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YÜCEL, SELÇUK

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Subject: CLINICAL MEDICINE ×

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    PublicationOpen Access
    Consistency of uroflowmetry analysis in children among observers
    (2023-01-01) ŞEKERCİ, ÇAĞRI AKIN; TANIDIR, YILÖREN; TARCAN, TUFAN; YÜCEL, SELÇUK; ŞEKERCİ Ç. A., TANIDIR Y., TARCAN T., YÜCEL S.
    © 2023 Wiley Periodicals LLC.Aim: The aim of the study is to compare the intra- and inter-observer interpretations of the same uroflowmetry study at two different times. Materials and Methods: Two-hundred children with a voided volume of 50% above the expected bladder capacity were included. All traces were asked to be evaluated by 11 observers two times in a time span of 1 month. These observers consist of pediatric urologists (n = 2), pediatric urology fellows (n = 2), urology residents (n = 5), and certified urodynamics nurses (n = 2). Each uroflowmetry was asked to be assessed for three domains: voided volume (VV), detrusor sphincter dyssynergia (DSD), and flow curve pattern (FCP). Results: Of the 200 patients with a median age of 10 (4–18) years, 128 (64%) were girls and 72 (36%) boys. The maximum flow rate and the median voided volume were found to be 20 (4–61) mL/s and 232 (116–781) mL. The Fleiss\" kappa coefficient of VV, DSD, and FCP in the first assessment was 0.510, 0.501, and 0.346. In the second assessment, κ values were 0.530, 0.422, and 0.373. The best-agreed findings were similar at both times. These were found to be low VV (0.602 and 0.626) and intermittent pattern (0.500 and 0.553). Interpreters were found to have a statistically significant difference in agreement with their own interpretation at different times. Conclusion: Both inter- and intra-observer reliability of the agreement point out the problem in the standardization of uroflowmetry. Inter- and intra-observer reliability of uroflowmetry interpretation can be increased by defining precise numbers and numerical algorithms.
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    The comparison of anxiety levels in children who underwent invasive or non-invasive urodynamic studies
    (2022-05-13) ŞEKERCİ, ÇAĞRI AKIN; TARCAN, TUFAN; YÜCEL, SELÇUK; TANIDIR, YILÖREN; Sekerci C. A., Can Ozkan O., Tanidir Y., Tarcan T., Yucel S.
    INTRODUCTION AND OBJECTIVE: Urodynamic studies play an important role in the evaluation of children with lower urinary tract dysfunction. In this study, we aimed to examine the effects of invasive and non-invasive urodynamic studies on the anxiety levels of children with the help of an anxiety scale. METHODS: Children aged 8-17 years who were scheduled for uroflowmetry (UF) or filling cystometry (FC) and who agreed to fill out an anxiety scale were included in the study. It was the first UF or FC of all children. “The Screen for Child Anxiety Related Disorders (SCARED)” form consisting of 41 questions was used in the evaluation. All children included in the study filled the form themselves. The SCARED results of children who underwent UF and FC were compared. RESULTS: A total of 56 children with a mean age of 10.85þ/- 2.98 years were included in the study. 31 (55.4%) of the children were females and 25 (44.6%) were males. The number of children who had UF was 26 (46.4%; 8.5 (8-14) years), and 30 (53.6%; 11.5 (8-17) years) had FC. The total SCARED scores of the children who underwent UF and FC were 26.5 (5-75) and 27 (2-57), respectively, and there was no statistical difference (p[0.980) (Table 1). A significant difference was found only in "Separation Anxiety Disorder" among sub-score evaluations (p[0.049) (Table 1). In children who underwent filling cystometry, there was no statistical difference in the total SCARED score between those who did and did not do clean intermittent catheterization (28 (3-41); 27 (2-57), respectively) (p[0.860). CONCLUSIONS: The SCARED scores above 25 indicate an anxiety disorder, and interestingly, in this study, both the invasive and noninvasive urodynamic study groups scored over 25. We consider that non-invasive urodynamic tests may cause stress on children as much as invasive ones.
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    Predictive factors of full response to desmopressin treatment in children with primary monosymptomatic enuresis nocturna
    (2023-02-01) ÖZGÜR, GÜNAL; TANIDIR, YILÖREN; TARCAN, TUFAN; YÜCEL, SELÇUK; Ozgur G., Sekerci C. A., TANIDIR Y., Tarcan T., YÜCEL S.
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    PublicationOpen Access
    Diagnosis of Testicular Torsion and Differentiation From Other Pathologies Using Near-Infrared Spectroscopy
    (2023-01-01) ŞEKERCİ, ÇAĞRI AKIN; YÜCEL, SELÇUK; ÇAM, HAYDAR KAMİL; Ali Üncü Y., ŞEKERCİ Ç. A., YÜCEL S., Sircan-Kucuksayan A., ÇAM H. K., Savaş M., Yıldırım A., Ağras K., Baykara M., CANPOLAT M.
