Nöropatik mesane tanılı çocuklardaürodinami bulgularının değerlendirilmesi
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Nöropatik mesane disfonksiyonu (NMD) olan çocuklara yaklaşım spektrumun bir ucunda proaktif, diğer ucunda reaktif yaklaşım olmak üzere geniş bir yelpazede değişiklik göstermektedir. Çalışmamızda NMD nedeniyle kliniğimizde postnatal proaktif yönetilen hastalarımızla reaktif stratejisi ile izlenen eski tanılı hastalarımızın bulgularını geriye dönük olarak değerlendirerek böbrek fonksiyonlarının korunmasında hangi yöntemin daha uygun olduğunu belirlemeyi amaçladık. Materyal ve Metot: Çalışmamızda 2018-2022 yılları arasında Turgut Özal Tıp Merkezi Çocuk Ürodinami Ünitesine başvuran NMD hastalarının dosyaları geriye dönük olarak incelendi. Kliniğimizde NMD tanısıyla en az 1 yıl izleme alınmış olan, üriner sistem ultrasonografisi (USG), voiding sistoüretrografi, dimerkaptosüksinik asit (DMSA) sintigrafik incelemeleri bulunan ve ürodinamik çalışma (ÜDÇ) yapılan hastalar çalışma kapsamına alındı. Toplam 180 hastanın dosyası tarandı ve çalışma kriterlerini karşılayan toplam 143 hasta (0-18 yaş arası 74 erkek ve 69 kız) çalışmaya dâhil edildi. Hastalar yaş grupları (5 yaş altı ve üstü), cinsiyet ve renal hasar durumlarına göre demografik ve klinik özellikler, tekrarlayan idrar yolu enfeksiyonları (İYE), vezikoüreteral reflü (VUR), ÜDÇ bulguları, renal hasar durumları ve kronik böbrek hastalığı (KBH) oranları açısından birbirleriyle karşılaştırıldı. Bulgular: Çalışmamızda DMSA sintigrafik incelemesinde NMD'li 58 (%40.6) çocukta renal skar varlığı ve 16 (%11.2) çocukta ise KBH tespit edildi. Renal skar gelişimini etkileyebilecek ÜDÇ parametreleri; detrüsör aşırı aktivitesi, detrüsör-sfinkter dissinerjisi ve artmış post-voiding rezidü olarak belirlendi (p değerleri sırasıyla p=0.044, p=0.014 ve p=0.038). Ek olarak; düşük yaş, meningomyelosel operasyon zamanı, tekrarlayan semptomatik ateşli İYE geçirilmesi, üriner sistem USG'de hidronefroz/mesane duvarında tabekülasyon ve VUR varlığı renal hasar gelişimini anlamlı olarak etkileyen diğer faktörler olarak tespit edildi (p değerleri sırasıyla p=0.023, p=0.0001, p=0.009, p=0.0001, p=0.0001 ve p=0.0001). Sonuç: Temiz aralıklı kateterizasyon ve antikolinerjik ilaçların yanı sıra ÜDÇ'yi içeren proaktif bir yaklaşımın, NMD olan bebeklerde hem tekrarlayan İYE hem de ikincil VUR gelişimini önleyebileceğine inanıyoruz. Bu yaklaşım aynı zamanda böbrek hasarı, KBH ve son dönem böbrek hastalığı riskini de azaltabilir. Anahtar Kelimeler: Çocuk, Spinal disrafizm, Nöropatik mesane, Ürodinami
Objective: The approach to children with neuropathic bladder dysfunction (NBD) varies widely, ranging from proactive to reactive approaches on the spectrum. We aimed to determine which approach is more appropriate for preserving kidney function by retrospectively evaluating the findings of our patients who were managed proactively in the postnatal period in our clinic due to NBD, and comparing them with the findings of patients with a previous diagnosis who were followed with a reactive strategy. Materials and Methods: In our study, the files of NBD patients who applied to the Turgut Özal Medical Center Pediatric Urodynamics Unit between 2018 and 2022 were retrospectively examined. Patients who had been followed for at least 1 year with a diagnosis of NBD in our clinic, had urinary system ultrasonography (USG), voiding cystourethrography, dimercaptosuccinic acid (DMSA) scintigraphic evaluations, and urodynamic studies (UDS) were included in the study. A total of 180 patient files were reviewed, and a total of 143 patients (74 males and 69 females, aged 0-18) who met the study criteria were included. The patients were compared with each other in terms of demographic and clinical characteristics, including age groups (under 5 years and above), gender, and renal damage status. They were also compared regarding recurrent urinary tract infections (UTIs), vesicoureteral