Person: ŞEKERCİ, ÇAĞRI AKIN
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ŞEKERCİ
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ÇAĞRI AKIN
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Publication Open 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.Publication Metadata only 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.Publication Open 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.Publication Open 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.Publication Metadata only 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.Publication Metadata only 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.Publication Open Access Normal glanular and meatal measurements in boys and men(2023-01-01) ŞEKERCİ, ÇAĞRI AKIN; ÖZKAN, ONUR CAN; GENÇ, YUNUS EMRE; TANIDIR, YILÖREN; TARCAN, TUFAN; YÜCEL, SELÇUK; ŞEKERCİ Ç. A., ÖZKAN O. C., Sahak M. Y., GENÇ Y. E., TANIDIR Y., TARCAN T., YÜCEL S.Objective: To determine the normal vertical urethral meatus length (ML), maximum glanular width (MGW), the glanular seam length (between the lowest edge of urethral meatus and the glans closure line corona) (GSL) and GSL/ML ratio in all age groups. Materials and Methods: Consecutive patients presented to urology and pediatric urology outpatient clinics were included in the study. Penile abnormalities, known endocrinological disorders, history of penile/urethral surgery were excluded. MGW, ML, and GSL were measured with a caliper. Glanular and meatal measurements were compared according to ages. Results: A total of 1398 boys and men (380 (27.18%) prepubertal (1-12), 203 (14.52%) adolescent (13-19), and 815 (58.30%) postpubertal (19-93)) with a median age of 31 years (range: 1-93) were included in the study. In consecutive age groups, ML and GSL gradually increased and became steady between 16-19 & 20-30 age groups and 10-12 & 13-15 age groups, respectively. On the other hand, MGW gradually increased until 20 years of age and became steady at median of 35 mm over 20 years of age. Another interesting finding was a rather stable GSL/ML ratio in all age groups. Pairwise comparison of different age groups seemed to be similar and suggests a fixed ratio of 1.33 (IQR: 0.6). Conclusion: The normal glanular and meatal measurements may guide the surgeons for better cosmetic results during hypospadias repair. The GSL/ML ratio appears to be a stable measure for all ages to achieve better cosmetic results.Publication Metadata only Çocuk hastalarda endoskopik böbrek ve üreter taşı cerrahisinin renal kan akımı üzerine etkisinin renal renkli doppler ultrasonografi ile değerlendirilmesi: Prospektif çalışma(2023-10-04) ŞEKERCİ, ÇAĞRI AKIN; TARCAN, TUFAN; YÜCEL, SELÇUK; Şekerci Ç. A., Topbaş B., Soydemir E., Yapıcı Ö., Akbaş S., Yücel S., Tarcan T., Tanıdır Y.AMAÇ: Böbrek taşlarının endoskopik tedavisi sırasında kullanılan irrigasyon sıvısının toplayıcı sistemde basınç artışına neden olduğu bilinmektedir ve 30-45 mmHg basınçlarda piyelorenal reflünün başladığı gösterilmiştir. Yetişkinlerde yapılan çalışmalarda bu cerrahilerin resistif indeksi (Rİ) etkilediği raporlanmıştır. Bildiğimiz kadarıyla çocuk hasta grubunda endokopik taş cerrahilerinin renal kan akımı parametreleri üzerine etkisi araştıran bir çalışma yoktur. Bu çalışmada, çocuklarda uygulanan endoskopik taş cerrahilerinin renal perfüzyon ve kan akımı üzerine etkilerinin renal renkli Doppler ultrasonografi (RRDUSG) ile değerlendirilmesi amaçlanmıştır. GEREÇ-YÖNTEM: Çalışmamıza supin perkütan nefrolitotomi (PNL), retrograd intrarenal cerrahi (RİRC), üreteroskopi (URS), endoskopik kombine intrarenal cerrahi (EKİRC) operasyonu yapılan 0-18 yaş arası hastalar