    © 2023 Elsevier Inc.Objective: To develop a near-infrared (NIR) spectroscopy device to diagnose testicular torsion with high sensitivity and specificity. Specifically, we aim to investigate the differentiation between testicular torsion from other pathologies such as orchidoepididymitis, varicocele, and hydrocele. Methods: Two LEDs with wavelengths of 660 nm and 940 nm were used as light sources in the device. Each wavelength was sent to the testicle successively, and a photodiode detected back-reflected diffuse light. The ratio of the light intensities of 660 nm and 940 nm was used as a diagnostic parameter. A multi-center clinical trial was performed in 5 different hospitals. Results: In total, 62 patients in urology clinics with acute testicular pain have been recruited for the study. The developed NIR spectroscopy correctly defined all 8 testicular torsion cases. Besides, 3 orchidoepididymitis, 1 varicocele, and 3 hydrocele cases were correctly distinguished from testicular torsion. Only 1 hydrocele case was misdiagnosed as torsion. The range of the ratio was between 0.14 and 1.16 overall measurements. The ratio varied between 0.14 and 0.3 for the testicle with torsion. The ratio was between 0.49 and 1.16 for the normal testicle and testicle with other pathologies mentioned above. Conclusion: We have chosen the threshold ratio of 0.4 to differentiate between the normal and torsion testis and diagnosed all the torsion cases among all normal and other pathologies. The developed optical device to diagnose testicular torsion is inexpensive, user-friendly, and works based on objective criteria with high sensitivity and specificity in real time.
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    PublicationOpen Access
    The association of urinary BDNF, ATP, and MMP-2 with bladder compliance in children with myelodysplasia
    (2023-01-01) ŞEKERCİ, ÇAĞRI AKIN; KÜTÜKOĞLU, MEHMET UMUT; YÜCEL, SELÇUK; TARCAN, TUFAN; ŞEKERCİ Ç. A., KÜTÜKOĞLU M. U., Basok B. I., Fidan M., ÇAM S., YÜCEL S., TARCAN T.
    Aim: The purpose of our study was to evaluate the relationship of urinary brain-derived neurotrophic factor (BDNF), adenosine triphosphate (ATP), matrix metallopreteinase-2 (MMP-2) with urodynamic findings and upper urinary tract deterioration (UUTD) in children with myelodysplasia. Materials and Methods: Children with myelodysplasia evaluated in outpatient clinic between 2022 and 2023 were included. All patients underwent urinary ultrasonography, voiding cystourethrography, urodynamics, and DMSA scintigraphy. Urine samples were collected before urodynamics. Control urine was collected from 10 healthy children. Urinary biomarker values of patients and controls were compared, and subgroup analysis was performed. Results: The median age of 40 children (26 girls) included in the study was 108 (8–216) months, and the control group (six girls) was 120 (60–154) (p = 0.981). Urinary BDNF, MMP-2, and ATP were found to be significantly higher in children with myelodysplasia compared to the control (p = 0.007, p = 0.027, p = 0.014, respectively). The three biomarker values were similar in children with bladder compliance below or above 10 cmH2O/mL (p = 0.750, p = 0.844, p = 0.575). No difference was found in terms of UUTD in all three biomarkers (p = 0.387, p = 0.892, p = 0.705). A negative correlation was found between urinary ATP and compliance (p < 0.05). Conclusion: In this study, all three biomarkers were found to be higher in children with myelodysplasia than in controls. There was a negative correlation between urinary ATP and compliance. Urinary biomarkers may contribute the follow-up of children with neurogenic lower urinary tract deterioration in future with their noninvasive features. However, the lack of standardization and the inability to reliably predict risky groups are important shortcomings of urinary biomarkers.
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    Obstrüktif üropati
    (Güneş Tıp Kitabevi, 2023-11-01) ŞEKERCİ, ÇAĞRI AKIN; YÜCEL, SELÇUK; Şekerci Ç. A., Yücel S.
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    PublicationOpen Access
    Primer monosemptomatik enürezis nokturnası olan çocuklarda desmopressin tedavisine tam yanıtın prediktif faktörleri
    (2023-10-04) ŞEKERCİ, ÇAĞRI AKIN; TARCAN, TUFAN; YÜCEL, SELÇUK; Özgür G., Şekerci Ç. A., Tanıdır Y., Tarcan T., Yücel S.