reflux (VUR), UDS findings, renal damage status, and rates of chronic kidney disease (CKD). Results: In our study, renal scarring was detected in 58 (40.6%) children with NBD and CKD was observed in 16 (11.2%) children based on DMSA scintigraphic evaluation. The UDS parameters that can affect the development of renal scarring were determined to be detrusor overactivity, detrusor-sphincter dyssynergia, and increased post-voiding residue (p=0.044, p=0.014, and p=0.038, respectively). Additionally, it was determined that young age, timing of meningomyelocele surgery, history of recurrent symptomatic febrile UTIs, presence of hydronephrosis/bladder wall trabeculation on urinary system USG, and VUR were identified as other significant factors affecting the development of renal damage (p=0.023, p=0.0001, p=0.009, p=0.0001 and p=0.0001, respectively). vii Conclusion: We believe that a proactive approach, including clean intermittent catheterization and the use of anticholinergic medications, as well as UDS, can prevent both recurrent UTIs and secondary VUR in infants with NBD. This approach can also reduce the risk of kidney damage, CKD, and end-stage renal disease. Keywords: Child, Spinal dysraphisms, Neuropathic bladder, Urodynamics
Objective: The approach to children with neuropathic bladder dysfunction (NBD) varies widely, ranging from proactive to reactive approaches on the spectrum. We aimed to determine which approach is more appropriate for preserving kidney function by retrospectively evaluating the findings of our patients who were managed proactively in the postnatal period in our clinic due to NBD, and comparing them with the findings of patients with a previous diagnosis who were followed with a reactive strategy. Materials and Methods: In our study, the files of NBD patients who applied to the Turgut Özal Medical Center Pediatric Urodynamics Unit between 2018 and 2022 were retrospectively examined. Patients who had been followed for at least 1 year with a diagnosis of NBD in our clinic, had urinary system ultrasonography (USG), voiding cystourethrography, dimercaptosuccinic acid (DMSA) scintigraphic evaluations, and urodynamic studies (UDS) were included in the study. A total of 180 patient files were reviewed, and a total of 143 patients (74 males and 69 females, aged 0-18) who met the study criteria were included. The patients were compared with each other in terms of demographic and clinical characteristics, including age groups (under 5 years and above), gender, and renal damage status. They were also compared regarding recurrent urinary tract infections (UTIs), vesicoureteral reflux (VUR), UDS findings, renal damage status, and rates of chronic kidney disease (CKD). Results: In our study, renal scarring was detected in 58 (40.6%) children with NBD and CKD was observed in 16 (11.2%) children based on DMSA scintigraphic evaluation. The UDS parameters that can affect the development of renal scarring were determined to be detrusor overactivity, detrusor-sphincter dyssynergia, and increased post-voiding residue (p=0.044, p=0.014, and p=0.038, respectively). Additionally, it was determined that young age, timing of meningomyelocele surgery, history of recurrent symptomatic febrile UTIs, presence of hydronephrosis/bladder wall trabeculation on urinary system USG, and VUR were identified as other significant factors affecting the development of renal damage (p=0.023, p=0.0001, p=0.009, p=0.0001 and p=0.0001, respectively). vii Conclusion: We believe that a proactive approach, including clean intermittent catheterization and the use of anticholinergic medications, as well as UDS, can prevent both recurrent UTIs and secondary VUR in infants with NBD. This approach can also reduce the risk of kidney damage, CKD, and end-stage renal disease. Keywords: Child, Spinal dysraphisms, Neuropathic bladder, Urodynamics
Açıklama
Anahtar Kelimeler
Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
