Çocuklarda İşeme Bozuklukları
Özet
Çocuklarda işeme bozuklukları; olgunlaşmamış mesane, anormal işeme alışkanlıkları ve idrar sfinkter işlev bozukluğundan kaynaklanan, hafif belirtilerden tekrarlayan idrar yolu enfeksiyonları (İYE), hidronefroz, vezikoüreteral reflü (VUR) ve böbrek hasarına kadar değişen klinik bulgularla ortaya çıkan durumlardır. Normal işeme döngüsü düşük basınçlı dolma ve tam boşalma aşamalarından oluşur; çocukların çoğu 4 yaşına geldiğinde erişkin tipi işeme modelini kazanır. Alt üriner sistem disfonksiyonları kapsamında gündüz veya gece idrar kaçırma (inkontinans) ile enürezis tanımlanmaktadır. Bu bozukluklar etiyolojik açıdan düşük ve yüksek riskli nedenler olarak iki grupta değerlendirilir. Gündüzleri sık idrara çıkma sendromu, işeme sonrası idrar damlatma (vajinal işeme), gülme inkontinansı, stres üriner inkontinansı, aşırı aktif mesane ve primer noktürnal enürezis düşük riskli durumlar arasında yer almaktadır. Buna karşılık disfonksiyonel eliminasyon sendromu, nörojenik olmayan nörojenik mesane (Hinman sendromu), posterior üretral valvler ve nörospinal disrafizm gibi patolojiler üst üriner sistem bozulma riski taşıyan yüksek riskli nedenlerdir. Hastaların değerlendirilmesinde ayrıntılı tıbbi öykü, iki günlük işeme günlüğü ve fizik muayene temel tanı araçlarıdır; gerekli vakalarda tam idrar tahlili, idrar kültürü, ultrasonografi, direkt karın grafisi, VCUG, MRG ve ürodinamik çalışmalardan yararlanılır. Tedavi yönetiminde zamanlı işeme, ikili işeme, diyet düzenlemeleri, bağırsak programı ve biofeedback gibi davranışsal müdahaleler ilk basamağı oluşturur. Dirençli ya da özel durumlarda antikolinerjikler, alfa-adrenerjik ajanlar, imipramin, desmopressin ve antibiyotikler gibi farmakolojik tedaviler ile temiz aralıklı kateterizasyon ve cerrahi girişimler tercih edilmektedir.
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