Kroni̇k Hastalığı Olan Çocuğun İzlemi̇ ve Toplumda Bakımı

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DOI :10.26650/B/CH32.2024.010.028   IUP :10.26650/B/CH32.2024.010.028    Tam Metin (PDF)

Mesane Di̇sfonksi̇yonu Olan Çocuğun İzlemi̇ ve Toplumda Bakımı

Zeynep Nagehan Yürük Yıldırım

Mesane disfonksiyonu çocuklarda sık görülen üriner sistem sorunlarındandır. Normal mesane fonksiyonunun gelişimi olgunlaşmayla ilişkili fizyolojik bir süreçtir. Bu sürecin sonunda çoğu çocuk sırasıyla dört ve beş yaşlarında gündüz ve gece mesane kontrolünü elde etmiştir. İdrar kaçırma, merkezi sinir sistemi ile omurilikteki otonom ve somatik sinirler arasındaki karmaşık ilişkiye bağlıdır. Mesanenin depolama ve/veya boşaltma fonksiyonlarının düzgün yapılamamasından kaynaklanır. Çocuklar kliniklere sıklıkla inkontinans şikayeti ile getirilirler. Klinik tablolar monosemptomatik nokturnal enüresis, aşırı aktif mesane, işeme erteleme, az aktif mesane, disfonksiyonel işeme, barsak ve mesane disfonksiyonu, olağanüstü gündüz sık idrara çıkma, gülme inkontinansı, vajinal reflü, primer mesane boynu disfonksiyonu şeklinde olabilir. Mesane disfonksiyonunun bazı tiplerinde tekrarlayan üriner sistem infeksiyonları, intravesikal basınç artışı ve sekonder vezikoüreteral reflü görülebilir. Bu durum renal hasarlanma ve böbrek yetersizliği gelişimine neden olabilir. Ayrıca çocuğun inkontinans durumu yaşam kalitesini etkileyebilir ve psikososyal sorunların ortaya çıkmasına yol açabilir. Bu nedenle tanının erken ve doğru konması ve erken tedavisini sağlamak önemlidir. Altta yatan etiyoloji; nörojenik nedenler (meningomyelosel, travma, spinal kord zedelenmesi vb), anatomik nedenler (ektopik üreter, yüksek dereceli vezikoüreteral reflü, posterior üretral valv vb) veya fonksiyonel (idiyopatik ya da altta yatan anatomik neden olmayan durumlar) nedenler olabilir. Fonksiyonel mesane disfonksiyonu düşünülmeden önce nörojenik ve anatomik nedenler dışlanmalıdır. Bu bölümde ağırlıklı olarak fonksiyonel mesane disfonksiyonlarına yer verilmiştir.


Anahtar Kelimeler: Mesane disfonksiyonu, işeme disfonksiyonu, inkontinans, aşırı aktif mesane, disfonksiyonel işeme
DOI :10.26650/B/CH32.2024.010.028   IUP :10.26650/B/CH32.2024.010.028    Tam Metin (PDF)

Follow-up and Community Care of the Child with Bladder Dysfunction

Zeynep Nagehan Yürük Yıldırım

Bladder dysfunction is one of the most common urinary tract disorders in children. The development of normal bladder function is a physiological process associated with maturation. At the end of this process, most children achieve daytime and nighttime bladder control at the age of 4 and 5 years, respectively. Urinary continence is dependent on the complex relationship between the central nervous system and the autonomic and somatic nerves in the spinal cord. Bladder dysfunction arises from the disruption of the storage and/or emptying function of the bladder. The clinical spectrum of bladder dysfunction has a broad range, including monosymptomatic nocturnal enuresis, overactive bladder, voiding postponement, underactive bladder, dysfunctional voiding, bowel–bladder dysfunction, extraordinary daytime frequency, giggle incontinence, vaginal reflux, and primary bladder neck dysfunction. Bladder dysfunction may cause renal scarring and renal function deterioration due to recurrent febrile urinary tract infections, secondary vesicoureteral reflux, and high intravesical pressure. In addition, incontinence may adversely affect the quality of life of the children and can cause psychosocial problems. Thus, prevention and/ or early detection and treatment of bladder dysfunction are important. The underlying causes of bladder dysfunction can be neurogenic (meningomyelocele, trauma, spinal cord injury, etc.), anatomical (ectopic ureter, high-grade vesicoureteral reflux, posterior urethral valve, etc.), or functional (idiopathic). Neurogenic and anatomical causes should be excluded before diagnosing functional bladder dysfunction. This section mainly focuses on functional bladder dysfunction.


Anahtar Kelimeler: Bladder dysfunction, voiding dysfunction, incontinence, overactive bladder, dysfunctional voiding

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