Objective: Vena cava thrombectomy together with radical tumor excision in the case of cavoatrial tumor thrombosis is vitally important. In this document, we present the infrarenal inferior vena cava cannulation technique which overcomes the need of total circulatory arrest during the treatment of renal tumors extending into the right atrium. Methods: Between June 2013 and December 2017, 5 patients with renal tumors extending into the right atrium, were diagnosed. The mean age of the patients was 43.2 years. One pediatric and 1 adult patient were male, the other 3 were adult females. The three-venous cannulation system containing vena cava superior, infrarenal vena cava inferior and two-stage venous cannulae was used. The tumor thrombus was removed following vena cava superior and infrarenal vena cava inferior cannulations. A two-stage venous cannula was placed in the right atrium while closing atriotomy. The procedure was continued. Results: There was no mortality in the peroperative and postroperative period. The mean operation time was 465 minutes, the duration of cardiopulmonary bypass was 48 minutes and myocardial ischemia time was 27 minutes. The mean hepatic and renal ischemia time was 15.4 minutes. The mean intensive care unit and hospital stay were 28.4 hours and 9.3 days, respectively. The total follow-up period was 12 months. There was no mortality in long term follow-up. Conclusion: Complete tumor resection without any remnant is the main predictor of mortality in this particular patient population. This technique allows tumor resection in moderate hypothermia without needing hypothermic circulation and provides a safe procedure for complete resection.

Hemangiomas are benign vascular tumors of childhood and they usually tend to be located in the upper parts of the body (head and neck). However, renal hemangiomas are very rare and usually occur to be small (1-2 cm) in size. Here, we report an adolescent girl with a giant renal hemangioma of 15 cm diameter.

We appreciate Prof. Yachia’s interest in our article (1). There are two main questions with regard to the treatment of congenital penile curvature (CPC) in pediatric age group. Those are timing and technique. Previously, post pubertal correction was more commonly performed with the belief of the ongoing developmental process of the penis and some also authors believed the spontaneous correction of the curvature with time. Most probably, reason for this approach may be attributed to the relatively late recognition of CPC in children. Moreover, the use of adult techniques in pediatric population (shortening and lengthening etc.) and lack of long-term surgical results have prepared the grounds for discussion. After unveiling penile neuroanatomy and the definition of dorsal midline plication technique by Baskin et al. (2), it has become globally popular within pediatric urologists in the correction of mild to moderate penile curvature with or without hypospadias. However, recurrence of curvature has been observed in some patients with hypospadias. In addition, there have been very few pediatric reports regarding the long-term results of patients with CPC in terms of recurrence. In Prof. Yachia’s article, it has been postulated that plication only method may not provide the fibrosis that has been made with incision or excision. However, there has been no long-term (post pubertal outcome of pre pubertal surgery) data about shortening excisional/incisional methods or lengthening methods. Thus, this idea has not been supported with evidence-based literature. Our practice was correcting mild-moderate curvature during circumcision. When we analyzed our results, we came across with 8/13 recurrence rate in the long-term (mean 7 years of follow-up). As Prof. Yachia has proposed the term post pubertal persistence can be replaced with ‘late onset recurrence’. We still believe that technique is not solely responsible for recurrences since there have been no comparative studies involving both techniques. In our cohort, even more severe curvature (when compared with pre operative degree) was observed in some patients. This finding can be attributed to the ongoing process of corporeal disproportion. Therefore, late onset recurrence of congenital penile curvature may depend on the developmental process as well as technical problems. Vol. 44 (2): 413-414, March Abril, 2018

ABSTRACT Objective: The aim of this study is to analyze post pubertal results of pre pubertal tunica albuginea plication with non-absorbable sutures in the correction of CPC. Materials and Methods: The files of patients who underwent tunica albuginea plication without incision (dorsal/lateral) were retrospectively reviewed. Patients younger than 13 years of age at the time of operation and older than 14 years of age in November 2015 were included. Patients with a penile curvature of less than 30 degrees & more than 45 degrees and penile/urethral anomalies were excluded. All of the patients underwent surgery followed by circumcision. Results: The mean age of patients at the time of the operation was 9.7 years (range, 6-13 years). The mean degree of ventral penile curvature measured during the operation was 39 degrees while it was 41 degrees in the lateral curvatures. All of the patients were curvature-free at the end of the operation. At the time of the follow-up examination, the mean age was 16.7 years (range, 14-25 years). Six patients had a straight (0-10 degrees) penis during erection and seven patients had recurrent penile curvatures ranging from 30 to 50 degrees. Conclusion: Pre pubertal tunica albuginea plication of congenital penile curvature (30-45 degrees) with non-absorbable sutures performed without incision is a minimal invasive method especially when performed during circumcision. However, recurrence might be observed in half of the patients after puberty.

PURPOSE:The aim of this study is to evaluate and compare the effectiveness of animated vs. non-animated biofeedback therapy in the treatment of dysfunctional voiding (DV) in the pediatric age group. METHODS:In this study, children with DV were randomly assigned for animated and non-animated biofeedback therapy. Age, voiding dysfunction symptom scores (VDSS), urinary ultrasound and uroflowmetry parameters such as electromyography (EMG) activity, voided volumes, post voiding residual urine volume (PVR) and maximum flow rate (Qmax) were evaluated. At the end of treatment, clinical success was regarded as the cessation of EMG activity during voiding, resolution of symptoms (reduction in VDSS, frequency, intermittency, urgency and incontinence), and improvements in uroflowmetry parameters. RESULTS:A total of 40 children were included in the study. There were 20 children in the non-animated group (16 girls, 4 boys; mean age: 10.5±3.2years) and 20 children in the animated group (15 girls, 5 boys; mean age: 9.5±3.63years). Patients received a mean of 5.2±1.9 sessions in both groups. Cessation of pelvic muscle activity on EMG was 75% in the non-animated group and 90% in the animated group (p=0.407). Reduction in VDSS was clinically significant in both groups (p=0.001 for both). There was no significant difference between the clinical success rates of the nonanimated and animated groups (80% vs. 70% respectively, p=0.125). PVR decreased by 68% in the non-animated group (p=0.015) while a 60% decrease was observed in the animated group (p=0.001). CONCLUSION:In our study, there was no difference between animated and non-animated biofeedback therapy in terms of clinical success rates. TYPE OF STUDY:Prospective comparative study LEVEL OF EVIDENCE: Level II.