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

Yıl 2019, , 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

• Referans1 Egemen A, Akil I, Canda E, Ozyurt BC, Eser E. An evaluation of quality of life of mothers of children with enuresis nocturna. Pediatr Nephrol 2008;23:93-98.
• Referans2 Nevéus T, von Gontard A, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardization Committee of the International Children’s Continence Society. J Urol 2006;176:314-24.
• Referans3 Allen TD. Forty years experience with voiding dysfunction. BJU Int 2003;92:15-22.
• Referans4 N Dinçel, İK Bulut, H Biçer, S Mir. Mesane disfonksiyonları tekrarlayan idrar yolu enfeksiyonlarının ne kadarından sorumludur? Türk Ped Arş 2013;48:110-116.
• Referans5 Alpay H, Bıyıklı N.K. İşeme bozuklukları. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi 2003;3:122-126.
• Referans6 Chang SJ, Chiang IN, Hseih CH, Lin CD, Yang SS. Age and gender specific nomograms for single and dual post void residual urine in healthy children. Neurorol Urodynam 2013;32:1014–1018.
• Referans7 Vaz GT, Vasconcelos MM, Oliveira EA, et al. Prevalence of lower urinary tract symptoms in school-age children. Pediatr Nephrol 2012;27:597-603.
• Referans8 Koff SA, Wagner TT, Jayanthi VR. The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol 1998;160:1019-1022.
• Referans9 Twaij M. Urinary tract infection in children: a review of its pathogenesis and risk factors. J R Soc Promot Health 2000; 120: 220.
• Referans10 O’Brien WM, Gibbons MD. Pediatric urinary tract infections. Am Fam Physician 1988;38:101-112.
• Referans11 Webster GD, Koefoot RB Jr, Sihelnik S. Urodynamic abnormalities in neurologically normal children with micturition dysfunction. J Urol 1984;132:74-77.
• Referans12 Jakobsson B, Jacobson SH, Hjalmås K. Vesico-ureteric reflux and other risk factors for renal damage: identification of high- and low- -risk children. Acta Paediatr Suppl 1999;88:31-39.
• Referans13 Van Batavia JP, Ahn JJ, Fast AM, Combs AJ, Glassberg KI. J Urol 2013;190:1495-1499.
• Referans14 van Gool JD, Hjälmås K, Tamminen-Möbius T, Olbing H. Prevalence of urinary tract infection and vesicoureteral reflux in children with lower urinary tract dysfunction. Historical clues to the complex of dysfunctional voiding, urinary tract infection and vesicoureteral reflux. J Urol 1992;148:1699-1702.
• Referans15 Schulman SL, Quinn CK, Plachter N, Kodman-Jones C. Comprehensive management of dysfunctional voiding. Pediatrics 1999;103:e31.
• Referans16 Sillen U, Hjalmas K, Aili M. Pronounced detrusor hypercontractility in infants with gross bilateral reflux. J Urol 1992;148:598-599.
• Referans17 Yeung CK, Godley ML, Dhillon HK, Duffy PG, Ransley PG. Urodynamic patterns in infants with normal urinary tracts or primary vesicoureteral reflux. Br J Urol 1998;81:461-467.
• Referans18 Sillen U. Bladder dysfunction and vesicoureteral reflux. Adv Urol 2008;815472:1e8.
• Referans19 Sillén U, Brandström P, Jodal U, et al. The Swedish Reflux Trial in Children: V. Bladder dysfunction. J Urol 2010;184:298.
• Referans20 Peters CA, Skoog SJ., Arant BS, et al. Summary of the AUA guideline on management of primary vesicoureteral reflux in children. J Urol 2010;184:1134.
• Referans21 Hoebeke P, Van Laecke E, Van Camp C, Raes A, Van De Walle J. One thousand video-urodynamics studies in children with non-neurogenic bladder sphincter dysfunction. BJU Int 2001;87:575-580.
