Abstract
Amaç: Az aktif mesane; underaktif mesane, tembel mesane, infrequent voiding veya akontraktil mesane olarakta adlanlandırılan, nörolojik ya da anatomik bir problemi olmayan, büyük kapasiteli mesanesi olan ve az sıklıkla işeyen olgularda gözlenen bir antitedir. Az aktif mesane nadir görülen bir durumdur. Alt üriner sistem semptomu nedeni ile değerlendirilen, anatomik ve nörolojik olarak normal olan çocukların %5-9’unda görülür. Çalışmamızda, az aktif mesane nedeni ile biyofeedback tedavi programına alınan olgular sunularak, sonuçlarının tartışılması amaçlandı.Gereç ve Yöntemler: 2009-2012 yılları arasında az aktif mesane tanısı koyarak biyofeedback tedavisine aldığımız 20 olgu değerlendirildi. Tüm olgularda ayrıntılı bir öykü, fizik muayene, idrar analizi, üroflovmetre/EMG ve sistometre incelemesi yapıldı. İşeme günlükleri ve semptom skorları değerlendirildi. Beraberinde kabızlık olup olmadığı sorgulandı.Az aktif mesane tanısı nörolojik hastalığı ve anatomik problemi olmayan olgularda artmış mesane kapasitesi (hesaplanan mesane kapasitesinin %150‘i) ile beraber sistometre incelemesinde basıncın artmaması ve detrusörde belirgin kasılmanın gözlenmemesi ile kondu.Az aktif mesanesi olduğuna karar verilen olgulara, standart üroterapi uygulamasının yanında biyofeedback tedavisine başlandı. Zamanlı (iki saatte bir) ve ikili işeme, bol hidrasyon ve proflaktif antibiotik tüm olgularda uygulandı. Biyofeedback uygulaması sonrası 1 yıl boyunca hastalar izlendi. Tedavi sonuçları üriner semptomlardaki düzelme, nokturnal enürezis düzelmesi, gündüz kaçırmasının düzelmesi, kabızlığın düzelmesi ve ürodiamik incelemelerdeki objektif düzelmeler ile değerlendirildi.Bulgular: Yaşları 5-17 yaş arası değişen (ortalama 11.95±3.3 yaş) 19 kız 1 erkek olgu değerlendirmeye alındı. 14 olgu (%70) idrar kaçırma, 5 olgu (%25) İYE, 1 olgu disüri yakınması ile başvurdu. 11 olguda (%55) kabızlığın, 5 olguda (%25) ise VUR eşlik ettiği belirlendi. Bir olgu izlemden çıkarken 9 olguda antibiyotik proflaksiside sonlandırılarak rezidü idrar kalmadan tedaviye tam yanıt alındı. İki olguda kısmi yanıt alınırken, 8 olguda halen yeterli yanıt alınmadığından tedaviye devam edilmektedir.Sonuç: Biyofeedback tedavisi alt üriner sistem semptomu olan olgularda diğer tedavi yöntemlerinin yanında uygulanarak iyileşme oranını artıran bir modalitedir. Az aktif mesane gibi kronik süreçli rahatsızlıkta %45 oranında tedaviye yanıt alınmaktadır. Az aktif mesaneli olgularda pelvik taban kaslarının fizyoterapisi diğer tedavi seçeneklerinin yanında mutlaka ek olarak uygulanmalıdır.
Keywords
References
- Neveus T, von Gontard A, Hoebeke P, Hjälmås K, Bauer S, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescents: Report from the Standardisation Committee of the International Children’s Continence Society. J Urol 2006;176:314-24.
- Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Subcommittee of the International Continence Society. Neurourol Urodyn 2002;21:167–78.
- van Koeveringe GA, Vahabi B, Andersson KE, Kirschner-Herrmans R, Oelke M. Detrusor underactivity: A plea for new approaches to a common bladder dysfunction. Neurourol Urodyn 2011;30:723-8.
- Madjar S, Appell RA. Impaired detrusor contractility: Anything new? Curr Urol Rep 2002;3:373-7.
- Anderson JB, Grant JB. Postoperative retention of urine: Aprospective urodynamic study. BMJ 1991;302:894-6.
- Krane R, Siroky M. Classification of voiding dysfunction: Value of classification systems. In: Barrett D, Wein A (eds). Controversies in Neuro-Urology. New York, NY: Churchill Livingstone, 1984:223-38.
- Alexander S, Rowan D. Treatment of patients with hypotonic bladder by radio-implant. Br J Surg 1972;59:302.
