Wos İndeksli Yayınlar Koleksiyonu
Permanent URI for this collectionhttps://hdl.handle.net/11727/4807
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Item Ability of ESWL nomograms to predict stone-free rate in children(2021) Ceyhan, Erman; Ozer, Cevahir; Ozturk, Bulent; Tekin, Mehmet Ilteris; Aygun, Yuksel Cem; 0000-0001-8223-6399; 0000-0002-6232-4313; 0000-0002-7850-6912; 33867289; ABI-2513-2020; AAM-3015-2021; AAM-2222-2020Introduction We aimed to evaluate whether the pediatric extracorporeal shock wave lithotripsy (ESWL) nomograms can predict stone-free status in children effectively and whether they are applicable to our series. We hypothesize that two current nomograms predicting successful treatment with ESWL in pediatric patients are valid. Study design We evaluated 415 renal units (children <18 years) with eligible data who received ESWL treatment for upper urinary tract stones. Children's age, gender, stone size, stone surface area, stone location and history of previous intervention were recorded. Children with no residual fragments after ESWL treatment were designated as stone-free. The nomograms described by Dogan and Onal were implemented to our series for the prediction of stone-free status. Results Mean age of children was 64.7 +/- 57.2 months. Male to female ratio was 219:196.78.8% (327) of children had single stone. Mean stone size was 10.0 +/- 3.7 mm and mean stone surface area was 380.0 +/- 72.2 mm(2). Our stone-free rate after single ESWL session was 52.5% (218/415). Mean residual stone size and stone surface area after single session was 6.4 +/- 3.3 mm and 36.0 +/- 44.2 mm(2) respectively. There were no significant difference between stone-free children and children with residual fragments regarding gender, age and history of previous intervention. Mean stone size and stone surface area in stone-free children were lower and lower pole stones had the lowest stone-free rate (p < 0.05). Area under curve for Dogan and Onal nomogram were 0.628 and 0.580 respectively in ROC analysis (0.05). The agreement between Dogan and Onal score was moderate in our series. In multivariate analysis only stone surface area and Dogan score found to be independent predictors of stone-free status (p < 0.05). Discussion Only one study has assessed both nomograms in the literature. Both nomograms are reported to be independent predictors of stone free status. ROC analysis in our study revealed fair accuracy for both nomograms with higher area under curve for Dogan nomogram. Higher accuracy for both nomograms were reported by other authors. These nomograms offer practical data but more effective tools are needed to be developed for the prediction of stone-free status in pediatric ESWL. Conclusions Stone size and stone surface area are associated with stone clearance. Dogan and Onal nomograms can be useful in prediction of stone-free status in children. Dogan nomogram is superior to Onal nomogram. [GRAPHICS]Item Our experience on management of failed pediatric pyeloplasty(2020) Ceyhan, Erman; Dogan, Hasan Serkan; Tekgul, Serdar; 0000-0001-8223-6399; 32542506; ABI-2513-2020Purpose The purpose of the study was to assess the outcomes of salvage procedures after failed pediatric pyeloplasty. Recurrent ureteropelvic junction obstruction treatment is a difficult course. The salvage surgery is more challenging in the pediatric population. We aimed to assess the outcomes of salvage procedures after failed pediatric pyeloplasty to determine the most efficient surgical intervention. Methods 40 children with 41 renal units who have been treated for recurrent ureteropelvic junction obstruction after pyeloplasty were analyzed retrospectively. The outcomes of all initial and sequent interventions were assessed including redo pyeloplasty, endopyelotomy and balloon dilatation. Results Children's mean age at initial intervention for failed pyeloplasty was 45.9 (+/- 46.4) months. Our mean follow-up time after the initial intervention was 46.9 (+/- 46.6) months. The success rate of our initial treatment methods was 48.7% (20/41). Although redo pyeloplasty was the most successful intervention (83.3%) than DJS placement (45.5%), endopyelotomy (50%) and balloon dilatation (30.8%), the statistical difference was not significant in the initial operations. The overall success rates of redo pyeloplasty, double-J stent placement, endopyelotomy and balloon dilatation were 78.9%, 46.1%, 38.8% and 29.4%, respectively (p < 0.05). Conclusions Redo pyeloplasty provides the best improvement in recurrent ureteropelvic junction obstruction in children. In selected patients, minimal invasive methods such as endopyelotomy and balloon dilatation offer alternative treatment.