Alt üriner sistem fonksiyon bozukluğu olan çocuklarda tekrarlayan idrar yolu enfeksiyonu ve vezikoüreteral reflü: Tek merkez deneyimi

Amaç: Alt üriner sistem fonksiyon bozukluğu sıklıkla idrar yolu enfeksiyonu (İYE) ve vezikoüreteral reflü (VUR) ile ilişkilidir. Tekrarlayan İYE kalıcı hasara ve böbrek fonksiyon kaybına neden olabilir. Bu çalışmada alt üriner sistem fonksiyon bozukluğu olan çocuklarda tekrarlayan İYE, VUR ve skar sıklığının belirlenmesi amaçlandı. Gereç ve yöntem: Eylül 2015- Ağustos 2018 tarihleri arasında acil işeme hissi ve gündüz idrar kaçırma şikayeti olan, beş yaşından büyük çocukların verileri retrospektif olarak değerlendirildi. Nörolojik hastalığı ve VUR dışında doğumsal böbrek ve üriner sistem anomalisi olan hastalar çalışmaya dahil edilmedi. Semptomatik İYE sıklığı, VUR ve skar varlığı, mesane trabekülasyonu ve mesane duvar kalınlığı ile ilgili veriler kayıtlardan elde edildi. Bulgular: Yüz otuz hastanın (86 kız, 44 erkek) ortalama yaşı 11,3±4,34 yıldı. Artmış rezidü idrar, trabeküle mesane ve azalmış mesane kapasitesi sıklığı tekrarlayan İYE’li hastalarda daha yüksekti (sırası ile p=0,005, p=0,001, p=0,023). Tekrarlayan İYE ile artmış rezidü idrar ve azalmış mesane kapasitesi arasında anlamlı bir ilişki olduğu belirlendi [sırası ile odds ratio (OR)=0,995, p=0,007; OR=0,818, p=0,024]. Yirmi iki hastada (%16,9) VUR saptandı. VUR varlığı ile artmış mesane duvar kalınlığı arasında pozitif ilişki mevcuttu (OR=2,996, p

Recurrent urinary tract infection and vesicoureteral reflux in children with lower urinary tract dysfunction: Single center experience

Purpose: Lower urinary tract dysfunction (LUTD) is often associated with urinary tract infections (UTI) and vesicoureteral reflux (VUR). Recurrent UTI (RUTI) may lead to loss of renal function in children with LUTD. In this study, it was aimed to evaluate the frequency of RUTI, VUR and renal scar in children with LUTD. Materials and methods: The data of children older than five-years-old with urgency, daytime incontinence between September, 2015 and August, 2018 were analyzed, retrospectively. The children with neurological problems, congenital anomalies of the kidney and urinary tract except for VUR were excluded. Data on incidence of symptomatic UTI, presence of VUR, renal scar, bladder trabeculation, and bladder wall thickness were obtained from medical records. Results: The 130 patients (86 girls, 44 boys) were included in this study. The frequencies of increased post voiding residue (PVR), trabeculae bladder and reduced bladder capacity were significantly higher in RUTI than patients without RUTI (p=0.005, p=0.001, p=0.023, respectively). There were significant relationships between RUTI and increased PVR or reduced bladder capacity [OR=0.995, p=0.007; OR=0.818, p=0.024; respectively]. The 22 (16.9%) patients had VUR. There was positive association between VUR and increased bladder wall thickness (OR=2.996, p=0.000). Renal scar was shown in 20 patients. The presence of scar was higher in RUTI (p=0.029). There was no significant difference between the patients with and without VUR with respect to renal scar (p=0.288). Conclusion: RUTI seems to play an important role in the development of renal scar in children with LUTD. The increased bladder wall thickness may be a predictor of the presence of VUR.

