Person: ŞEKERCİ, ÇAĞRI AKIN
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ŞEKERCİ
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ÇAĞRI AKIN
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Publication Open 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.Publication Open Access Are voiding volumes and frequencies different in the three-day voiding diary in children with lower urinary tract dysfunction(2023-10-03) ŞEKERCİ, ÇAĞRI AKIN; YÜCEL, SELÇUK; TARCAN, TUFAN; Ergun R., ŞEKERCİ Ç. A., Cetin M., Sahak M. Y., YÜCEL S., TARCAN T.AIM: The voiding diary (VD) yields crucial insights into voiding volumes (VV), voiding frequency (VF), and management habits in children with lower urinary tract (LUT) dysfunction. It is recommended to be conducted for a minimum of 2 days. Nevertheless, certain studies have indicated similarities in voided volumes between days in a three-day VD. This study aims to compare VV and VF values across days based on bladder capacity and symptom scores. MATERIALS AND METHODS: Children who applied to the pediatric urology clinic due to LUT symptoms between 2022 and 2023 were included in the study. Retrospective evaluation was conducted on the records. Children with neurological deficits and incomplete data were excluded from the study. All children were assessed following the guidelines of ICCS and EUA and underwent a 3-day voiding diary. Mean VV and VF values of the whole group for each day were compared and subgroup analyzes were performed in terms of gender, Voiding Dysfunction Symptom Score (VDSS), bladder capacity (BC), and diagnoses. RESULTS: A 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). 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 (p = 0.942, p = 0.160, respectively). In subgroup analyses based on gender, bladder capacity, and symptom score, mean VV was also found to be similar. 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). In subgroup analysis for diagnoses, mean and maximum VV and VF were similar between the groups, except for VF (p = 0.026) in OAB. CONCLUSION: While the voided volumes of children with non-neurogenic LUT dysfunctions appear to be consistent across the days of the VD, variations in VF might arise, especially among children with a VDSS of > 8.5 and normal bladder capacity. As a result, we believe that using a VD spanning at least two days could enhance diagnostic accuracy and help prevent unnecessary treatment.Publication Open Access The Utility and Safety of Ureteral Access Sheath During Retrograde Intrarenal Surgery in Children(2024-01-01) TANIDIR, YILÖREN; ŞEKERCİ, ÇAĞRI AKIN; TANIDIR Y., ŞEKERCİ Ç. A., Bujons A., Castellani D., Ferretti S., Gatti C., Campobasso D., Quiroz Y., Teoh J. Y., Pietropaolo A., et al.OBJECTIVE: To compare retrograde intrarenal surgery (RIRS) with and without ureteral access sheath (UAS) in different pediatric age groups. METHODS: The data of RIRS for kidney stone in children were obtained from 9 institutions. Demographic characteristics of patients and stones, intraoperative and postoperative results were recorded. While analyzing the data, patients who underwent RIRS without UAS (group 1) (n = 195) and RIRS with UAS (group 2) (n = 194) were compared. RESULTS: Group 1 was found to be young, thin, and short (P <.001, P = .021, P <.001), but there was no gender difference and similar symptoms were present except hematuria, which was predominant in group 2 (10.6% vs 17.3%, P <.001). Group 1 had smaller stone diameter (9.91 ± 4.46 vs 11.59 ± 4.85 mm, P = .001), shorter operation time (P = .040), less stenting (35.7% vs 72.7%, P = .003). Re-intervention rates and stone-free rates (SFR) were similar between groups (P = .5 and P = .374). However, group 1 had significantly high re-RIRS (P = .009). SFR had a positive correlation with smaller stone size and thulium fiber laser usage compared to holmium fiber laser (HFL) (P <.001 and P = .020), but multivariate analysis revealed only large stone size as a risk factor for residual fragments (P = .001). CONCLUSION: RIRS can be performed safely in children with and without UAS. In children of smaller size or younger age (<5 years), limited use of UAS was observed. UAS may be of greater utility in stones larger than 1 cm, regardless of the age, and using smaller diameter UAS and ureteroscopes can decrease the complications.Publication Open Access Endoscopic combined intrarenal surgery versus percutaneuos nephrolithotomy for complex pediatric stone disease: A comparative analysis of efficacy and safety.(2024-05-31) ŞEKERCİ, ÇAĞRI AKIN; Tanidir Y., Sekerci Ç. A., Genc Y. E., Gokmen E., Arslan F., Yucel S., Tarcan T., Cam K.Introduction Decision-making for complex pediatric urinary system stone disease is still a challenge for pediatric urologists. The interest in supine percutaneous nephrolithotomy (PCNL) is increasing among centers to achieve high surgical success rates with less morbidity. Despite advanced retrograde intrarenal surgery armamentarium, percutaneous approaches remain the first-line surgical treatment modality for >2 cm and complex renal stones. There are no comparative studies yet in the literature for pediatric endoscopic combined intrarenal surgery (ECIRS) Objective In this study, we aimed to contribute to the literature by evaluating the safety and efficacy of ECIRS by comparing it with PCNL. Study design Patients under 18 years of age who underwent PCNL and ECIRS for urinary tract stone disease at our Pediatric Urology department between 2012 and 2024 were included. Preoperative (demographic characteristics, stone characteristics, biochemical parameters), perioperative (duration of surgery, number of accesses, lasing and fluoroscopy times, endoscopic and fluoroscopic stone-free rates) and postoperative (hospital stay, urinary tract infection, complication and radiological stone-free rates) parameters were retrospectively evaluated. Results A total of 68 children [28 (41%) girls and 40 (59%) boys] aged 5 (0e17) years were included in the study. ECIRS was performed in 19 (28%), supine in 28 (41%) and prone PCNL in 21 (30%) patients. Age (p Z 0.029), Guy’s stone score (p < 0.001), S.T.O.N.E. (p < 0.001), and Seoul National University Renal Stone Complexity (S-ReSC) scores (p Z 0.001) for preoperative parameters were found to be higher in ECIRS group over both PCNL methods (Summary Table). However, Clinical Research Office of the Endourological Society (CROES) score was seen lower for ECIRS group patients compared to other groups (p Z 0.028). Surgery time (in favor of supine over prone PCNL), fluoroscopy time (in favor of ECIRS and Supine PCNL over Prone PCNL), preferred laser type (prone PCNL group was mostly performed with holmium laser, whereas other groups were balanced between Holmium and Thulium Fiber Laser) and exit strategy (the preferred exit strategy was DJ Stent in most of the ECIRS patients, whereas nephrostomy tube was used in some of the PCNL group) showed significant difference among the groups as perioperative parameters (p Z 0.042, <0.001, <0.001, <0.001, respectively). Surgery time was lower for supine PCNL compared to prone PCNL. For postoperative parameters, stone-free rates, complication rates and urinary tract infections were similar between the 3 groups, while a difference was detected in terms of length of hospital stay in favor of ECIRS over both supine and prone PCNL (p Z 0.006). Discussion The current trial suggests that stone-free and complication rates of ECIRS and supine PCNL were similar in the pediatric complex stone patients. Although, the stones in the ECIRS group we found to be more complex. Also, ECIRS was superior to PCNL in terms of fluoroscopy exposure and hospital stay. Conclusion With the widespread use of new generation ureteral access sheaths and flexible ureterorenoscopes, ECIRS may have an important role in treatment of complex pediatric kidney stones.