- Kirby RS, Fowler C, Gilpin SA, Holly E, Milroy EJ, Gosling JA, et al. Non-obstructive detrusor failure. A urodynamic, electromyographic, neurohistochemical and autonomic study. Br J Urol 1983;55: 652-9.
- Glassberg KI, Combs AJ, Horowitz M. Nonneurogenic voiding disorders in children and adolescents: Clinical and videourodynamic findings in 4 specific conditions. J Urol 2010;184:2123-7.
- Porena M, Costantini E, Rociola W, Mearini E. Biofeedback successfully cures detrusor sphincter dyssynergia in pediatric patients. J Urol 2000;163:1927-31.
- Chin-Peuckert L, Salle JL. A modified biofeedback program for children with Detrusor sphincter dyssynergia: 5-year experience. J Urol 2001;166:1470-5.
- J. One thousand video-urodynamic studies in children with non neurogenic bladder sphincter dysfunction. BJU Int 2001;87: 575-80.
- Vasconcelos M, Lima E, Caiafa L, Noronha A, Cangussu R, Gomes S, et al. Voiding dysfunction in children. Pelvic-floor exercises or biofeedback therapy: A randomized study. Pediatr Nephrol 2006 21:1858-64.
Abstract
Objective: Underactive bladder is also known as lazy bladder, infrequent voiding or acontractile bladder. Patients do not have neurological or anatomical problems, void less frequently and have a large bladder capacity. Underactive bladder is a rare condition and is diagnosed in 5-9% of anatomically and neurologically normal children with lower urinary tract dysfunction. We present our patients who underwent biofeedback treatment for underactive bladder and discuss the treatment results in this article.Material and Methods: We evaluated 20 cases that underwent biofeedback treatment for underactive bladder between 2009 and 2012. Physical examination, urinalysis, uroflow/EMG and cystometry were performed in all cases. Voiding diaries and symptom scores were evaluated. The presence of constipation was queried. A diagnosis of underactive bladder was made in patients without neurological disease or anatomical problems, with increased bladder
Keywords
References
- Neveus T, von Gontard A, Hoebeke P, Hjälmås K, Bauer S, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescents: Report from the Standardisation Committee of the International Children’s Continence Society. J Urol 2006;176:314-24.
- Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Subcommittee of the International Continence Society. Neurourol Urodyn 2002;21:167–78.
- van Koeveringe GA, Vahabi B, Andersson KE, Kirschner-Herrmans R, Oelke M. Detrusor underactivity: A plea for new approaches to a common bladder dysfunction. Neurourol Urodyn 2011;30:723-8.
- Madjar S, Appell RA. Impaired detrusor contractility: Anything new? Curr Urol Rep 2002;3:373-7.
- Anderson JB, Grant JB. Postoperative retention of urine: Aprospective urodynamic study. BMJ 1991;302:894-6.
- Krane R, Siroky M. Classification of voiding dysfunction: Value of classification systems. In: Barrett D, Wein A (eds). Controversies in Neuro-Urology. New York, NY: Churchill Livingstone, 1984:223-38.
- Alexander S, Rowan D. Treatment of patients with hypotonic bladder by radio-implant. Br J Surg 1972;59:302.
- Kirby RS, Fowler C, Gilpin SA, Holly E, Milroy EJ, Gosling JA, et al. Non-obstructive detrusor failure. A urodynamic, electromyographic, neurohistochemical and autonomic study. Br J Urol 1983;55: 652-9.
- Glassberg KI, Combs AJ, Horowitz M. Nonneurogenic voiding disorders in children and adolescents: Clinical and videourodynamic findings in 4 specific conditions. J Urol 2010;184:2123-7.
- Porena M, Costantini E, Rociola W, Mearini E. Biofeedback successfully cures detrusor sphincter dyssynergia in pediatric patients. J Urol 2000;163:1927-31.
- Chin-Peuckert L, Salle JL. A modified biofeedback program for children with Detrusor sphincter dyssynergia: 5-year experience. J Urol 2001;166:1470-5.
- J. One thousand video-urodynamic studies in children with non neurogenic bladder sphincter dysfunction. BJU Int 2001;87: 575-80.
- Vasconcelos M, Lima E, Caiafa L, Noronha A, Cangussu R, Gomes S, et al. Voiding dysfunction in children. Pelvic-floor exercises or biofeedback therapy: A randomized study. Pediatr Nephrol 2006 21:1858-64.
Details
| Other ID | JA59FG58CJ |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | December 1, 2015 |
| Submission Date | December 1, 2015 |
| Published in Issue | Year 2015 Volume: 9 Issue: 4 |
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