Assessment of Serotonin Metabolite 5-hydroxyindoleacetic Acid Levels in Urine Sample for Diagnosis and Treatment Efficacy in Children with Dysfunctional Voiding and Their Interaction with Biofeedback Therapy

Objective: Dysfunctional voiding (DV), which is explained as an incoordination between the external urethral sphincter and the bladder, is a situation developing in neurologically normal children. Serotonin has some effects on the lower urinary tract which cannot be fully explained. The selective 5-hydroxyindoleacetic acid (5-HIAA) agonist improves voiding efficacy in the rat model with voiding dysfunction as serotonin. Serotonin decomposes to 5-HIAA which excreted from urine. We considered that a problem in neuromodulator levels can lead to DV and evaluated the levels of 5-HIAA in urine. Materials and Methods: Our study included 130 children aged 5-15 years who were diagnosed with DV and 48 children with no urological complaints as controls. Urine samples were taken only once in control group, and 3 times [before and after the biofeedback treatment (sixth month and twelfth month)] in the study group to determine the difference and the interaction between 5-HIAA and biofeedback therapy. Results: Biofeedback therapy was found to be an effective method in the treatment of DV. However, there was no significant difference in the level of mean urine 5-HIAA/creatinine (u5-HIAA/Cr) between study (6.139±3.652) and control groups (6.374±4.329) (p=0.751). The mean u5-HIAA/ Cr levels in the DV group at baseline and at the end of biofeedback therapy (6th month) were 6.249±4.132 and 6.19±4.715, respectively (p=0.951). The mean u5-HIAA/Cr levels in the DV group at baseline and at 12 months were 5.901±3.291 and 6.644±4.206, respectively (p=0.557). There was no significant difference in u5-HIAA/Cr levels between pre-treatment and post-treatment in the DV group. Conclusion: We still do not know if a problem at the level of neurotransmitter metabolite in the central nervous system plays a role in the etiology of DV. We evaluated this relationship, but we could not find a significant result. New studies are needed to get more information about the role of neuromodulators in the etiology and treatment of DV.

Disfonksiyonel İşemeli Çocukların Tanısında ve Tedavi Etkinliğinin Değerlendirilmesinde Serotonin Metaboliti İdrar 5-hidroksiindolasetik Asit Düzeyleri ve Biofeedback Tedavisi ile Etkileşimi

Amaç: Disfonksiyonel işeme (Dİ), nörolojik olarak normal çocuklarda gelişen bir durumdur ve dış üretral sfinkter ile mesane arasındaki koordinasyonsuzluk olarak açıklanmaktadır. Serotoninin alt üriner sistem üzerinde tam olarak açıklanamayan bazı etkileri vardır. Selektif 5-hidroksiindolasetik asit (5- HIAA) agonisti, serotonin gibi işeme disfonksiyonu olan sıçan modelinde işeme etkinliğini geliştirir. Serotonin 5-HIAA’ya parçalanarak idrar ile atılır. Nöromodülatör düzeylerindeki bir sorunun Dİ etiyolojisine yol açabileceğini düşünüyorduk ve idrardaki 5-HIAA düzeylerini değerlendirdik. Gereç ve Yöntem: Çalışmamız Dİ tanısı konulan 5-15 yaş arasındaki 130 çocuk ile 2013 ve 2015 yılları arasında planlandı. İdrar numuneleri, kontrol grubunda sadece bir kez ve çalışma grubunda biofeedback tedavisi ile olan farkı ve etkileşimi belirlemek için 3 kez [biofeedback tedavisinden önce ve sonra (altıncı ay ve on ikinci ay)] alındı. Bulgular: Biofeedback tedavisinin Dİ’de etkili bir yöntem olduğu bulundu. Ancak çalışma (6,139±3,652) ve kontrol grubu (6,374±4,329) arasında ortalama idrar 5-HIAA/kreatinin (u5-HIAA/Cr) düzeyinde anlamlı farklılık yoktu (p=0,751). Dİ grubunda, biofeedback tedavisinin başlangıcında ve sonundaki (6. ay) ortalama u5-HIAA/Cr düzeyleri sırasıyla 6,249±4,132 ve 6,19±4,715 idi (p=0,951). Dİ grubunda, biofeedback tedavisinin başlangıcında ve on ikinci ayda ortalama u5-HIAA/Cr düzeyleri sırasıyla 5,901±3,291 ve 6,644±4,206 idi (p=0,557). Dİ grubunda tedavi öncesi ve sonrası u5-HIAA/Cr düzeyleri arasında anlamlı fark yoktu. Sonuç: Dİ etiyolojisinde merkezi sinir sisteminde nörotransmitter metaboliti seviyesinde bir sorun olup olmadığını hala bilmiyoruz. Bu ilişkiyi değerlendirdik, ancak önemli bir sonuç bulamadık. Dİ etiyolojisi ve tedavisinde nöromodülatörlerin rolü hakkında daha fazla bilgi edinmek için yeni çalışmalara ihtiyaç vardır.

Kaynakça

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