suggest that in children with neurogenic bladder, high SEP scores may predict the presence of detrusor sphincter dyssynergia but not the status of detrusor function while providing pathophysiological evidence for neural injury.

Gastrointestinal duplications are rare congenital anomalies. Herein, we present a single institutional experience in pediatric gastrointestinal tract duplications. Patient records from 2014 to 2019 were retrospectively evaluated for demographic data, clinical presentation, diagnostic methods, surgical findings, and pathological reports. This study included 19 patients, of whom 10 were males and nine were females, with a median age of 30 (21 days-15.5 years) months. Three patients were antenatally and three were incidentally diagnosed. Abdominal pain, vomiting, constipation, and perianal accessory orifice were the most common presenting symptoms. Preoperative diagnostic workup included ultrasonography (n=13), cross-sectional imaging (n=8), and nuclear scintigraphy (n=1). A preoperative diagnosis was possible in 14 (74%) patients. The duplications originated from the foregut in seven (37%) patients, midgut in seven (37%), and hindgut in five (26%). Cystic duplications were observed in 14 (74%) patients and tubular in five (26%). The total surgical excision with (n=8) or without (n=10) associated organ resection was possible in 18 patients. Partial cyst excision with a complete mucosal removal was done in 1 patient. Heterotopic mucosa was present in six (32%) specimens. The respiratory origin with thyroid transcription factor-1 positivity was contained in two para-esophageal duplications. Among five patients with heterotopic gastric mucosa, 1 had presented with perforation and the others with hemorrhage. Duplications may involve any gastrointestinal segment. The clinical presentation is highly variable because of the wide variation in the involved segment and sizes and the possibility of bearing heterotopic mucosa. The surgery aims to totally excise the cyst or at least totally remove the inner mucosal lining.