dahil edildi. Hastalara operasyondan 1-3 gün önce, postoperatif 1. gün ve postoperatif 1. ay RRDUSG yapıldı. Ultrasonografide pik sistolik hız (PSV) ve end-diyastolik hız (EDV) ölçüldü. Rezistif indeks (PSV-EDV)/PSV formülü ile hesaplandı. Hastaların yaş, cinsiyet, boy, vücut ağırlığı ve diğer özellikleri, taşın özellikleri, operasyonda kullanılan ekipmanların özellikleri, cerrahi sonuç ve komplikasyonlar kaydedildi. RRDUSG parametreleri tüm hastalarda cerrahi öncesi ve sonrası ile ipsilateral ve konralateral böbrek arası karşılaştırıldı. Ardından cerrahi tiplerine göre alt gruplar oluşturularak benzer karşılaştırma tekrar yapıldı. BULGULAR: Çalışmaya dahil edilen 45 hastanın 15’i (%33,3) kız, 30’u (%66,7) erkekti ve yaş ortalaması ortalama 8,71±3,98 yıldı. Toplamda 13 hastaya (%28,8) PNL, 11 hastaya (%24,4) RİRC, 12 hastaya (%26,7) URS, 9 hastaya (%20) ise EKİRC yapıldı. Taşların maksimum çapı 11,39±6,55 mm ölçüldü, maksimum Hounsfield ünitesi (HU) değerleri ise 1132,88±491,79’du. Hastaların %28,9’unda (n=13) Clavien Dindo (CD) 1 ve/veya 2 komplikasyon gelişti, hiçbir hastada CD 3 ve üzeri komplikasyon görülmedi. Operasyonun yapıldığı taraf böbrekte preoperatif, postoperatif erken dönem ve postoperatif 1. ayda yapılan RRDUSG’lerde renal ve segmental/arkuat arter PSV, EDV ve Rİ değerlerinde istatistiksel olarak anlamlı bir fark bulunmadı (Tablo 1). İpsilateral böbrekle kontralateral böbreğin RRDUSG parametrelerini karşılaştırdığımızda, preoperatif dönemde, postoperatif erken dönemde ve postoperatif 1. ay ölçümlerinde anlamlı fark görülmedi. Operasyon türlerine göre sınıflandırdığımızda; PNL, RİRC, URS ve EKİRC operasyonlarının hiçbirinin preoperatif ve postoperatif ölçümlerinde RRDUSG parametrelerinde anlamlı bir değişiklik gözlenmedi ve Rİ değerlerinin ortalamasının her dönemde 0,7 eşik değerinin altında olduğu görüldü. Preoperatif DJ stent takılmayan hastalarda postoperatif 1. aydaki ortalama segmental arter PSV ve EDV değerleri sırasıyla 37,01 ve 14,1’ken DJ takılan hastalarda sırasıyla 29,05 ve 10,995 bulundu, DJ stent takılmayan hastalarda bu değerler DJ stent takılmış olanlara göre anlamlı olarak düşüktü (PSV için p:0,031 EDV için p:0,041). SONUÇ: Mevcut literatürde bu konuyla ilgili çalışmaların hepsi erişkin hastalarla yapılmış olsa da çalışmaların bazılarında PSV, EDV veya Rİ değerlerinin operasyondan sonra yükselebildiği görüldü. Ancak, çalışmaların neredeyse tamamı bu değerlerin güvenli aralığın dışına çıkmadığını gösterdi. Çalışmamızda da benzer sonuçlara ulaşıldı. Çocuk hastalarda da bu parametrelerin hem operasyon öncesi ve sonrası, hem de operasyon tarafıyla karşı taraf böbreği kıyaslandığında anlamlı fark oluşturmadığı izlendi. Dolayısıyla çocuk hastalarda bu cerrahilerin renal vaskülarizasyona zarar vermeden güvenle uygulanabileceği sonucuna varıldı.Publication Metadata only Are Voiding volumes and frequencies different in the three-day voiding diary in children with lower urinary tract dysfunction(2023-09-27) ŞEKERCİ, ÇAĞRI AKIN; YÜCEL, SELÇUK; TARCAN, TUFAN; Ergün R., Şekerci Ç. A., Çetin M., Sahak M. Y., Yücel S., Tarcan T.HYPOTHESIS / AIMS OF STUDYInitial evaluation of children presenting with lower urinary tract (LUT) symptoms includes physical examination, urinalysis, symptom scores, voiding diary (VD), uroflowmetry, and residual urine measurement. VD is an important tool that provides information about voiding volumes (VV), voiding frequency (VF) and habits, and it is recommended to be applied for at least 2 days in International Children Continence Society (ICCS) and European Urology Association (EAU) guidelines. However, some studies have reported similarities in VV between days at three-day