Çocuklarda Mesane Çikiş Darliği: Posterior Üretral Valv
Özet
Posterior üretral valv (PUV), erkek çocuklarda konjenital alt üriner sistem obstrüksiyonunun en sık nedeni olup yaklaşık 1:7.000-8.000 canlı doğumda görülmektedir. Posterior üretrada lümeni tıkayan membranöz doku oluşumuyla karakterize olan bu anomali, sıklıkla mezonefrik kanal gelişim bozukluklarına dayanmaktadır. Prenatal ultrasonografide bilateral hidroüreteronefroz, distandü mesane, dilate posterior üretranın oluşturduğu "anahtar deliği" görünümü ve oligohidramniyoz tespiti PUV açısından kritik bulgulardır. Ağır vakalarda şiddetli oligohidramniyoza ikincil pulmoner hipoplazi, Potter sekansı ve kalıcı renal displazi gelişerek perinatal morbidite ve mortaliteye yol açabilmektedir. Tanıda prenatal ultrasonografi ve fetal idrar biyokimyasının yanı sıra postnatal dönemde ultrasonografi, işeme sistoüretrografisi (VSUG) ve radyonüklit sintigrafi yöntemleri (MAG-3, DMSA) kullanılır. Postnatal yönetimde bebek ilk olarak kateterizasyon ile stabilize edilerek sıvı-elektrolit dengesizlikleri ve ürosepsis tedavi edilir. Genel durumu uygun olan hastalarda temel tedavi seçeneği endoskopik valv ablasyonudur. Prematüre bebeklerde veya ablasyonun yetersiz kaldığı durumlarda ise vezikostomi veya üreterostomi gibi üriner diversiyon yöntemleri uygulanır. Uzun dönem takipte böbrek fonksiyonlarının korunması, idrar yolu enfeksiyonlarının önlenmesi, işeme disfonksiyonlarının ve mesane gelişiminin düzenli ürodinamik ve tıbbi izlemi hayati önem taşımaktadır.
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