Purpose: The most important point in cases of ureteropelvic junction obstruction (UPJO) is to decide on the need and timing of surgical treatment. Renal damage may become irreversible as the duration of the obstruction is prolonged. Worsening of hydronephrosis and a decrease in renal parenchymal thickness after pyeloplasty may herald irreversible renal damage. It is important to know at what age this damage begins. In this study, we aimed to determine the relationship between the age of the patients at the time of pyeloplasty performed for UPJO and parenchymal recovery.Materials and Methods: In our study, 156 patients (mean age: 43.5 months) who underwent pyeloplasty with the diagnosis of UPJO between 2007 and 2019 were evaluated retrospectively. Demographic characteristics, ultrasonographic (USG) and nuclear renal scintigraphy findings, and previous surgeries of the patients were recorded.Results: Numerical variables were evaluated statistically, and the best cut-off point was determined. Parenchymal thickening was determined as the most important criterion in postoperative renal recovery which was more evident at early ages. Based on statistical assessments, the cut-off age for renal parenchymal recovery was determined as 38 months. While parenchymal recovery was inadequate after pyeloplasty performed in patients older than 38 months, the most significant improvement in renal functions was seen in children younger than 13 months of age.Conclusion: Pyeloplasty should be performed in patients with UPJO before the development of severe renal damage. Statistically, the best parameter to evaluate the recovery after pyeloplasty is the change in parenchymal thickness. With advancing age, it is impossible to reverse the obstructive nephropathy.

Background and Objectives: Penile tissue loss, which can be an acquired condition due to trauma or infection, but is also seen in congenital anomalies, is a rare condition in children. A standard surgical approach is often not possible due to the different degrees and etiologies of penile tissue loss. The continuing growth and the presence of various congenital anomalies in children require a different penile reconstruction approach than in adults. We aimed to share our experience and surgical results with children in whom we performed penile reconstruction with different techniques due to penile tissue loss. Materials and Methods: Ten cases that underwent penile reconstruction between 2018 and 2023 were evaluated retrospectively. Age at initial operation, associated anomalies, surgical technique, and other related surgical attempts, as well as functional and cosmetic results, were recorded. Results: Ten boys aged between 6 months and 17 years underwent phalloplasty due to penile tissue absence. In six cases, penile tissue loss was due to acquired causes, and in four cases, congenital anomalies were the reason. The most common cause of penile tissue loss was circumcision complications. In four cases, penile reconstruction was achieved by mobilization of the remaining corpus cavernosum tissues, in two cases, the cavernous tissue was adequate and repaired with glansplasty and penile skin graft. Phalloplasty was performed by tubularization of a skin and subcutaneous fat flap, removed from the pubic region and scrotal region, in two cases. A microvascular radial forearm flap was performed in a 17-year-old patient with penile tissue loss because of trauma, and a free skin flap taken from the forearm was used for penile reconstruction. Thirty percent of patients required a second surgery. Urinary continence was present in eight of the cases. Although four cases were classified as cosmetically unsatisfactory in our evaluation, all patients and their families reported being satisfied with the cosmetic results. Conclusions: Penile reconstruction for penile tissue loss in children should be performed in clinics where different scenarios can be applied. With maximum preservation and mobilization of existing cavernous tissues, temporary penile reconstruction with local flaps should be performed in young children at an early stage to minimize the psychological effects of penile absence. Although an esthetically perfect result cannot be guaranteed, patients and families are generally satisfied with the outcome.