VD. We hypothesized that the VV and VF between days may vary depending on the severity of the symptoms. Therefore, in this study, it was aimed to compare VV and VF values between days according to bladder capacity and symptom score.STUDY DESIGN, MATERIALS AND METHODSChildren who applied to the pediatric urology clinic due to LUT symptoms between 2022 and 2023 were included in the study. The records were evaluated retrospectively. Children with neurological deficits and missing data were excluded from the study. All children were evaluated in accordance with ICCS and EUA recommendations and underwent VD for 3 days. Mean VV and VF values of the whole group for each day were compared and subgroup analyzes were performed. The first subgroup was created according to Voiding Dysfunction Symptom Score (VDSS). VDSS by Akbal et al. was filled in by all parents. Children were divided into two groups as below and above the cut-off value of 8.5 showing LUT dysfunctions. The second subgroup was formed according to bladder capacity (BC). Bladder capacity is calculated as: uroflowmetry voided volume + residual urine volume. The Koff formula was used to calculate the expected bladder capacity (EBC) by age. BC/EBC of less than 65% was considered a low-capacity bladder (1). Decreased VF was accepted as <4 per day, normal VF 4-7 per day, and increased VF >7 per day.RESULTSA total of 109 (53 girls (48.6%), 56 boys (51.4%)) children with a median age of 8 (3-17) were included in the study. 77 (70.6%) children were diagnosed with overactive bladder, 8 (7.4%) with dysfunctional voiding, and 24 (22%) with monosymptomatic enuresis nocturne. The mean VVs between days were similar in the whole group (p=0.759) (Table 1). Moreover, the mean VV of the first day was similar to the average of both the first two days and the three days (p=0.021, p=0.490). Also, the maximum and minimum VVs were similar between days (1st day= 215.29+/-116.10 & 70.51+/-54.56 ml, 2nd day= 222.09+/-249.86 & 71.75+/-56.82 ml, 3rd day= 205.99+/-110.98 & 69.15+/-44.83 ml, p=0.942, p=0.160). In subgroup analyses based on gender, bladder capacity, and symptom score, mean VV was also found to be similar (Table 1). VF values were found to be significantly different between days. There was also a difference between VF values in children with VDSS>8.5 (p=0.012) and BC/EBC (%) >65 (p=0.030) (Table 2). In addition, 72 (66.1%) normal VF, 5 (4.6%) decreased VF, 32 (29.4%) increased VF were detected in first day; 75 (68.8%) normal VF, 10 (9.2%) decreased, 24 (22%) increased VF in second day; 77 (70.6%) normal VF, 6 (5.5%) decreased VF, 26 (23.9%) increased VF in third day.INTERPRETATION OF RESULTSVD is a highly useful tool that allows to show voiding habits, features of bladder function and is characterized by being an easy, non-invasive, no cost method. A properly completed VD provides information about VV, VF, presence and type of incontinence, enuresis, and fluid intake habits. Although at least two or three days of FVC is recommended, it is known that this form is difficult for parents to fill out, especially during school days. In the study of Franck et al., in which they evaluated the voiding diaries of 89 children, it was reported that the VF and mean VV were similar between the three days, but the maximum voiding volumes gradually decreased (2). The authors stated that one day\"s VD may be sufficient to evaluate LUT dysfunctions and shows good correlation with the three-day chart. Unlike these results, present study showed that VVs are similar in all group and sub-group analyses but there are differences between VFs. In another study, mean VV, maximum VV, and fluid intake