    AMAÇ: Primer monosemptomatik enürezis nokturna (PMEN), pediatrik ürolojide sık görülen bir problemdir ve medikal tedavide ilk tercih desmopressindir. Bu çalışmada, desmopressine tam yanıt alınan PMEN'li çocuklarda prediktif faktörleri ve desmopressinin idrar elektrolit düzeyleri (sodyum, potasyum ve kalsiyum) üzerindeki etkisini değerlendirmeyi amaçladık. MATERYAL-METOD: Çalışmaya çocuk ürolojisi polikliniğine başvurup PMEN tanısı alan ve desmopressin tedavisi başlanan çocuklar dahil edildi. Gündüz semptomları olan veya sekonder enürezisi bulunan çocuklar çalışmaya alınmadı. Hastalar fizik muayene, idrar tahlili, semptom skoru ve işeme günlüğü ile değerlendirildi. Tüm hastalara 120 mcg desmopressin başlandı. Hastalardan tedavi öncesinde, tedavi sonrası ise 1. ve 3. aylarda elektrolit değerlendirmesi için 24 saatlik idrar toplandı. Üçüncü aydaki semptomlarına göre tedaviye tam yanıt veren grup ve diğer (tedaviye dirençli veya kısmi yanıtlı) grup olarak hastalar ikiye ayrıldı. Hastaların tedavi öncesi ve tedavi sonrası elektrolit değerleri karşılaştırıldı ve tam yanıtlı grupta yanıtı öngörebilecek olası prediktif faktörler değerlendirildi. BULGULAR: Çalışmaya 34 çocuk (23 erkek, 11 kız) dahil edildi. Ortanca yaş 8 (5-15) idi. Tedavi öncesi ve sonrasındaki (1. ve 3. ay) idrar dansitesi, 24 saatlik idrar sodyum, potasyum ve kalsiyum değerleri arasında fark yoktu (p=0,432, 0,822, 0,970, 0,970, sırasıyla). Cinsiyet, bir aydaki ıslak gece sayısı ve bir gecede olan idrar kaçırma sayısı desmopressine tam yanıtı öngören faktörler olarak bulundu (p=0,015, 0,022, p=0,001, sırasıyla) (Tablo 1). Yaşın, aile öyküsünün, işeme günlüğündeki mesane kapasitesi/beklenen mesane kapasitesinin ve tedavi öncesi idrar sodyum seviyesinin tam yanıtı öngörme üzerinde etkisinin olmadığı gösterildi (p=0,230, p=0,547, p=0,763, p=0.060, sırasıyla) (Tablo 1). SONUÇ: PMEN'li çocuklarda erkek cinsiyet olması, bir ayda çok sayıda ıslak gece olması ve bir gecede çoklu idrar kaçırma olması desmopressin tedavisine tam yanıt alınmasında olumsuz faktörler olarak bulundu.
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    Alt üriner sistem disfonksiyonu olan çocuklarda üç günlük işeme günlüğündeki işeme hacimleri ve sıklıkları farklı mıdır
    (2023-10-25) ŞEKERCİ, ÇAĞRI AKIN; YÜCEL, SELÇUK; TARCAN, TUFAN; Ergün R., Şekerci Ç. A., Çetin M., Sahak M. Y., Yücel S., Tarcan T.
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    Predictive factors of full response to desmopressin treatment in children with primary monosymptomatic enuresis nocturna
    (2023-03-10) ŞEKERCİ, ÇAĞRI AKIN; TARCAN, TUFAN; YÜCEL, SELÇUK; Özgür G., Şekerci Ç. A., Tanıdır Y., Tarcan T., Yücel S.
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    The value of urinary BDNF, ATP And MMP-2 in children with myelodysplasia
    (2023-09-27) ŞEKERCİ, ÇAĞRI AKIN; KÜTÜKOĞLU, MEHMET UMUT; YÜCEL, SELÇUK; TARCAN, TUFAN; Şekerci Ç. A., Kütükoğlu M. U., İşbilen Başok B., Fidan M., Yücel S., Tarcan T.
