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

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

Abstract

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.

Keywords

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

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