Hikaye ve Fizik Muayene
Özet
Alt üriner sistem semptomlarının (AÜSS) değerlendirilmesinde ilk basamak her zaman ayrıntılı hikâye ve fizik muayenedir. Hikâye; idrar kaçırma tipi, sıklığı, tetikleyici faktörler, eşlik eden cerrahi öykü, nörolojik sorunlar, kullanılan ilaçlar ve sıvı tüketim alışkanlıklarını kapsamalıdır. Stres tipi idrar kaçırma, öyküdeki tipik bulgularla yüksek olasılıkla tanınsa da tek başına kesin tanı koydurmaz. Aşırı aktif mesane varlığında sıkışma, sık işeme ve sıkışma tipi kaçırma öyküsü önemlidir. Ayrıca gastrointestinal ve cinsel fonksiyonların sorgulanması, altta yatan patolojinin anlaşılmasına katkı sağlar. Fizik muayene; genel durum, suprapubik bölge, genital muayene, pelvik taban fonksiyonu, pelvik organ sarkması değerlendirmesini içerir. Kadın hastalarda öksürük stres testi, Bonney ve Q-tip testleri üretral mobilite ve idrar kaçırmanın objektif doğrulanması için kullanılır. Pelvik taban kas gücü, tonusu ve gevşemesi vajinal palpasyonla değerlendirilebilir. Prolapsus varlığında POP-Q sistemi ile evreleme yapılmalıdır. Erkeklerde rektal muayene prostat hacmi ve tonus değerlendirmesi açısından önemlidir. Nörolojik muayene, sakral sinir köklerini ve refleksleri değerlendirerek nörojenik disfonksiyon varlığını ortaya koyar. Sonuç olarak, öykü ve muayenenin sistematik uygulanması AÜSS’nin doğru tanısı ve uygun tedavi planı için kritik öneme sahiptir.
Referanslar
D'Ancona C, et al. The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn. 2019;38(2): p. 433-477.
Arıkan N, Çetinel B, İlker Y, et al. ICS 2002 Terminoloji Standardizasyon Raporunun Kontinans Derneği Terminoloji Çalışma Grubu Tarafından Dilimize Uyarlama Çalışması, Kontinans Derneği Terminoloji Standardizasyon Raporu (15/4/2010).
Harding CK(Chair), Lapitan MC (Vice-chair), Arlandis S, et al. EAU Guidelines on Management of Non-Neurogenic Female Lower Urinary Tract Symptoms. 2024.
Cameron AP, Chung DE, Dielubanza EJ, et al. The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder. Journal of Urology. 2024 Jul 1;212(1):11–20.
Kobashi KC, Vasavada S, Bloschichak A, et al. Updates to Surgical Treatment of Female Stress Urinary Incontinence(SUI): AUA/SUFU Guideline (2023). Journal of Urology. 2023 Jun 1;209(6):1091–8.
Clemens JQ, Erickson DR, Varela NP, et al. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2022;208(1):34-42.
Fıne PM, Antonını TG, Appell RA, et al. Clinical Evaluation of Women With Lower Urinary Tract Dysfunction Clinical Obstetrics And Gynecology. 2004;47(1):44–52.
Portman DJ, Gass ML, et al. Vulvovaginal Atrophy Terminology Consensus Conference, Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the ISSWSH and NAMS. Climacteric. 2014;17(5): 557-63.
Holroyd-Leduc JM, et al. What type of urinary incontinence does this woman have? JAMA. 2008;299(12):1446-56.
Guralnick ML, et al. ICS Educational Module: Cough stress test in the evaluation of female urinary incontinence: Introducing the ICS-Uniform Cough Stress Test. Neurourol Urodyn. 2018;37(5):1849-1855.
Robinson, BL, et al. Diagnostic accuracy of visual urethral mobility exam versus Q-Tip test: a randomized crossover trial. Am J Obstet Gynecol. 2012;206(6):528.
Haylen BT, et al. An International Urogynecological Association (IUGA) / International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Organ Prolapse (POP). Neurourol Urodyn. 2016;35(2):137-68.
Deegan EG, et al. Quantification of pelvic floor muscle strength in female urinary incontinence: A systematic review and comparison of contemporary methodologies. Neurourol Urodyn. 2018;37(1):33-45.
Cornu JN (Chair), Gacci M, Hashim H, et al. EAU Guidelines on Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS). 2024.
Blok B (Chair), Castro-Diaz D, Del Popolo G, et al. EAU Guidelines on Neuro-Urology. 2024.
Cardozo L, Rovner E, WaggA, et al. Initial Assessment of Urinary Incontinence in Adult Male and Female Patients. Incontinence 7th Edition. 2023:411.
Referanslar
D'Ancona C, et al. The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn. 2019;38(2): p. 433-477.
Arıkan N, Çetinel B, İlker Y, et al. ICS 2002 Terminoloji Standardizasyon Raporunun Kontinans Derneği Terminoloji Çalışma Grubu Tarafından Dilimize Uyarlama Çalışması, Kontinans Derneği Terminoloji Standardizasyon Raporu (15/4/2010).
Harding CK(Chair), Lapitan MC (Vice-chair), Arlandis S, et al. EAU Guidelines on Management of Non-Neurogenic Female Lower Urinary Tract Symptoms. 2024.
Cameron AP, Chung DE, Dielubanza EJ, et al. The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder. Journal of Urology. 2024 Jul 1;212(1):11–20.
Kobashi KC, Vasavada S, Bloschichak A, et al. Updates to Surgical Treatment of Female Stress Urinary Incontinence(SUI): AUA/SUFU Guideline (2023). Journal of Urology. 2023 Jun 1;209(6):1091–8.
Clemens JQ, Erickson DR, Varela NP, et al. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2022;208(1):34-42.
Fıne PM, Antonını TG, Appell RA, et al. Clinical Evaluation of Women With Lower Urinary Tract Dysfunction Clinical Obstetrics And Gynecology. 2004;47(1):44–52.
Portman DJ, Gass ML, et al. Vulvovaginal Atrophy Terminology Consensus Conference, Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the ISSWSH and NAMS. Climacteric. 2014;17(5): 557-63.
Holroyd-Leduc JM, et al. What type of urinary incontinence does this woman have? JAMA. 2008;299(12):1446-56.
Guralnick ML, et al. ICS Educational Module: Cough stress test in the evaluation of female urinary incontinence: Introducing the ICS-Uniform Cough Stress Test. Neurourol Urodyn. 2018;37(5):1849-1855.
Robinson, BL, et al. Diagnostic accuracy of visual urethral mobility exam versus Q-Tip test: a randomized crossover trial. Am J Obstet Gynecol. 2012;206(6):528.
Haylen BT, et al. An International Urogynecological Association (IUGA) / International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Organ Prolapse (POP). Neurourol Urodyn. 2016;35(2):137-68.
Deegan EG, et al. Quantification of pelvic floor muscle strength in female urinary incontinence: A systematic review and comparison of contemporary methodologies. Neurourol Urodyn. 2018;37(1):33-45.
Cornu JN (Chair), Gacci M, Hashim H, et al. EAU Guidelines on Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS). 2024.
Blok B (Chair), Castro-Diaz D, Del Popolo G, et al. EAU Guidelines on Neuro-Urology. 2024.
Cardozo L, Rovner E, WaggA, et al. Initial Assessment of Urinary Incontinence in Adult Male and Female Patients. Incontinence 7th Edition. 2023:411.