were shown to be similar between 2- and 3-day VD (3). In addition, high number of voids numbers and low bladder capacities were found to be close to each other. It has been emphasized once again that a two-day VD may be sufficient for the evaluation of children with LUT dysfunctions. The highlight of the present study is the evaluation of VV and VF by forming subgroups according to symptom score and bladder volumes.CONCLUDING MESSAGEAlthough the voiding volumes of children with non-neurogenic LUT dysfunctions are similar between the days of the VD, there may be differences in the voiding frequencies particularly in children with IBSS>8.5 and normal bladder capacity. Therefore, we think that at least two daily voiding diary will contribute to strengthen the diagnosis and avoid over treatment.FIGURE 1Table 1. Comparison of voiding volume in frequency volume chartFIGURE 2Table 2. Comparison of voiding frequencies in frequency volume chartREFERENCESNevéus T, von Gontard A, Hoebeke P, Hjälmås K, Bauer S, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children\"s Continence Society. J Urol. 2006;176(1):314-24.Franck HHM, Guedes ACS, Alvim YFS, de Andrade TMS, Oliveira LF, da Silva LI, et al. One-day voiding diary in the evaluation of Lower Urinary Tract Symptoms in children. Int Braz J Urol. 2023;49(1):89-96.Lopes I, Veiga ML, Braga AA, Brasil CA, Hoffmann A, Barroso U, Jr. A two-day bladder diary for children: Is it enough? J Pediatr Urol. 2015;11(6):348.e1-4.Publication Unknown A survey study on evaluation and management of nocturnal enuresis in pediatricians and family physicians(2023-09-01) ŞEKERCİ, ÇAĞRI AKIN; KÜTÜKOĞLU, MEHMET UMUT; DÖRÜCÜ, DOĞANCAN; TANIDIR, YILÖREN; ÇAM, HAYDAR KAMİL; TARCAN, TUFAN; YÜCEL, SELÇUK; Şekerci Ç. A., Kütükoğlu M. U., Dörücü D., Ergün R., Tanıdır Y., Çam H. K., Tarcan T., Yücel S.Objective:Nocturnal enuresis (NE) is one of the most common disorders in pediatric urology, and patients often turn to family physicians (FP) and pediatricians (P) initially. The aim of this study was to understand the awareness, self-confidence and suggestions of physicians regarding the management of NE.Materials and Methods:In this study, 360 FP and family medicine residents (FMR), as well as 280 P and pediatrics residents (PR), were contacted through a cellular phone texting system. A simple multiple-choice questionnaire (Surveymonkey®) consisting of 10 questions was used to gather data. The survey included questions about their experience, training, evaluation, and management of NE.Results:A total of 119 FPs and Ps (18.5%) filled the questionnaire. Thirty (25.21%) of the participants were P, 27 (22.69%) PR, 3 (2.52%) FP and 59 (49.58%) FMR. The rate of physicians who encounter at least 5 children with NE per month is 31.33%. The mean self-confidence in the management of NE was 4.5 out of 10. The self-confidence of pediatricians was significantly higher than that of PR and FMR (p<0.001, p<0.001). Most (n=78, 65.55%) of the participants stated that they received training on EN during medical faculty and 62 (52.10%) during residency. Psychological problems (89.92%), sleep disorders (78.15%), and excessive fluid intake (75.63%) were the most frequently considered factors in etiology. While most responders (75.63%) considered dietary regulation and behavioral interventions as the first-line treatment, 25.21% consult a pediatric urologist and only 1.6% recommend medical treatment.Conclusion:Although FP and P admit they had training on NE, they mostly felt incompetent to manage NE and exclusively avoided pharmacological treatment.Keywords:Children, enuresis nocturna, pediatric urology, physicians, survey