Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Measurement of Pubic Symphysis Joint Width in the Evaluation of Patients with Primary Nocturnal Enuresis: A Case-Control Study
Primer Enürezis Nokturnalı Hastaların Değerlendirilmesinde Simfizis Pubis Eklem Genişliğinin Ölçümü: Vaka-Kontrol Araştırması
Uğur Ufuk IŞINa , Emin ÇAKMAKCIb , Nuray Gülden TANGALb , Numan İlteriş ÇEVİKc
aUniversity of Health Sciences Ankara Atatürk Sanatoryum Training and Research Hospital, Department of Pediatrics, Ankara, Türkiye
bUniversity of Health Sciences Ankara Atatürk Sanatoryum Training and Research Hospital, Department of Radiology, Ankara, Türkiye
cUniversity of Health Sciences Ankara Bilkent City Hospital, Department of Radiology, Ankara, Türkiye
J Reconstr Urol. 2024;14(3):69-76
doi: 10.5336/urology.2024-104514
Article Language: EN
Full Text
ABSTRACT
 Objective: The aim of this study was to investigate whether pubic symphysis width (PSW) and renal pelvis diameter (RPD) are associated with the presence of monosymptomatic primary nocturnal enuresis (MPNE) in children. Material and Methods: A total of 80 children, including 40 with MPNE and 40 without (controls) were included in this prospective original article conducted between May 2024 and June 2024. Age, sex, height, weight and body mass index were obtained. PSW and RPD were measured using an ultrasound device. To assess the associations between the measurements and MPNE, patients with and without MPNE were compared via various analyses. Results: The median age of the MPNE group was 8 (7-10), and that of the control group was 9 (7,5-11) years (p=0.039). In the MPNE group 55.0% were boys, while only 32.5% of the control group were boys (p=0.071). PSW, left RPD and average RPD were significantly lower in the MPNE group. Diagnostic analysis showed that a PSW value of <8 mm had 76.3% overall accuracy to distinguish children with MPNE from controls (80% sensitivity, 72.5% specificity, 74.4% positive predictive value and 78.4% negative predictive value). Multiple logistic regression showed that children with decreased PSW (<8 mm) had 8.527- fold higher likelihood of enuresis, after adjusting for age, sex, BMI and presence of spina bifida (p<0.001). Conclusion: Lower PSW (<8 mm) was found to be an independent risk factor and a significant predictor for MPNE, after matching for age, sex, BMI and spina bifida presence. RPD was not associated with enuresis or PSW-apart from a minor correlation.

Keywords: Monosymptomatic primary nocturnal enuresis; pubic symphysis width; diameter of the renal pelvis; ultrasound
ÖZET
 Amaç: Bu çalışmanın amacı, Simfizis pubis eklem genişliği (SPG) ve renal pelvis çapının (RPÇ) çocuklarda monosemptomatik primer noktürnal enürezis (MPNE) varlığı ile ilişkili olup olmadığını araştırmaktır. Gereç ve Yöntemler: Mayıs 2024-Haziran 2024 tarihleri arasında yürütülen bu prospektif vaka-kontrol çalışmasına 40'ı MPNE olan ve 40'ı kontrol grubu olmak üzere toplam 80 çocuk dâhil edilmiştir. Yaş, cinsiyet, boy, kilo ve beden kitle indeksi (BKİ) elde edilmiştir. SPG ve RPÇ, USG cihazı kullanılarak ölçülmüştür. Ölçümler ile MPNE arasındaki ilişkileri değerlendirmek için MPNE olan ve olmayan hastalar tek değişkenli ve çok değişkenli analizlerle karşılaştırılmıştır. Bulgular: MPNE grubunun ortanca yaşı 8 (7-10), kontrol grubununki ise 9 (7,5-11) idi (p=0,039). MPNE grubunun %55,0'i erkek iken kontrol grubunun yalnızca %32,5'i erkekti (p=0,071). SPG, sol RPÇ ve ortalama RPÇ, MPNE grubunda anlamlı derecede düşüktü. Tanısal analiz, SPG değerinin <8 mm olmasının MPNE'li çocukları kontrol grubundan ayırt etmede %76,3 genel doğruluğa sahip olduğunu göstermiştir (%80 duyarlılık, %72,5 özgüllük, %74,4 pozitif prediktif değer ve %78,4 negatif prediktif değer). Çoklu lojistik regresyon, yaş, cinsiyet, BKİ ve spina bifida varlığı ayarlandıktan sonra, SPG'si azalmış (<8 mm) çocukların enürezis olasılığının 8,527 kat daha yüksek olduğunu göstermiştir (p<0,001). Sonuç: Düşük SPG (<8 mm), yaş, cinsiyet, BKİ ve spina bifida varlığı için eşleştirme yapıldıktan sonra bağımsız bir risk faktörü ve MPNE için anlamlı bir belirleyici olarak bulunmuştur. RPÇ, küçük bir korelasyon dışında enürezis veya SPG ile ilişkili saptanmamıştır.

