Ömer Barış Yücel

The use of the vermiform appendix as a replacement for ureteral segments has been rarely reported, particularly in children, and even more rarely in the left ureteral stenosis. Herein, a case where the appendix was successfully used to bridge a left mid-ureteral iatrogenic stricture in a child was presented. A two-year-old male with a history of ureteric stone and laser lithotripsy at six months of age presented with ongoing hydroureteronephrosis and recurrent urinary tract infections despite prophylactic antibiotics. Hydroureteronephrosis arose two months after the surgery and progressed slowly. Retrograde pyelogram revealed a stenosis in the left mid-ureter 4 cm above the iliac cross. The mesoappendix allowed the appendix to be used for interposition on the left ureter. The patient was followed with a JJ stent for two months. Ureterorenoscopy during JJ removal showed no stricture. Three years after the surgery, imaging showed improved hydronephrosis, stable function, and no obstructive findings on the nuclear renal scan. Children undergoing stone surgery should be monitored for potential complications, including strictures. Appendiceal interposition should be considered a viable treatment option for ureteric injuries, even for the left ureter.

Objectives: In this study, we aimed to assess the perspective of the patients and the parents regarding their satisfaction with the televisits in our center. Patients and methods: Between November 2019 and December 2021, a total of 247 participants (155 males, 92 girls, median age 76.9 months; range, 4.9 to 518.6 months) who met the inclusion criteria were analyzed. A questionnaire which was prepared to evaluate parents' satisfaction with telemedicine, was sent to parents of the children who were evaluated with televisits. Results: There was no statistically significant difference between the groups in terms of the satisfaction and simplicity scores according to the diagnosis (p=0.099 and p=0.243, respectively). Also, 77% of parents in our study found televisits similar to face-to-face (in-person) visits. Conclusion: Our study results show that patient satisfaction with televisit is high in terms of ease of use, shortened travel time and reduced cost. In addition, televisit provides parents with a positive opportunity to take time off from work. The majority of our participants reported that they desired to continue televisit after the end of the pandemic.

Bu vaka sunumunda, antenatal 32. haftada sol böbrekte saptanan grade 2 hidroüreteronefroz ve 10 mm üreter çapı nedeniyle yönlendirilen 12 günlük bir kız bebek ele alınmaktadır. Yapılan değerlendirmeler sonucunda hastaya, retrovezikal üreter çapının 7 mm'den büyük olması kriterine dayanarak megaüreter tanısı konmuştur. İlk ayında yapılan kontrol ultrasonografisinde bulgularının stabil kalması ve işeme sistoüretrografisinde vezikoüreteral reflü (VUR) saptanmaması üzerine, olası bir tıkanıklığın belirlenmesi amacıyla MAG-3 renal sintigrafi planlanmıştır. Sintigrafide sol böbrekte fonksiyon kaybı görülmemiş (%50-%50 separe fonksiyon) ancak diüretiğe yanıt vermeyen bir boşalma paterni saptanarak üreterovezikal bileşke obstrüksiyonu (primer obstrüktif megaüreter - POM) tanısı doğrulanmıştır. Antibiyotik profilaksisi altında izlenen hasta, 4 aylıkken ateşli idrar yolu enfeksiyonu (piyonefrit) ve üreter çapının 20 mm'ye yükselmesi tablosuyla başvurmuştur. Akut enfeksiyon tedavisi sonrası, üretere sistoskopi eşliğinde JJ stent yerleştirilmesi denense de kateterizasyon başarısız olmuştur. Bunun üzerine, böbrek fonksiyonlarını korumak ve hızlı dekompresyon sağlamak amacıyla geçici diversiyon yöntemi olarak üreterokutanostomi uygulanmıştır. Takibinde enfeksiyon geçirmeyen ve 13. ayda üreter dilatasyonu gerileyen hastaya, altın standart tedavi olan Cohen antireflüksif üreteroneosistostomi (UNS) operasyonu başarıyla gerçekleştirilmiş ve üreter çapı küçüldüğü için ek bir daraltma işlemine gerek kalmamıştır. This case report presents a 12-day-old female infant referred due to grade 2 hydroureteronephrosis and a 10 mm ureteric diameter detected in the left kidney at the 32nd gestational week antenatally. Following the evaluations, the patient was diagnosed with megaureter based on the criterion of a retrovesical ureteric diameter larger than 7 mm. Since the findings remained stable on the control ultrasonography performed in her first month and voiding cystourethrography revealed no vesicoureteral reflux (VUR), a MAG-3 renal scintigraphy was planned to determine a potential obstruction. The scintigraphy demonstrated no loss of function in the left kidney (50%-50% differential function) but revealed an drainage pattern non-responsive to diuretics, confirming the diagnosis of ureterovesical junction obstruction (primary obstructive megaureter - POM). While followed under antibiotic prophylaxis, the patient presented at 4 months of age with a febrile urinary tract infection (pyelonephritis) and an increased ureteric diameter of 20 mm. Although cystoscopy-guided JJ stent placement was attempted after acute infection treatment, catheterization failed. Consequently, cutaneous ureterostomy was performed as a temporary diversion method to preserve renal function and provide rapid decompression. The patient remained infection-free during follow-up, and at 13 months, as her ureteric dilatation regressed, she successfully underwent Cohen antireflux ureteroneocystostomy (UNS), the gold standard surgical treatment, without requiring any tapering procedure since the ureteric diameter was suitable.

