Haluk EMİR, Sebuh KURUĞOĞLU, İbrahim ADALETLİ, Neval KOCAOĞLU, Nur CANPOLAT

Alt üriner sistem işlev bozukluğu bulunan çocuklarda ürodinami ve ultrasonografi bulgularının karşılaştırılması

Amaç: Bu çalışmanın amacı, çocuklarda ultrason aracılığı ile mesane duvar kalınlığı ölçümünün alt üriner sistem işlev bozukluğu tanısındaki rolünü belirlemektir. Gereç ve yöntem: Çalışmamızda Cerrahpaşa Tıp Fakültesi’nde 2007-2009 yılları arasında alt üriner sistem işlev bozukluğu nedeniyle takip ve tedavi edilen ve ürodinamik incelemesi yapılmış olan 114 çocuk hasta geriye dönük olarak değerlendirildi. Hastalar stabil olmayan detrusor kasılması varlığı ve mesane duvar kalınlıklarına göre sınıflandırıldı. Hastaların ebeveynlerinden aydınlatılmış onam formu alındı. Bulgular: Çalışma grubumuzun 13’ünde anatomik, 40’ında nörolojik neden saptanırken, 61 hasta idiyopatik grubu oluşturdu. Ürodinamik incelemede 66 hastada stabil olmayan detrusor kasılması gözlenirken, 48 hastada kasılma saptanmadı. Ultrasonografide stabil olmayan detrusor kasılması saptanan hastaların 22’sinde (22/66) mesane duvarı kalınlığı ince bulundu. 44 hastada ise (44/66) mesane duvarları kalın bulundu. Çıkarımlar: Çalışmamız sonucunda sadece sonografik mesane duvar kalınlığı ölçümünün alt üriner sistem işlev bozukluğu tanısı koymada yetersiz kalacağı ve ürodinamik çalışmaların yerini alamayacağını düşünmekteyiz. Alt üriner sistem işlev bozukluğu olan hastaların değerlendirilmesinde, tedavi planının belirlenmesinde ve hasta izleminde sonografi ve ürodinaminin birbirlerine seçenek değil, birbirini tamamlayıcı yöntemler olduğu sonucuna varıldı. (Türk Ped Arfl 2011; 46: 241-5)

Comparison of urodynamic studies and sonographic findings in children with lower urinary system dysfunction

Purpose: The purpose of this study is to determine the role of sonographic bladder wall thickness measurement in children with lower urinary system dysfunction. Material and methods: In this study, we reviewed 114 pediatric patients who underwent urodynamic studies for lower urinary system dysfunction between 2007-2009 at Istanbul University Cerrahpasa Medical Faculty. The patients were classified according to instable detrusor contractions and bladder wall thicknesses. Informed consent form was obtained from their parents. Results: Our study groups consisted with anatomical reasons (n=13), neurological problems (n=40) and idiopathic group (n=61). Urodynamic study detected unstable detrusor contractions in 66 patients while it did not determine contraction in 48 patients. Ultrasonography in 22 patients with unstable detrusor contraction (22/66) of bladder wall thickness was thin. In 44 patients (44/66) bladder wall thickness was detected thick. Conclusions: Our study suggests that the measurement of bladder wall thickness alone can not diagnose lower urinary system dysfunction correctly and can not replace urodynamic studies. Sonography and urodynamic studies are complementary rather than alternative modalities in evaluation and management of children with lower urinary system dysfunction. (Turk Arch Ped 2011; 46: 241-5)

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