Anahtar Kelimeler: Monosemptomatik primer nokturnal enürezis; simfizis pubis genişliği; renal pelvis çapı; ultrasonografi
REFERENCES:
  1. Ghobrial EE, Fawzi NM, Shiba MF, Tawfik MA. Abdomino-pelvic ultrasound evaluation in monosymptomatic primary nocturnal enuresis. Clin Pediatr (Phila). 2023;62(1):33-8. [Crossref]  [PubMed] 
  2. Walker RA. Nocturnal enuresis. Prim Care. 2019;46(2):243-8. [Crossref]  [PubMed] 
  3. Nevéus T, Fonseca E, Franco I, Kawauchi A, Kovacevic L, Nieuwhof-Leppink A, et al. Management and treatment of nocturnal enuresis-an updated standardization document from the International Children's Continence Society. J Pediatr Urol. 2020;16(1):10-9. [Crossref]  [PubMed] 
  4. Kuwertz-Bröking E, von Gontard A. Clinical management of nocturnal enuresis. Pediatr Nephrol. 2018;33(7):1145-54. [Crossref]  [PubMed] 
  5. Collis D, Kennedy-Behr A, Kearney L. The impact of bowel and bladder problems on children's quality of life and their parents: a scoping review. Child Care Health Dev. 2019;45(1):1-14. [Crossref]  [PubMed] 
  6. Van Herzeele C, Dhondt K, Roels SP, Raes A, Hoebeke P, Groen LA, et al. Desmopressin (melt) therapy in children with monosymptomatic nocturnal enuresis and nocturnal polyuria results in improved neuropsychological functioning and sleep. Pediatr Nephrol. 2016;31(9):1477-84. [Crossref]  [PubMed] 
  7. Acosta J, López E, Olvera GI, Ortega R. Capacidad vesical funcional mediante ultrasonido en pacientes con enuresis primaria monosintomática [Functional bladder capacity by ultrasound in patients with monosymptomatic primary enuresis]. Rev Chil Pediatr. 2017;88(5):608-13. Spanish. [Crossref]  [PubMed] 
  8. Loeys B, Hoebeke P, Raes A, Messiaen L, De Paepe A, Vande Walle J. Does monosymptomatic enuresis exist? A molecular genetic exploration of 32 families with enuresis/incontinence. BJU Int. 2002;90(1):76-83. [Crossref]  [PubMed] 
  9. Eiberg H, Berendt I, Mohr J. Assignment of dominant inherited nocturnal enuresis (ENUR1) to chromosome 13q. Nat Genet. 1995;10(3):354-6. [Crossref]  [PubMed] 
  10. Bakwin H. Enuresis in twins. Am J Dis Child. 1971;121(3):222-5. [Crossref]  [PubMed] 
  11. Nevéus T. The role of sleep and arousal in nocturnal enuresis. Acta Paediatr. 2003;92(10):1118-23. [Crossref]  [PubMed] 
  12. Butler RJ, Holland P. The three systems: a conceptual way of understanding nocturnal enuresis. Scand J Urol Nephrol. 2000;34(4):270-7. [Crossref]  [PubMed] 
  13. Butler RJ, Robinson JC, Holland P, Doherty-Williams D. Investigating the three systems approach to complex childhood nocturnal enuresis--medical treatment interventions. Scand J Urol Nephrol. 2004;38(2):117-21. [Crossref]  [PubMed] 
  14. Rittig S, Schaumburg HL, Siggaard C, Schmidt F, Djurhuus JC. The circadian defect in plasma vasopressin and urine output is related to desmopressin response and enuresis status in children with nocturnal enuresis. J Urol. 2008;179(6):2389-95. [Crossref]  [PubMed] 
  15. Cayan S, Doruk E, Bozlu M, Akbay E, Apaydin D, Ulusoy E, et al. Is routine urinary tract investigation necessary for children with monosymptomatic primary nocturnal enuresis? Urology. 2001;58(4):598-602. [Crossref]  [PubMed] 
  16. Damen-Elias HA, Luijnenburg SE, Visser GH, Stoutenbeek PH, de Jong TP. Mild pyelectasis diagnosed by prenatal ultrasound is not a predictor of urinary tract morbidity in childhood. Prenat Diagn. 2005;25(13):1239-47. [Crossref]  [PubMed] 
  17. Telli O, Samancı C, Sarıcı H, Hascıcek AM, Kabar M, Eroglu M. Can urinary nerve growth factor and bladder wall thickness correlation in children have a potential role to predict the outcome of non-monosymptomatic nocturnal enuresis? J Pediatr Urol. 2015;11(5):265.e1-5. [Crossref]  [PubMed] 