PDF

___

1. Egemen A, Akil I, Canda E, Ozyurt BC, Eser E. An evaluation of quality of life of mothers of children with enuresis nocturna. Pediatr Nephrol 2008;23:93-98. doi:10.1007/s00467-007-0605-0
2. Nevéus T, von Gontard A, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardization Committee of the International Children’s Continence Society. J Urol 2006;176:314- 324. doi:10.1016/S0022-5347(06)00305-3
3. Allen TD. Forty years experience with voiding dysfunction. BJU Int 2003;92:15-22.
4. Dinçel N, Bulut İK, Biçer H, Mir S. Mesane disfonksiyonları tekrarlayan idrar yolu enfeksiyonlarının ne kadarından sorumludur? Türk Ped Arş 2013;48:110-116. doi: 10.4274/tpa.1007
5. Alpay H, Bıyıklı Karaaslan N. İşeme bozuklukları. Turk Neph Dial Transpl Derg 2003;12:122-126.
6. Chang SJ, Chiang IN, Hseih CH, Lin CD, Yang SS. Age and gender specific nomograms for single and dual post void residual urine in healthy children. Neurorol Urodynam 2013;32:1014-1018.
7. Vaz GT, Vasconcelos MM, Oliveira EA, et al. Prevalence of lower urinary tract symptoms in school-age children. Pediatr Nephrol 2012;27:597-603. doi:10.1007/ s00467-011-2028-1
8. Koff SA, Wagner TT, Jayanthi VR. The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol 1998;160:1019-1022.
9. Twaij M. Urinary tract infection in children: a review of its pathogenesis and risk factors. J R Soc Promot Health 2000;120:220-226.
10. O’Brien WM, Gibbons MD. Pediatric urinary tract infections. Am Fam Physician 1988;38:101-112.
11. Webster GD, Koefoot RB Jr, Sihelnik S. Urodynamic abnormalities in neurologically normal children with micturition dysfunction. J Urol 1984;132:74-77.
12. Jakobsson B, Jacobson SH, Hjalmås K. Vesicoureteric reflux and other risk factors for renal damage: identification of high- and low- risk children. Acta Paediatr Suppl 1999;88:31-39.
13. Van Batavia JP, Ahn JJ, Fast AM, Combs AJ, Glassberg KI. Prevalence of urinary tract infection and vesicoureteral reflux in children with lower urinary tract dysfunction. J Urol 2013;190:1495-1499. doi: 10.1016/j.juro.2013.02.016
14. van Gool JD, Hjälmås K, Tamminen-Möbius T, Olbing H. Historical clues to the complex of dysfunctional voiding, urinary tract infection and vesicoureteral reflux. The International Reflux Study in Children. J Urol 1992;148:1699-1702.
15. Schulman SL, Quinn CK, Plachter N, Kodman-Jones C. Comprehensive management of dysfunctional voiding. Pediatrics 1999;103:e31.
16. Sillen U, Hjalmas K, Aili M, Bjure J, Hanson E, Hansson S. Pronounced detrusor hypercontractility in infants with gross bilateral reflux. J Urol 1992;148:598-599.
17. Yeung CK, Godley ML, Dhillon HK, Duffy PG, Ransley PG. Urodynamic patterns in infants with normal lower urinary tracts or primary vesico-ureteric reflux. Br J Urol 1998;81:461-467.
18. Sillen U. Bladder dysfunction and vesicoureteral reflux. Adv Urol 2008;815472:1-8. doi:10.1155/2008/815472
19. Sillén U, Brandström P, Jodal U, et al. The Swedish reflux trial in children: V. bladder dysfunction. J Urol 2010;184:298-304.
20. Peters CA, Skoog SJ, Arant BS Jr, et al. Summary of the AUA guideline on management of primary vesicoureteral reflux in children. J Urol 2010;184:1134- 1144. doi: 10.1016/j.juro.2010.05.065
21. Hoebeke P, Van Laecke E, Van Camp C, Raes A, Van De Walle J. One thousand video-urodynamics studies in children with non-neurogenic bladder sphincter dysfunction. BJU Int 2001;87:575-580.
