Birgül SAY, Sevilay KARAHAN, Nilgün ÇAKAR, Tuğrul TİRYAKİ

Tekrarlayan İdrar Yolu Enfeksiyonu Geçiren Çocuklarda İşeme Bozukluklarının ve Standart Üroterapiye Yanıtın Değerlendirilmesi

Amaç: İdrar yolu enfeksiyonu (İYE) çocukluk döneminin en sık görülen bakteriyel enfeksiyonlarından biridir. Tekrarlayan İYE’larında en önemli risk faktörlerinden biri işeme bozukluklarıdır.Çalışmanın amaçları; nörolojik sorunu olmayan tekrarlayan İYE’nu olan çocuklarda işeme bozukluğu semptom skorunun (İBSS), işeme sonrası rezidü idrar hacminin, üroflovmetrik inceleme bulgularının değerlendirilmesi ve standart üroterapinin işeme bozukluğu semptomları üzerine etkisini değerlendirmektir. Gereç ve Yöntemler: Çalışmaya Mart 2006 ile Haziran 2008 tarihleri arasında, yılda en az iki kez İYE geçiren, 4 yaş ve üzeri 98 hasta kabul edildi. Olgular İBSS, üroflovmetri ile değerlendirildi. İşeme bozukluğu saptanan 68 hastaya standart üroterapi uygulandı. Bu hastalar tedavinin 6. ayında işeme bozukluğu semptomları açısından tekrar değerlendirildi. Bulgular: Çalışmaya alınan 98 hastanın 96 (%98)’sı kız, ortalama yaşları 9.9±3.95 yıldı. İBSS; 68 (%72) hastada 8.5 ve üstünde; 27 (%28) hastada 8.5’dan küçük bulundu. Kabızlık 48 (%49) hastada saptandı. Rezidü idrar hacmi 86 hastanın 46 (%54)’ında 20 ml’nin üstünde bulundu. Üroflovmetri ile değerlendirilen 86 hastanın 40(%47)’ında çan, 21(% 22)’inde stakkato, 20 (%21)’inde fraksiyone, 4 (%4)’ünde plato, 1 (%1)’inde kule biçimli işeme eğrisi tespit edildi. İBS skoru yüksek olan 68 olguya standart üroterapi tedavisi uygulandı. Altı ay sonunda İBS skoru 35 hastada ≤ 8.5 saptandı. Enürezis diürnada %68, enürezis noktürnada %58, kesik kesik işemede %84, idrarını yaptıktan kısa bir süre sonra tekrar idrara gitme şikayetinde %91 oranında tam düzelme saptandı. Sonuç: İBSS ve üroflovmetri işeme bozukluğunun tanımlanmasında pratik yöntemlerdir. Standart üroterapi, fonksiyonel işeme bozukluğu olan hastaların semptomlarının düzelmesinde etkin bir tedavi yöntemidir.

Anahtar Kelimeler:

Çocuk, Prognoz, Standart üroterapi, İdrar yolu enfeksiyonu, İşeme bozukluğu

Evaluation of Voiding Dysfunction and Response to Standard Uroterapy in Children with Recurrent Urinary Tract Infections

Objective: Urinary tract infection (UTI) is one of the most common bacterial infections of children. The aims of this study were to evaluate voiding disfunction, and the effect of standart uroteraphy on the symptoms of disfunctional voiding in children with recurrent urinary tract infection. Material and Methods: Between March 2006 and June 2008, 99 patients aged ≥4 years who had UTI at least twice in a year were evaluated. The cases were assessed by uroflowmetry and dysfunctional voiding symptom score (DVSS). 68 patients with voiding dysfunction administered standard urotherapy. These patients were reevaluated for symptoms of voiding dysfunction at the end of six month - standart urotherapy. Results: Ninety-six (98%) of the 98 patients were female, mean age was 9.9±3.95 years. DVSS was ≥8.5 in 68 (72%) patients. Constipation was found in 48 patients (49%). 86 of 46 patients (54%) had high residual urine volume (>20 ml). Uroflowmetric examinations were performed in 86 patients. 40 patients (47%) had bell, 21 patients (22%) had staccato, 20 patients (21%) had fractioned, 1 patient (1%) tower, 4 patients (4%) had plateau shaped voiding curve. 68 patients with high DVSS underwent standard urotherapy. At the end of six month- standart urotherapy, the DVS score was ≤ 8.5 in 35 patients. Complete recovery was found in 68% of diurnal enuresis, 58% in nocturnal enuresis, 84% in intermittent incontinence, 91% in feeling of incomplete urination and re-voiding. Conclusion: DVSS and uroflowmetry are practical methods for defining voiding dysfunction. Standard urotherapy is an effective treatment technique for the recovery of symptoms of voiding dysfunction.

Keywords:

Children, Prognosis, Standard urotherapy, Urinary tract infection,

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