• Referans22 Ural Z, Ulman I, Avanoglu A. Bladder dynamics and vesicoureteric reflux: factors associated with idiopathic lower urinary tract dysfunction in children. J Urol 2008;179:1564-1567.
• Referans23 Cvitkovic-Kzumic A, Brkljacic B, Ivankovic D, Grga A. Ultrasound assessment of detrusor muscle thickness in children with non-neuropathic bladder/sphincter dysfunction. Eur Urol 2002;41:214-218.
• Referans24 Sjöström S, Bachelard M, Sixt R, Sillén U. Change of urodynamic patterns in infants with dilating vesicoureteral reflux: 3-year followup. J Urol 2009;182:2446–2453.
• Referans25 Brierly RD, Hindley RG, McLarty E, Harding DM, Thomas PJ. A prospective controlled quantitative study of ultrastructural changes in the underactive detrusor. J Urol 2003;169:1374–1378.
• Referans26 Deveaud CM, Macarak EJ, Kucich U, Ewalt DH, Abrams WR, Howard PS. Molecular analysis of collagens in bladder fibrosis. J Urol 1998;160:1518–1527.
• Referans27 Thomas DFM. Vesicoureteric reflux. In: Thomas DFM, Rickwood AMK, Duffy PG. Essentials of Paediatric Urology. London: Martin Dunitz. 2002:45-55.
• Referans28 Lee RS, Cendron M, Kinnamon DD, Nguyen HT. Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics 2006;118:586–593.
• Referans29 Weinberg B, Yeung N. Sonographic sign of intermittent dilatation of the renal collecting system in 10 patients with vesicoureteral reflux. J Clin Ultrasound 1998;26:65–68.
• Referans30 Hanbury DC, Coulden RA, Farman P, Sherwood T. Ultrasound cystography in the diagnosis of vesicoureteric reflux. Br J Urol 1990;65:250–253.
• Referans31 Ismaili K, Hall M, Donner C, Thomas D, Vermeylen D, Avni FE. Results of systematic screening for minor degrees of fetal renal pelvis dilatation in an unselected population. Am J Obstet Gynecol 2003;188:242–246.
• Referans32 Mostwin J. Pathophysiology: the varieties of bladder overactivity. Urology 2002;60:22–26.
• Referans33 Leonardo CR, Filgueiras MF, Vasconcelos MM, et al. Risk factors for renal scarring in children and adolescents with lower urinary tract dysfunction. Pediatr Nephrol 2007;22:1891–1896.
• Referans34 Mendoza JM, Roberts JA. Effects of sterile high pressure vesicoureteral reflux on the monkey. J Urol 1983;130:602-606.
• Referans35 Preda I, Jodal U, Sixt R, et al. Normal dimercaptosuccinic acid scintigraphy makes voiding cystourethrography unnecessary after urinary tract infection. J Pediatr 2007;151:581-584.
• Referans36 Holland N, Jackson E, Kazee M, Conrad GR, Ryo UY. Relation of urinary tract infection and vesicoureteral reflux to scars: follow up in 38 patients. J Pediatr 1990;116:65-71.
• Referans37 Vega-P JM, Pascual LA. High-pressure bladder:an underlying factor mediating renal damage in the absence of reflux? BJU Int 2001;87:581-584.
• Referans38 Hoebeke P, Walle JV, Bishop WP, Bower WF, Austin JC, Schulman SL. Current management of dysfunctional voiding. Dialogues in Pediatric Urology (eds.Erlich RM,Cooper CS). 2002;25:1-8.
• Referans39 Burgers RE, Mugie SM, Chase J, et al. Management of functional constipation inchildren with lower urinary tract symptoms: report fromthe Standardization Committee of the International Children’sContinence Society. J Urol 2013;190:29-36.
• Referans40 Hagstroem S, Rittig N, Kamperis K, et al. Treatment outcome of day-time urinary incontinence in children. Scand J Urol and Nephrol 2008; 42:528–533.