Çocuk Ürolojisinde Yenilikler

General Anesthesia

Prenatal Diagnosis:

Diagnostic methods that can be applied to expectant mothers during pregnancy, especially ultrasound, have been developing gradually in recent years, and congenital anomalies are more common in the 14th-16th days. It allows to be diagnosed with high sensitivity at the gestational week. Hydronephrosis (enlargement of the intrarenal urine collecting system) is the most common anomaly encountered with ultrasound before birth, and hydronephrosis is found in the baby of one out of every 100 pregnant mothers in ultrasound examinations performed by specialists (Figure 1). In a few of them, attempts are made to prevent kidney damage by making an attempt while in the womb. These new and still very risky interventions are carried out in very limited numbers in only a few centers in the world today, and they are still considered as experimental initiatives. Apart from this, congenital anomalies that are very severe and life-threatening can be diagnosed in the early stages of pregnancy and the pregnancy can be terminated. However, this decision will be made after discussion by a council attended by perinatology specialists, geneticists, and related specialists dealing with the treatment of the anomaly (neurosurgeon, pediatric surgeon, pediatric urologist, etc.), which will minimize the margin of medical and ethical error. Innovations in the Treatment of Vesicoureteral Reflux (Bad Urine Backflow from the Bladder to the Kidney): Reflux is the most common cause of urinary tract infections in children, and reflux that does not go away on its own or causes damage to the kidneys should be treated (Figure 2). This treatment, which is classically performed with open surgery, can be performed without surgery with the closed (endoscopic) method, which has been very easy in recent years. A small amount of foreign material (Teflon, etc.) is injected through the bladder into the mouth of the urinary canal that causes reflux. The entrance to the bladder is made through the urination canal with a thin lighted instrument (endoscope). This process takes 5-10 minutes and the patient is sent home 2 hours after the intervention. The search for the ideal (non-alien, harmless, harmless) substance to be injected with this method continues.

Innovations in the Treatment of Hypospadias (Half Circumcision):

The treatment of this disease is now carried out from the age of 6 months and the child recognizes the genitals with its normal appearance, which is between the ages of 2.5 and 5 years. In other words, performing genital surgeries before the age of 2 reduces the psychological problems that may occur in the future. With the sensitive surgical materials and techniques used today, 90-95% of the patients can restore normal appearance and function to the penis with a single operation.

Innovations in Undescended Testicle Treatment:

Testes remaining in the abdomen can be lowered with the endoscopic method (bladeless surgery), which is the method used in gallbladder surgeries. In addition, it can be understood that the testicle has not developed at all, without opening the abdomen. Testicle-like silicone prostheses can be placed in order to reduce psychological trauma and normalize the cosmetic appearance in patients who have no testicles or have to be removed.

Innovations in Sleep Peeing (Bed Wetting) Treatment:

This problem can be solved at a rate of 80-90% with new, easy-to-use and safe drugs. Again, in children of appropriate age, the problem can be eliminated by using a device called a voiding alarm device, which develops conditioned reflexes, for a short time, without the use of medication.

Innovations in the Treatment of Urological Problems in Spina Bifida:

Most of these patients have persistent urinary and fecal incontinence. With some new surgical methods (bladder enlargement surgeries, bladder neck tightening surgeries, Long-acting bowel enema – ACE surgery) and applications (Clean Intermittent Catheter Application, etc.), these complaints can be completely corrected or greatly reduced, and patients can adapt to social life. One of the most important innovations in this regard was the establishment of a Spina Bifida Association in Turkey in 1997 (http://www.med.ege.edu.tr/spina). Participating in association activities for the solution of social problems also makes positive changes in the lives of patients.

Innovations in Stone Disease Treatment:

The extracorporeal sound waves and lithotripsy (ESWL) method applied to adults can now be applied to most of the stones in children. Stones that cannot be broken in this way are approached with fine instruments placed with the endoscopic (without knife) method, and the practice of pulverizing the stone with laser light is becoming increasingly common. As a result, the surgical stone removal method is about to become a thing of the past for children as well as adults.

Innovations in the Treatment of Kidney Tumors:

The rate of recovery and return to normal life with treatment in Wilms tumor, which is the most common kidney tumor in children, was 5% at the beginning of the century, while it increased to over 90% in the left years (Figure 3). Especially new cancer drugs have played a very important role in this. In the near future, it will be possible to reveal people who are at risk of developing cancer and which types of cancer they are at risk of developing with genetic research, and it will be possible to take precautions earlier in these people.

Innovations in Circumcision:

Innovations in circumcision, which is the most frequently applied surgery, are unfortunately very slow to be implemented in our society. Moreover, some methods such as circumcision with laser and cautery, which can be extremely risky and harmful, can be applied for commercial purposes under the name of "innovation". However, circumcision with cautery is prohibited. The vast majority of circumcisions continue to be performed in extremely unsanitary environments (houses, wedding halls, etc.) and with very risky methods. The biggest innovation in circumcision will be the acceptance by everyone that this procedure is an operation and the fulfillment of its requirements.

Figure 1. X-ray view of the kidney with hydronephrosis.

Figure 2. Vesicoureteral reflux (reflux of urine from the bladder to the kidney) is one of the leading causes of kidney failure in children, and it is extremely difficult to diagnose except by X-ray examination with a urinary catheter, as in this picture. For this reason, this film must be taken in children who have frequent urinary tract infections.

Figure 3. The survival rates of Wilms tumor, which is the most common kidney tumor in children, with early diagnosis and treatment have exceeded 90%.