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.

Ventral curvature (VC), and penile straightening is a key step in severe proximal hypospadias surgery. One of the most important variables in selecting the appropriate technique for primary severe hypospadias repair seems to be the urethral plate transection to achieve penile straightening. In some cases, cutting the urethral plate is not sufficient and VC is corrected with ventral corporotomies. In the presented study, it was aimed to evaluate the early results of patients who underwent urethral plate transsection (UPT). Thirty-two cases with severe proximal hypospadias who underwent chordee correction by transsection of the urethral plate between 2019 and 2022 years were evaluated retrospectively. The patients’ ages varied between 8 months and 16 years, with a mean age of 4.61 ± 4.10 years. Ventral curvature was below 90 degrees in 6 patients and above 90 degrees in 26 patients. Penile curvature was corrected by plate transection in 9 children (28.2%) and plate transection combined with ventral corporotomies in 23 children (71.8%). Bracka operation was performed on 8 cases, Duckett operation on 1 case, STAG operation on 8 cases, and STAC operation on 15 cases. We noted recurrence of curvature in 7 children (Bracka 3, STAG 2, STAC 2) which required dorsal plication during the urethroplasty. Second/third stage was completed in all children. Success, hematoma, fistula, meatal stricture, glanuler dehisence, graft stricture rates determined to be 53.2%, 6.25%, 12.5%, 12.5%, 6.25% and 9.37% respectively. Staged procedures give the oppurtunity to correct the residuel or recurrence curvature before urethroplasty. Follow up is important to address long term functional results of ventral corporotomies.

Amaç: Israrcı hava kaçakları, göğüs tüpü çekilmesini geciktiren ve uzun süreli hastanede yatışa neden olan sık komplikasyonlardan biridir. Literatürde uzun süreli hava kaçakları (UHK) için otolog kan yaması plörodezisi (OKYP) yapılması hakkında sınırlı ancak olumlu deneyimler mevcuttur. Çocuklarda etkinliği ve güvenilirliği konusunda OKYP’nin UHK için uygulanması konusunda deneyimlerimizi paylaşmayı amaçladık. Gereç ve Yöntemler: UHK’li 18 yaş altı hastalarda geriye dönük tek merkezli bir çalışma yapılmıştır. UHK, 5 günden uzun süren alveolar-plevral fistüllerin varlığı olarak tanımlandı. Geçirilmiş göğüs cerrahisi, göğüs travması ve UHK ‘nin spontan pnömotoraksı gibi etiyolojik nedenleri dahil edildi. Çalışmaya 1 Ocak 2016’dan 1 Aralık 2021’e kadar olan hastalar dahil edildi. Otolog kan yaması plöredezi (OKYP) önceden var olan bir göğüs tüpü aracılığıyla gerçekleştirildi. 1. günde periferik venden alınan 1-2 cc/kg taze tam kan mevcut göğüs tüpünden verildi. Hava kaçağının devam etme durumunda işlem 2. ve 4. günlerde tekrarlandı. Kaçak devam etse de maksimum üç uygulama hedeflendi. Takip süresi boyunca işlem ilişkili komplikasyonlar değerlendirildi. Tam başarı, hava kaçaklarının giderilmesi olarak kabul edildi. Bulgular: Erkek çocukların daha sık olduğu toplam 11 hasta değerlendirildi (n=7, %63.9). UHK için OKYP uygulanan çocukların yaş ortalaması 13.4±2.1 yıldı (IQR 10-17). Ortalama tekrarlanan prosedür sayısı, 1 ila 3 uygulama arasında değişmekle beraber 1.8 saptandı. Çalışma grubumuzda en sık etiyolojik nedeni spontan pnömotoraksa ikincil yapılan torasik girişimlerdi. Altı olguda ilk uygulamadan sonra (%54.5) tam iyileşme mümkün oldu ve tüm olgularda OKYP prosedürleri tekrarlandıktan sonra UHK düzeldi (%100 iyileşme). OKYP’e bağlı herhangi bir komplikasyon saptanmadı. Sonuç: Çocuklarda PAL için alternatif tedavi seçeneği olan otolog kan yaması plörodezis (ABPP) ile ilgili deneyimlerimizi paylaşmak istiyoruz. ABPP, etkinliği yüksek, komplikasyonlardan uzak, kolay uygulanabilir bir tedavi olup, serimizin tüm hastalarında PAL için ABPP kullanımı başarılı olmuştur.

With the developments in endourology in the last 30 years, the indication for open stone surgery in the urinary system has gradually decreased. In this study, it was aimed to evaluate the cases and the indications who underwent open stone surgery by examining the cases that were operated for urinary system stones in the first four-year learning period (2009-2012) and the following five-year period (2013-2018). Open surgery was required in 25 cases due to renal stones (17.24%) at learning period. In the second period 217 cases were operated due to renal stones, while 4 cases (1.84%). Also open surgery was performed in a total of six cases due to stone-related complications or complications related to endoscopic procedures. In almost all of our patients who underwent endoscopic stone treatment, stone-free was achieved with repeated procedures. More than one anesthesia was required in all patients In the second period of endourological experience, open surgical procedures were performed only because of the complications of endourological procedures. Stone-free status can be achieved even in infants by applying more than one session of endourological interventions. If necessary, staged interventions can be planned and urinary system stone treatment can be provided in children without open surgery.