22. Ural Z, Ulman I, Avanoglu A. Bladder dynamics and vesicoureteric reflux: factors associated with idiopathic lower urinary tract dysfunction in children. J Urol 2008;179:1564-1567.
23. Cvitkovic-Kzumic A, Brkljacic B, Ivankovic D, Grga A. Ultrasound assessment of detrusor muscle thickness in children with non-neuropathic bladder/sphincter dysfunction. Eur Urol 2002;41:214-218.
24. Sjöström S, Bachelard M, Sixt R, Sillén U. Change of urodynamic patterns in infants with dilating vesicoureteral reflux: 3-year followup. J Urol 2009;182:2446-2453. doi: 10.1016/j.juro.2009.07.057
25. Brierly RD, Hindley RG, McLarty E, Harding DM, Thomas PJ. A prospective controlled quantitative study of ultrastructural changes in the underactive detrusor. J Urol 2003;169:1374-1378. doi: 10.1097/01. ju.0000055781.07630.aa
26. Deveaud CM, Macarak EJ, Kucich U, Ewalt DH, Abrams WR, Howard PS. Molecular analysis of collagens in bladder fibrosis. J Urol 1998;160:1518-1527.
27. Thomas DFM. Vesicoureteric reflux. In: Thomas DFM, Rickwood AMK, Duffy PG, eds. Essentials of paediatric urology. London: Martin Dunitz, 2002:45-55.
28. Lee RS, Cendron M, Kinnamon DD, Nguyen HT. Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics 2006;118:586- 593. doi:10.1542/peds.2006-0120
29. Weinberg B, Yeung N. Sonographic sign of intermittent dilatation of the renal collecting system in 10 patients with vesicoureteral reflux. J Clin Ultrasound 1998;26:65-68.
30. Hanbury DC, Coulden RA, Farman P, Sherwood T. Ultrasound cystography in the diagnosis of vesicoureteric reflux. Br J Urol 1990;65:250-253.
31. Ismaili K, Hall M, Donner C, Thomas D, Vermeylen D, Avni FE. Results of systematic screening for minor degrees of fetal renal pelvis dilatation in an unselected population. Am J Obstet Gynecol 2003;188:242-246.
32. Mostwin J. Pathophysiology: the varieties of bladder overactivity. Urology 2002;60:22-26.
33. Leonardo CR, Filgueiras MF, Vasconcelos MM, et al. Risk factors for renal scarring in children and adolescents with lower urinary tract dysfunction. Pediatr Nephrol 2007;22:1891-1896.
34. Mendoza JM, Roberts JA. Effects of sterile high pressure vesicoureteral reflux on the monkey. J Urol 1983;130:602-606.
35. Preda I, Jodal U, Sixt R, Stokland E, Hansson S. Normal dimercaptosuccinic acid scintigraphy makes voiding cystourethrography unnecessary after urinary tract infection. J Pediatr 2007;151:581-584. doi:10.1016/j. jpeds.2007.05.008
36. Holland NH, Jackson EC, Kazee M, Conrad GR, Ryo UY. Relation of urinary tract infection and vesicoureteral reflux to scars: follow up in thirty-eight patients. J Pediatr 1990;116:65-71.
37. Vega-P JM, Pascual LA. High-pressure bladder: an underlying factor mediating renal damage in the absence of reflux? BJU Int 2001;87:581-584.
38. Hoebeke P, Walle JV, Bishop WP, Bower WF, Austin JC, Schulman SL. In: Erlich RM, ed. Current management of dysfunctional voiding. Dialog Pediatr Urol 2002;25:1- 8.
39. Burgers RE, Mugie SM, Chase J, et al. Management of functional constipation inchildren with lower urinary tract symptoms: report from the Standardization Committee of the International Children’s Continence Society. J Urol 2013;190:29-36. doi:10.1016/j.juro.2013.01.001
40. Hagstroem S, Rittig N, Kamperis K, Mikkelsen MM, Rittig S, Djurhuus JC.Treatment outcome of day-time urinary incontinence in children. Scand J Urol Nephrol 2008;42:528-533. doi:10.1080/00365590802098367