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

Yıl 2019, Cilt: 12 Sayı: 1, 141 - 147, 18.01.2019

Nuran Çetin Aslı Kavaz Tufan

https://doi.org/10.31362/patd.481801

Öz

Amaç

Alt üriner sistem fonksiyon bozukluğu (AÜSFB) sıklıkla idrar
yolu enfeksiyonu (İYE) ve vezikoüreteral reflü (VUR) ile ilişkilidir.
Tekrarlayan İYE kalıcı hasara ve böbrek fonksiyon kaybına neden olabilir. Bu
çalışmada fonksiyonel AÜSFB 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 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). Lojistik regresyon analizi ile tekrarlayan İYE ve
artmış rezidü idrar ile azalmış mesane kapasitesi arasında anlamlı ilişki
olduğu belirlendi [sırası ile, odds ratio (OR)=0.995, p=0.007; OR=0.818,
p=0.024]. Yirmi iki hastada VUR saptandı. VUR varlığı artmış mesane duvar
kalınlığı arasında pozitif ilişki mevcuttu (OR=2.996, p=0.000). Statik böbrek
sintigrafisi uygulanan 86 hastanın 20’sinde skar olduğu belirlendi. Skar
varlığı tekrarlayan İYE’li hastalarda daha yüksekti (p=0.029). VUR olan ve olmayan hastalar arasında skar varlığı açısından
anlamlı bir farklılık yoktu (p>0.05).

Sonuç

Fonksiyonel
AÜSFB olan çocuklarda tekrarlayan İYE skar gelişmesinde önemli rol
oynamaktadır. Artmış mesane duvar kalınlığı VUR varlığı için bir gösterge
olabilir.

Anahtar Kelimeler

Fonksiyonel üriner sistem fonksiyon bozukluğu, idrar yolu enfeksiyonu, vezikoüreteral reflü

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

Öz

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 RUTI, VUR and renal scar in children with
functional 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 kidney
and urinary tract except VUR were excluded. Information on episodes of UTI, VUR
and renal scar, radiological findings were obtained by medical records.

Results

The 130
patients (86 girls, 44 boys) was included in this study. The frequencies of
increased post voiding residue (PVR), trabeculated bladder and reduced bladder
capacity were significantly higher in RUTI than patients without RUTI (p=0.005,
p=0.001, p=0.023, respectively). Logistic regression analysis showed
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 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.

Conclusion

RUTI seems to play an important role in the development of renal scar in
children with functional LUTD. The increased BWT may be a predictor of the
presence of VUR.

Anahtar Kelimeler

Lower urinary tract dysfunction, urinary tract infection, vesicoureteral reflux. children

Kaynakça

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