Hasan Serkan DOĞAN, Mesut ALTAN, Adil HÜSEYNOV, Onur TELLİ, Serdar TEKGÜL, Tarkan SOYGÜR, Cesur SAMANCI, Perviz HACİYEV, Ali Cansu BOZACI, Emin MAMADOV, Berk BURGU

Çocuklarda Nörojenik Mesanede Antibakteriyel Kateterle Temiz Aralıklı Kateterizasyon Etkinliği

Amaç: Nörojen mesaneli çocuklarda, ürolojik takibin amacı üriner sistem enfeksiyonu riskini ve bununla ilişkili böbrek hasarını azaltmaktır. Bu çalışmada nörojen mesaneli çocuklarda kullanılan antibakteriyel (kitosan) temiz aralıklı kateterlerin standart kateterlere göre idrar yolu enfeksiyonu ve sonuçları açısından karşılaştırılması yapılmıştır. Gereç ve Yöntemler: Ocak 2007 ile Haziran 2016 tarihleri arasında, iki refere merkezde takip edilen, yaşları 6 ile 16 arasında değişen 144 nörojen mesane tanısıyla temiz aralıklı kateterizasyon yapan hasta dosyaları retrospektif olarak tarandı. Grup 1 antibakteriyel kateter kullanan 55 hasta, Grup 2'de standart kateter kullanan 42 hasta ve Grup 3'de ise daha önceden standart kateter kullanan ve daha sonra en az 6 ay süreyle antibakteriyel kateter kullanan 29 hastadan oluşmuştur. Olgular ateşli idrar yolu enfeksiyonu ve asemptomatik bakteriuri açısından geriye dönük olarak değerlendirildi. Ayrıca pyelonefrit açısından yüksek riskli olabilecek (grade 3 ve üstü vezikoüreteral reflü varlığı veya nükleer görüntülemede skar varlığı) tanımlanan alt-grupta da, TAK kateterleri arasındaki fark değerlendirilmiştir. Bulgular: Toplamda 126 hasta (89 kız, 37 erkek) çalışmaya dahil edildi. Çalışmaya katılan hastaların ortalama yaşı 9.6±2.6 yıl (6-16 yıl) ve ortalama takip süresi 58±14 ay (22-69 ay) olarak bulunmuştur. Her üç grup arasında asemptomatik bakteriuri ve ateşli idrar yolu enfeksiyonu açısından bir fark bulunamamıştır. Riskli grupta ise, ateşli idrar yolu enfeksiyonu ve sintigrafide yeni skar oluşumu standart kateter kullanan hastalarda, antibakteriyel kateter kullananlara ve daha sonradan antibakteriyel katetere geçenlere göre daha sık olduğu görülmüştür. Sonuç: Antibakteriyel ve standart TAK nörojenik mesaneli çocuklarda benzer enfeksiyon oranları ile kullanılabilir. Üriner sistem enfeksiyonu açısından daha riskli kabul edilebilecek gruplarda (grade 3'den büyük vezikoüreteral reflü varlığı, daha önce sintigrafide tanımlanan pyelonefrit bağlı skar veya dilate üreter) antibakteriyel kateterler, standart kateterlere göre daha güvenle kullanılabilir.

Efficacy of Antibiotic Coated Clean Intermittent Catheterization in Children with Neurogenic Bladder

Aim: The primary goal of urologic management in children with neurogenic bladder is to reduce the risk of urinary tract infection (UTI) and associated renal injury. We aimed to evaluate the use of antibacterial-coated clean intermittent catheterization (CIC) catheters for neurogenic bladder patients in comparison with standard catheters. Material and Methods: We performed a retrospective study of 144 neurogenic bladder patients aged 6-16 years old, who received CIC at two major centers between January 2007 and June 2016. Group 1 consisted of children used antibacterial coated (chitosan) catheter (n=55), group 2 of children used standard CIC without antibacterial (n=42) and group 3 of children used standard CIC returned into antibiotic coated CIC mimimum 6 months (n=29). Febrile urinary tract infection and asymptomatic bacteriuria were evaluated among patients with antibacterial coated or standard catheters. We also focused on a subgroup of patients with high risk of urinary tract infection (grade 3> vesicoureteral reflux, previously scar formation in renal scintigraphy). Results: Totally 126 patients (89 female, 37 male) were involved in this study. The mean age of the study group was 9.6±2.6 years (range 6 to 16) and the mean follow-up 58±14 months (min: 22, max: 69). There was no significant difference between three groups for asymptomatic bacteriuria and febrile UTI frequencies. However, febrile UTI frequencies and de nova scar formation in renal scintigraphy were higher in previously defined subgroup of patients with high risk of urinary tract infection in group 2 than group1 and 3. Discussion: Both antibiotic coated and standard CIC can be used in children with neurogenic bladder with similar complication rates. Patients with high risk of urinary tract infection (higher than grade 3 vesicoureteral reflux, dilated ureter, previously de nova scar formation in renal scintigraphy) will benefit from antibacterialcoated catheters rather than standard ones.

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