  18. Kovacevic L, Wolfe-Christensen C, Mirkovic J, Yih J, Lakshmanan Y. Renal bladder ultrasound evaluation in monosymptomatic primary nocturnal enuresis: is it really necessary? Pediatr Nephrol. 2014;29(7):1189-94. [Crossref]  [PubMed] 
  19. Berger MB, Doumouchtsis SK, DeLancey JO. Bony pelvis dimensions in women with and without stress urinary incontinence. Neurourol Urodyn. 2013;32(1):37-42. [Crossref]  [PubMed]  [PMC] 
  20. Bogusiewicz M, Rosińska-Bogusiewicz K, Drop A, Rechberger T. Anatomical variation of bony pelvis from the viewpoint of transobturator sling placement for stress urinary incontinence. Int Urogynecol J. 2011;22(8):1005-9. [Crossref]  [PubMed]  [PMC] 
  21. McAlister DM, Webb HR, Wheeler PD, Shinault KA, Teague DC, Fish JR, et al. Pubic symphyseal width in pediatric patients. J Pediatr Orthop. 2005;25(6):725-7. [Crossref]  [PubMed] 
  22. Weiss G, Becker JA, Berdon WE, Baker DH. Epispadias. Radiology. 1968;90(1):85-7. [Crossref]  [PubMed] 
  23. Herman TE, Siegel MJ, Austin PF. Imaging case book: superior vesical fissure: variant classical bladder exstrophy. J Perinatol. 2007;27(3):193-5. [Crossref]  [PubMed] 
  24. Loeschcke H. Untersuchungen über Entstehung und Bedeutung der Spaltbildungen in der Symphyse, sowie über physiologische Erweiterungsvorgänge am Becken Schwangerer und Gebärender. Zugleich ein Beitrag zur Frage der Beeinflussung des Knochenwachstums durch die Schwangerschaft. 1912;96(3):525-60. [Crossref] 
  25. Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: update report from the Standardization Committee of the International Children's Continence Society. J Urol. 2014;191(6):1863-5.e13. [Crossref]  [PubMed] 
  26. Haid B, Tekgül S. Primary and secondary enuresis: pathophysiology, diagnosis, and treatment. Eur Urol Focus. 2017;3(2-3):198-206. [Crossref]  [PubMed] 
  27. Rustamova S, Predanic M, Sumersille M, Cohen WR. Changes in symphysis pubis width during labor. J Perinat Med. 2009;37(4):370-3. [Crossref]  [PubMed] 
  28. Piaggio G, Degl'innocenti M. Antenatal diagnosis of mild renal pelvis dilatation: ultrasonographic follow-up and clinical relevance. Ultrasound Med Biol. 2011;37(8):S37. [Crossref] 
  29. Elsayed ER, Abdalla MM, Eladl M, Gabr A, Siam AG, Abdelrahman HM. Predictors of severity and treatment response in children with monosymptomatic nocturnal enuresis receiving behavioral therapy. J Pediatr Urol. 2012;8(1):29-34. [Crossref]  [PubMed] 
  30. Nevéus T. Pathogenesis of enuresis: towards a new understanding. Int J Urol. 2017;24(3):174-82. [Crossref]  [PubMed] 
  31. von Gontard A, Eiberg H, Hollmann E, Rittig S, Lehmkuhl G. Molecular genetics of nocturnal enuresis: clinical and genetic heterogeneity. Acta Paediatr. 1998;87(5):571-8. [Crossref]  [PubMed] 
  32. Neveus T, Eggert P, Evans J, Macedo A, Rittig S, Tekgül S, et al; International Children's Continence Society. Evaluation of and treatment for monosymptomatic enuresis: a standardization document from the International Children's Continence Society. J Urol. 2010;183(2):441-7. [Crossref]  [PubMed] 
  33. Mohammad SA, Rawash LM, Abouzeid AA. Imaging of urinary tract in children in different clinical scenarios: a guide for general radiologists. Egyptian Journal of Radiology and Nuclear Medicine. 2021;52(1):1-18. [Crossref] 
  34. Sreedhar B, Yeung CK, Leung VY, Chu CW. Ultrasound bladder measurements in children with severe primary nocturnal enuresis: pretreatment and posttreatment evaluation and its correlation with treatment outcome. J Urol. 2008;179(4):1568-72; discussion 1572. [Crossref]  [PubMed] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com