Background: In children with neurogenic bladder, urine cultures and uropathogen patterns often guide treatment decisions. Whether these patterns add to renal risk beyond established anatomical and urodynamic factors is unclear. Patients: Retrospective cohort of 151 children with neurogenic bladder followed between November 2023 and March 2025. Contaminated urine cultures were excluded from primary multivariable analyses. Method: Uropathogen category (E. coli, Proteus spp., other Gram-negative organisms) was modelled together with high-grade vesicoureteral reflux, ultrasonographic megaureter, bladder wall thickness, and maximum filling detrusor pressure (Pdet). Renal injury was defined as advanced DMSA scarring (score ≥3) and reduced function (eGFR <90 mL/min/1.73 m²). Multivariable logistic regression was used. Results: Megaureter independently predicted advanced scarring (OR 5.86; 95% CI 1.73–19.87; p=0.005). Higher Pdet was independently associated with reduced eGFR (OR 1.41 per 10 mmHg; 95% CI 1.10–1.82; p=0.007). Uropathogen category was not independently associated with renal injury. Discussion: In pediatric neurogenic bladder, renal vulnerability is driven mainly by pressure and by upper tract anatomy rather than by uropathogen identity. Conclusion: The findings suggest that pressure-related factors may contribute more strongly to renal injury than the isolated pathogen itself. Long-term renal protection should prioritize storage pressure control and upper tract drainage. Zusammenfassung Hintergrund: Bei Kindern mit neurogener Blase steuern Urinkulturen und Uropathogenmuster häufig klinische Entscheidungen. Ob diese Muster über anatomische und urodynamische Faktoren hinaus zur Nierenschädigung beitragen, ist unklar. Patienten: Retrospektive Kohorte von 151 Kindern mit neurogener Blase, nachbeobachtet zwischen November 2023 und März 2025. Kontaminierte Urinkulturen wurden aus den primären multivariablen Analysen ausgeschlossen. Methode: Die Uropathogenkategorie (E. coli, Proteus spp., andere gramnegative Erreger) wurde gemeinsam mit hochgradigem vesikoureteralem Reflux, sonographischem Megaureter, Blasenwanddicke und maximalem Füllungsdetrusordruck (Pdet) modelliert. Nierenschädigung war definiert als fortgeschrittene DMSA-Narben (Score ≥3) und reduzierte Funktion (eGFR <90 mL/min/1,73 m²). Es wurde eine multivariable logistische Regression durchgeführt. Ergebnisse: Megaureter war ein unabhängiger Prädiktor fortgeschrittener Narben (OR 5,86; 95%-KI 1,73–19,87; p=0,005). Ein höherer Pdet war unabhängig mit reduzierter eGFR assoziiert (OR 1,41 pro 10 mmHg; 95%-KI 1,10–1,82; p=0,007). Die Uropathogenkategorie zeigte keine unabhängige Assoziation. Diskussion: Die Nierenvulnerabilität wird überwiegend durch druck- und oberen-Trakt-bezogene Faktoren bestimmt, nicht durch den Erregertyp. Schlussfolgerung: Die Befunde legen nahe, dass druckbezogene Faktoren stärker zur Nierenschädigung beitragen können als der isolierte Erreger selbst. Der langfristige Nierenschutz sollte sich auf Speicherdruckkontrolle und obere Trakt-Drainage konzentrieren.

Background: Desmopressin is an important treatment option for monosymptomatic nocturnal enuresis (MEN), yet relapse after discontinuation remains a major problem. This study aimed to compare the outcomes of different desmopressin formulations (orally fast-dissolving lyophilized vs. sublingual tablet) used in MEN treatment and to examine the recurrence rates of gradual versus sudden discontinuation. Methods: Patients who received desmopressin treatment with a diagnosis of MEN from a single center (Dec 2022–Aug 2023) were retrospectively analyzed. Desmopressin treatment (136 in fast-dissolving lyophilized form, 98 in sublingual tablet) was started in 234 patients (75 girls, 159 boys) (mean age 9.26 years) (preschooler 72, preadolescent 135, adolescence 27), was given for an average of 3.1 months, and was terminated (suddenly 204, gradually 30 patients). Afterwards, the patients were evaluated with follow-up visits in the first and third months, and statistical analyses were performed. Results: There were no significant differences in relapse rates among patients with different drug formulations or discontinuation methods. However, preschool children (5-7 years of age) had significantly lower relapse rates than older age groups (P = .004 and P = .018). No dose-related differences in relapse were found. Conclusion: Age was the main determinant of relapse, with preschool children exhibiting better sustained responses. Drug formulation and discontinuation method did not significantly affect relapse. The fast-dissolving form may improve treatment adherence due to ease of administration. Cite this article as: Yayla D. What affects relapse after desmopressin treatment in monosymptomatic nocturnal enuresis?. Turk J Nephrol. Published online February 23, 2026. doi: 10.5152/turkjnephrol.2026.251127.