    HYPOTHESIS / AIMS OF STUDYStudies on the effects of various urinary biomarkers in children with neurogenic or non-neurogenic lower urinary tract dysfunction (LUTD) have been published in recent years. Three of them are Brain Derived Neurotrophic Factor (BDNF), Adenosine Triphosphate (ATP), Matrix Metallopreteinase-2 (MMP-2), and various positive effects in diagnosis and follow-up have been reported in different patient groups. In this study, it was aimed to evaluate the relationship of these urinary biomarkers with urodynamic findings and upper urinary tract deterioration (UTTD) in children with myelodysplasia.STUDY DESIGN, MATERIALS AND METHODSChildren with myelodysplasia evaluated in the pediatric urology outpatient clinic between 2022 and 2023 were included in the study. All patients underwent urinary ultrasonography, voiding cystourethrography, urodynamic studies, and DMSA renal scintigraphy. Children with missing data were excluded from the study. Urine samples were collected into sterile urine collection tubes before urodynamics. After each urine sample was centrifuged at 3000 g for 10 minutes, the supernatant was separated and stored at -800C until further analysis. In addition, control urine was collected from 10 healthy children. Urinary BDNF, ATP, and MMP-2 were studied by ELISA method. Urinary biomarker values of patients and controls were compared and subgroup analysis was performed in the myelodysplasia group in terms of urodynamic findings and UUTD. The presence of renal scar, vesicoureteral reflux, or hydronephrosis was considered as UUTD. Constipation status was evaluated with the Bristol stool chart.RESULTSThe median age of 40 children (26 girls (65%), 14 boys (35%)) included in the study was 108 (8-216) months, and the healthy control group (6 girls, 4 boys) was 120 (60-154) months (p=0.981). The primary etiology of 35 children was myelomeningocele (87.5%), 2 dermal sinus (5%), 2 tethered cord (5%), and one sacrococcygeal immature teratoma (2.5%). Urinary BDNF, MMP-2, and ATP were found to be significantly higher in children with myelodysplasia compared to the control group (p=0.007, p=0.027, p=0.014, respectively) (Table 1). In the subgroup analysis, the three biomarker values were similar in children with bladder compliance below or above 10 cmH2O/ml (p=0.750, p=0.844, p=0.575). In addition, no difference was found in terms of UUTD in all three biomarkers (p=0.387, p=0.892, p=0.705). However, a negative correlation was found between urinary ATP and bladder compliance in the correlation analysis (p<0.05) (Table 2). Interestingly, a positive correlation was detected among the three biomarkers (p<0.01) (Table 2). There was no significant difference in urinary biomarkers between children with and without constipation.INTERPRETATION OF RESULTSInvasive urodynamic studies are the gold standard method in the evaluation of children with neurogenic LUTD after first-step tests. In recent years, it is tried to define tests that help and support urodynamic studies in the diagnosis and follow-up of these children. Among these, urine biomarkers come to the forefront with their easy-to-measure features. Three biomarkers evaluated in this study were found to be higher in children with myelodysplasia compared to the healthy control group. However, in subgroup analyses, they were not found to be significantly different in children with UUTD. One of these, urinary BDNF, is the most frequently studied biomarker in children with LUTD after NGF. Urinary BDNF has only been studied in one study in children with myelodysplasia, and decreased after the intravesical injection of botulinum toxin (1). Urinary MMP-2 has been previously studied in adults with spina bifida, and ATP in women with overactive bladders, and significant findings on both biomarkers have been reported (2,3). To our knowledge, these two biomarkers have been studied for the first time in children. In particular, we think that the negative relationship between urinary ATP and bladder compliance may be significant in clinical follow-up. The small number of patients seems to be the most important limitation of the study.CONCLUDING MESSAGEUrinary biomarkers seem promising for the future with their non-invasive features in the follow-up of children with neurogenic LUTD. However, the lack of standardization, the inconsistency between the results of the studies, and the inability to reliably predict risky groups are important shortcomings of urinary biomarkers. We consider that urinary biomarkers should only be assessed as a part of well-designed studies and should not be used in the clinical decision-making process of neurogenic LUTD in children.FIGURE 1Table 1. Comparison of urinary BDNF, ATP and MMP-2 values between patients and controlsFIGURE 2Table 2. Correlations for bladder compliance, ATP, BDNF and MMP-2 in patientsREFERENCESSekerci CA, Tanidir Y, Toprak T, Basok BI, Isman F, Simsek F, et al. Value of Urinary Brain-Derived Neurotrophic Factor Levels on the Assessment of Botulinum Toxin Type A Treatment for Neurogenic Detrusor Overactivity in Children with Myelodysplasia. J Urol. 2019;201(1):174-80.Peyronnet B, Richard C, Bendavid C, Naudet F, Hascoet J, Brochard C, Senal N, Jezequel M, Alimi Q, Khene ZE, Corlu A, Clément B, Siproudhis L, Bouguen G, Kerdraon J, Manunta A, Gamé X. Urinary TIMP-2 and MMP-2 are significantly associated with poor bladder compliance in adult patients with spina bifida. Neurourol Urodyn. 2019 Nov;38(8):2151-2158. doi: 10.1002/nau.24163. Epub 2019 Sep 4. PMID: 31486131.Silva-Ramos M, Silva I, Oliveira O, Ferreira S, Reis MJ, Oliveira JC, Correia-de-Sá P. Urinary ATP may be a dynamic biomarker of detrusor overactivity in women with overactive bladder syndrome. PLoS One. 2013 May 31;8(5):e64696. doi: 10.1371/journal.pone.0064696. PMID: 23741373; PMCID: PMC3669404.