Nida DİNÇEL, İpek BULUT KAPLAN, Hasan BİÇER, Sevgi MİR

Mesane disfonksiyonları tekrarlayan idrar yolu enfeksiyonlarının ne kadarından sorumludur?

Amaç: Alt üriner sistem işlev bozuklukları cocuklarda sık rastlanılan ürolojik sorunlardan olup, idrar kaçırma, sıkışma, çaprazlama, kesintili işeme ve artmış idrar sıklığı gibi “mesane disfonksiyonunu” işaret eden yakınmalarla karşımıza çıkar. Ancak bir grup hasta sadece tekrarlayan idrar yolu enfeksiyonu ile karşımıza çıkar. Bu çalışmada amacımız öyküde herhangi bir yakınması olmadığı halde tekrarlayan idrar yolu enfeksiyonu ile gelen olgularda alt üriner sistem işlev bozuklukları sıklığını belirtmek ve öykü bulgusu olmasa bile tekrarlayan idrar yolu enfeksiyonu sebebine yönelik ürodinami yapılması gerekliliğini vurgulamaktır. Gereç ve Yöntem: Çalışma kliniğimizde ürodinami yapılan 564 olgu ile yapılmış olup, öyküde “mesane disfonksiyonu” yakınması olan, ürodinamik inceleme yapılan 300 olgu grup 1 olarak sınıflandırılmıştır. Grup 2’de ise öyküde “mesane disfonksiyonu” öyküsü olmayanancak tekrarlayan idrar yolu enfeksiyonu nedeni bulunamayan olgulara yer verilmiştir. Bulgular: Çalışmanın sonunda patolojik ürodinamik değerlendirme saptanan olguların sayısı iki grupta da benzerdi (sırası ile %86,3 ve %84). Grup 2’de yer alan olgulardan ikinci kez alınan öyküde aslında bu grubun %63’ünde başlangıçta yakınma olduğu, ancak %37’sinde (n=98) ikinci öykünün ilki ile uyumlu olduğu görülmüştür. Gerçekten yakınması olmadığından emin olunan 98 olgu içinde 63’ünün (63/98; %64) ürodinamik incelemesinde patoloji saptanmıştır. Grup 2’de yer alan olgulardan 113 aşırı aktif mesaneli olgunun 29’unda (29/113; %25,6) gerçekten hiç bir “mesane disfonksiyon” bulgusu olmayıp, olgularda tek verinin tekrarlayan idrar yolu enfeksiyonu olduğu görülmüştür. Yine işeme bozukluğu tanısı alan 85 olguda tek bulgunun tekrarlayan idrar yolu enfeksiyonu olma oranı 17/85; %20 ve tembel mesane tanısında da 17/24; %71 olarak saptanmıştır. Çıkarımlar: Tekrarlayan idrar yolu enfeksiyonu olan çocuklarda dikkatli bir öykü alınması ileri incelemelere başvurmadan önce mesane işlev bozukluklarının saptanmasında önemlidir. Çalışmamızda görüldüğü üzere dikkatli bir öykü için hasta ve ebeveynlerin rahat davranabileceği daha samimi ve özel bir ortam sağlanmalıdır. Ancak unutulmamalıdır ki önemli derecede yüksek bir oranda hastada öyküde hiçbir “mesane disfonksiyon” bulgusu olmadığı halde ürodinamik patoloji elde edilmektedir.

Bladder dysfunctions are responsible for how much of the recurrent urinary tract infections?

Aim: Lower urinary tract function disorders are frequently seen urological problem in children, admitted us for the presence of incontinance, urgency, wetting and increased urination need. Whereas they can only be presented by recurrent urinary tract infection. The aim of this study is to evaluate the frequency of lower urinary tract function disorders in patients coming with recurrent urinary tract infection without any complaint on history taking and to emphasize the necessity of urodynamic evaluation for etiology of recurrent urinary tract infections even if there were no any history. Material and Method: The study was conducted out by 564 patients underwent urodynamic evaluation in our clinic, 300 cases with bladder dysfunction history, underwent urodynamic evaluation were classified in group1. In group 2 there were cases without any bladder dysfunction history but with undefined etiology of recurrent urinary tract (R.UTI) infection. Results: At the end of study, the number of cases with pathological urodynamic evaluation, were similar to each other in both groups, 86.3% and 84%, respectively. In secondly taken history of group 2, it was seen that actually in 63% of this group had complaints at beginning, only 37% (n=98) of them had a compatible history with former. Among the 98 cases getting sure that without any complain, 63 of them had urodynamical pathology (63/98;64%). It was seen that in 29 of 113 bladder instability case (29/113; 25.6%) in group 2, had really no bladder dysfunction complaint, the only data was recurrent urinary tract infection. Also, in 85 cases diagnosed with dysfunctional bladder, the rate of being only finding of R.UTI was found as 17/85; 20% and 17/24; 71% in lazy bladder. Conclusions: It is important to take a careful history from children with R.UTI’s before performing advanced exams, in the evaluation of bladder dysfunctions. As it was seen in our study, a specific and more friendly environment in which patient and parents be relax, must be supplied for a careful history taking. Also, it must be in mind that, there is urodynamical pathology without any bladder dysfunction history, in significiantly high rate of cases.

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