Kateterizasyon Yaparken Mesane Taşı ile Gelen Nörojen Mesane Hastası: Vaka Takdimi

Öz

Mesane içine yabancı cisimler çok çeşitli yollarla ortaya çıkabilir. En sık olarak direk üretradan yabancı cismin mesaneye girmesi veya diğer komşu organlardan perforasyon yoluyla mesaneye geçmesiyle ortaya çıkabilmektedir. Bu olgu sunumunda nörojen mesane nedeniyle temiz aralıklı kateterizasyon (TAK) sonda kullanan ve sonda işlemi sırasında fark edilmeden sondanın iticisinin mesane içine kaçması ve zamanla taşlaşmasıyla oluşan mesane taşı olgusunu sunmayı planladık. Kırk dokuz yaşında kadın hasta tekrarlayan üriner sistem enfeksiyonu nedeniyle yapılan tetkikler sırasında üriner sistem ultrasonografisinde mesanede 45 x 17 mm’lik taş bulunması üzerine sistolitotripsi planlandı. Yapılan sistoüretroskopide mesanede yaklaşık 4,5 cm’lik taş olduğu görüldü ve sistolitotripsi yapıldı. Taş lazer yardımı ile fragmente edildiği sırada taşın içinde yabancı cisim olduğu görüldü. Yabancı cismin etrafındaki taş tamamen fragmente edildikten sonra forseps yardımı ile mesaneden çıkarıldı. Yabancı cismin TAK sonda itici kılıfı olduğu anlaşıldı. Özellikle kadın hastalarda infravezikal obstrüksiyon az olması nedeniyle mesane taşı olan kadın hastalarda mesanede taş oluşumuna zemin hazırlayan yabancı cisim olabileceği unutulmamalıdır. Vakamız bu teoriyi destekler nitelikte olması nedeniyle önemlidir. TAK sonda kullanan hastalara, ayrıntılı bir eğitim verilmesi ve TAK sondanın itici kılıfı hakkında dikkat etmeleri konusunda uyarılmaları son derece önemlidir. Nörojen mesane olan hastalar mesanedeki yabancı cismi hissetmedikleri için geç dönemde başvurabilirler ve genellikle yabancı cisimler taşlaşmış olur.

Anahtar Kelimeler

• Mesane taşı
• Temiz aralıklı kateterizasyon
• Yabancı cisim

A Neurogenic Bladder Patient with Bladder Stones During Catheterization: Case Report

Öz

Foreign bodies can occur in the bladder in many ways. Most commonly, it can occur when a foreign body enters the bladder directly from the urethra or passes into the bladder through perforation from other adjacent organs. In this case report, we planned to present a case of bladder stone that occurred when a TAK (clean intermittent catheterization) catheter was used due to neurogenic bladder and the pusher of the catheter escaped into the bladder without being noticed during the catheterization procedure and calcified over time. A 49-year-old female patient was planned to undergo cystolithotripsy due to a 45 x 17 mm stone in the bladder during the examinations performed due to recurrent urinary tract infection. Cystourethroscopy revealed a stone of approximately 4.5 cm in the bladder and cystolithotripsy was performed. When the stone was fragmented with the help of laser, it was seen that there was a foreign body inside the stone. After the stone around the foreign body was completely fragmented, it was removed from the bladder with the help of forceps. It was understood that the foreign body was the pusher sheath of the TAK catheter. It should not be forgotten that there may be a foreign body that paves the way for stone formation in the bladder in female patients with bladder stones, especially because infravesical obstruction is less in female patients. Our case is important because it supports this theory. It is extremely important that patients using TAK catheters are given detailed training and warned to be careful about the pusher sheath of the TAK catheter. Patients with neurogenic bladder may present at a late stage because they cannot feel the foreign body in the bladder, and the foreign bodies are usually petrified.

Anahtar Kelimeler

• Bladder calculi
• Clean intermittent catheterization
• Foreign body

Kaynakça

1. 1. Schwartz BF, Stoller ML. The vesical calculus. Urol Clin North Am. 2000;27:333-346.
2. 2. Drach GW. Urinary lithiasis: etiology, diagnosis, and medical management. In: Walsh PC, Retick AB, Stamey TA, eds. Campbell’s Urology. 6th ed. Philadelphia: WB Saunders; 1992:2085-2156.
3. 3. Ali SH, Rifat UN. Etiological and geographical study on urolithiasis in Iraq. Pediatr Nephrol. 2005;20:1453-1457.
4. 4. Kochakarn W, Pummanagura W. Foreign bodies in the female urinary bladder: 20-year experience in Ramathibodi Hospital. Asian J Surg. 2008;31(3):130-133.
5. 5. Fikri O, Özkan A, Kurtuluş OF, Balcı MBC, Hazar Aİ, Nuhoğlu B. Üretra Darlığı Olan Bir Hastada Saptanan Mesane İçi Yabancı Cisim: Olgu Sunumu. J Acad Res Med. 2012;2(2):82-84.
6. 6. Yenice MG, Şahin S, Ekşi M, Atar FA, Şeker KG, Tuğcu V. Bladder Stones as an Etiological Factor that Must Be Kept in Mind Due to Their Increased Incidence in Female Patients with Lower Urinary Tract Complaints. J Acad Res Med. 2017;7(1):7-10.
7. 7. Yoshida O. A chronological and geographical study on urolithiasis in Japan. Jpn J Endourol ESWL. 1990;3:5. 8. Wai CY, Margulis V, Baugh BR, Schaffer JI. Multiple vesical calculi and complete vaginal vault prolapse. Am J Obstet Gynecol. 2003;189:884-885.
8. 9. Ord J, Lunn D, Reynard J. Bladder management and risk of bladder stone formation in spinal cord injured patients. J Urol. 2003;170:1734-1737.

9. 10. Peyromaure M, Dayma T, Zerbib M. Development of a bladder stone following a tension-free vaginal tape intervention. J Urol. 2004;171:337.
10. 11. Stav K, Dwyer PL. Urinary bladder stones in women. Obstet Gynecol Surv. 2012;67:715-725.
11. 12. Granados EA, Riley G, Rios GJ, Salvador J, Vicente J. Self introduction of urethro vesical foreign bodies. Eur Urol. 1991;19:259-261.
12. 13. Kati B, Polat EC, Turan U. Intravesical Foreign Body Causing Unilateral Hydronephrosis: Case Report. Turkiye Klinikleri J Urol. 2013;4(3):134-136.
13. 14. Torricelli FC, Mazzucchi E, Danilovic A, Coelho RF, Srougi M. Surgical management of bladder stones: literature review. Rev Col Bras Cir. 2013;40:227-233.
14. 15. Ikari O, Netto NR Jr, D’Ancona CA, Palma PC. Percutaneous treatment of bladder stones. J Urol. 1993;149:1499-1500.
15. 16. Badlani GH, Douenias R, Smith AD. Percutaneous bladder procedures. Urol Clin North Am. 1990;17:67-73.
16. 17. Bhatia V, Biyani CS. Vesical lithiasis: Open surgery versus cystolithotripsy versus extracorporeal shockwave therapy. J Urol. 1994;151:660-662.