Tekrarlayan İdrar Yolu Enfeksiyonu Olan Çocuklarda Tuvalet Alışkanlıklarının Değerlendirilmesi ve Böbrek Hasarı Gelişmesinde Rol Oynayan Risk Faktörlerinin Araştırılması

Amaç: İdrar yolu enfeksiyonu çocukluk çağında sık görülen enfeksiyonlardan biridir. Tekrarlayan enfeksiyonu olan çocuklar yaşamın ilerleyen dönemlerinde kalıcı böbrek hasarı açısından risk altındadır. Bu çalışmada doğumsal böbrek ve üriner sistem anomalisi olmayan tekrarlayan idrar yolu enfeksiyonlu çocuklarda tuvalet alışkanlıklarının ve skar gelişmesinde rol oynayan risk faktörlerinin araştırılması amaçlanmıştır.Gereç ve Yöntemler: Bu çalışmaya tuvalet eğitimi olan tekrarlayan idrar yolu enfeksiyonu tanılı 6 ve 18 yaş arasındaki hastalar dahil edildi. Doğumsal böbrek ve üriner sistem anomalisi olan hastaların verileri çalışma dışı bırakıldı. Hastaların idrar erteleme alışkanlığı, azalmış idrar sıklığı, tutma manevrası ve skar hakkındaki bilgileri dosya kayıtlarından elde edildi.Bulgular: Çalışmaya 208 (146 kız, 62 erkek) hasta dahil edildi. Hastaların yarıdan fazlasında (n=132, %63.5) idrar erteleme alışkanlığı, üçte birinde idrarını tutma manevrası (n=65, %31.3) mevcuttu. Azalmış idrar sıklığı hastaların 47’sinde (%22.6) saptandı. Hastaların 38’inde (%18.3) DMSA sintigrafide skar olduğu belirlendi. İdrar erteleme alışkanlığı, idrar tutma manevrası ve azalmış idrar sıklığı oranı skar olan hastalarda olmayanlara göre anlamlı olarak daha yüksek bulundu [sırası ile 30 (%78,9)/102 (%60), p=0,048; 12 (%31,6)/53 (%21,2), p=0,039; 15 (%39,5)/32 (%18,8), p=0,009]. İdrar erteleme alışkanlığı ve azalmış idrar sıklığı ile skar arasında anlamlı pozitif bir ilişki olduğu belirlendi [sırası ile Odds oranı=3,21, p=0,.011; Odds oranı=1,46, p=0,021; Odds oranı=3,43, p=0,001]. Sonuç: Tekrarlayan idrar yolu enfeksiyonlu çocuklarda tuvalet alışkanlıklarının sorgulanarak gerekli önlemlerin alınması skar gelişiminin önlenmesinde rol oynayabilir.

Anahtar Kelimeler:

Çocukluk Çağı, İdrar Yolu Enfeksiyonu, Renal Skar, Tuvalet Alışkanlıkları

Evaluation of Toilet Habits in Children with Recurrent Urinary Tract Infections and Investigation of Risk Factors That Play a Role in The Development of Kidney Damage

Objective: Urinary tract infection is one of the common infections in children. The patients with recurrent infection are at risk for permanent renal damage in later life. In this study, it was aimed to investigate the toilet habits and risk factors for renal scarring in children with recurrent urinary tract infection without congenital anomalies of the kidney and urinary tract.Materials and Methods: Patients between the ages of 6 and 18 with a diagnosis of recurrent urinary tract infection who were toilet trained were included in this study. Data of patients with congenital anomalies of kidney and urinary tract were excluded from the study. The detailed information on the voiding postponement, infrequent voiding, holding maneuvers and renal scarring were obtained from file records.Results: The 208 patients (146 girls, 62 boys) were included in this study. The more than half of the patients (n=132, 63.5%) had a habit voiding postponement, and one third (n=65, 31.3%) had holding maneuver. There was infrequent voiding in 47 (22.6%) patients. Renal scarring was determined in 38 (18.3%) patients. The frequencies of voiding postponement, holding maneuver and infrequent voiding were higher in patients with renal scarring than those of without [30 (78.9%)/102 (60%), p=0.048; 12 (31.6%)/53 (21.2%), p=0.039; 15 (39.5%)/32 (18.8%), p=0.009, respectively]. It was determined a significant positive association between renal scarring and voiding postponement with infrequent voiding [Odds ratio=3.21, p=0.011; Odds ratio=1.46, p=0.021; Odds ratio=3.43, p=0.001, respectively]. Conclusion: Toilets habits should be questioned in routine follow-up program in children with recurrent urinary tract infection. The development of true toilet habits may be useful to prevent the development of renal scarring in children.

Keywords:

Children, Urinary Tract Infection, Renal Scarring, Toilet Habits,

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