Bu vaka sunumunda, yenidoğan döneminde perineal fistüllü anorektal malformasyon (ARM) tanısı ile kolostomi açılıp sonradan kapatılan ve üç yıl önce gergin omurilik ameliyatı geçiren sekiz yaşındaki bir kız hastanın, ateşli idrar yolu enfeksiyonu (İYE) ve son dönemde başlayan idrar kaçırma şikayetleriyle başvurusu ele alınmaktadır. Hastaya yapılan tetkiklerde sol evre 1 hidronefroz ile sağ evre 1 ve sol evre 2-3 vezikoüreteral reflü (VUR) saptanmıştır. ARM, rektumun anal açıklık yerine perineuma veya ürogenital sisteme bir fistülle açılmasıyla karakterize konjenital anomalilerdir. Hastaların %20-54’ünde konjenital ürogenital anomaliler, %25’inde ise nörovezikal disfonksiyon gibi ciddi ürolojik problemler eşlik eder. Bu nedenle, ARM saptanan tüm hastaların doğumda ultrasonografi (USG) ile taranması; İYE veya kaçırma durumunda ise sistoüretrografi (İSUG), sintigrafi ve ürodinami gibi yöntemlerle detaylıca incelenmesi gerekmektedir. Sunulan hastada yapılan ürodinami sonrası mesane disfonksiyonu için antikolinerjik tedavisi ve kabızlık tedavisi başlanmış, takibinde reflünün gerilediği görülerek antibiyotik profilaksisi kesilmiştir. Bu olgu, ARM hastalarında gelişebilecek böbrek hasarı ve son dönem böbrek yetmezliği riskini en aza indirmek için multidisipliner takip ve erken müdahalenin önemini gözler önüne sermektedir. This case presentation discusses the admission of an eight-year-old female patient—who underwent colostomy due to an anorectal malformation (ARM) with a perineal fistula in the newborn period that was subsequently closed, and who had tethered cord surgery three years ago—with complaints of febrile urinary tract infection (UTI) and recent urinary incontinence. Evaluation revealed left grade 1 hydronephrosis along with right grade 1 and left grade 2-3 vesicoureteral reflux (VUR). ARM is a group of congenital anomalies characterized by the rectum opening into the perineum or urogenital system via a fistula instead of a normal anal opening. Serious urological problems, such as congenital urogenital anomalies in 20-54% of patients and neurovesical dysfunction in 25%, often accompany this condition. Therefore, all patients diagnosed with ARM must be screened with ultrasonography (USG) at birth, and those with UTIs or incontinence should be evaluated in detail using methods like voiding cystourethrography (VCUG), scintigraphy, and urodynamics. In the presented patient, anticholinergic therapy for bladder dysfunction and treatment for constipation were initiated after urodynamics, and antibiotic prophylaxis was discontinued upon observing the resolution of reflux during follow-up. This case highlights the vital importance of multidisciplinary follow-up and early intervention to minimize the risk of renal damage and end-stage renal disease in patients with ARM.