Suprapontin ve Pontin Nörojenik Hastalıklar
Özet
Serebrovasküler olay (SVO) veya inme, fokal bir nörolojik hasarın akut başlangıcı olarak tanımlanan özellikle ileri yaştaki hastaları etkileyen, serebral emboli veya aterosklerotik trombüs gibi tıkayıcı bir olaydan veya kanamadan kaynaklanan ciddi bir sağlık sorunudur. SVO sonrası alt üriner sistem işlev bozukluğu yaşanması sıklığı %37- %79 arasındadır ve inme sonrası gelişen nörojenik alt üriner sistem işlev bozukluklarının patogenezi mesane kontrolünü sağlayan nöral yolakların kesintiye uğraması ile ilişkilidir. SVO sonrası en fazla üzerinde durulan, en rahatsız edici alt üriner sistem semptomu idrar kaçırma olsa da kesitsel araştırmalara göre inme geçiren hastalarda noktüri, aciliyet hissi ve gün içinde sık idrara çıkma gibi alt üriner sistem semptomları (AÜSS) da sık görülür. Akut üriner retansiyon da serebrovasküler olaydan hemen sonra sık görülmektedir. Retansiyona sebep olan detrusor arefleksisinin nörofizyolojik temeli tam olarak bilinmemekle birlikte bu duruma serebral şok denmektedir. Serebrovasküler olay sonrası hastanın tedavisi multidisipliner yaklaşımla gerçekleştirilmelidir. Üriner retansiyon görülmesi durumunda temiz aralıklı kataterizasyon veya kalıcı sonda kullanımı önerilirken, idrar kaçırmanın geleneksel tedavisi uyarlanabilir. Mevcut tedaviler çevre ve yaşam tarzı değişiklikleri, mesane eğitimi, zamanlı işeme, temiz aralıklı katater kullanımı ve anikolinerjik veya beta 3 agonist ilaç kullanımıdır. Eğer davranış terapileri ve medikal tedavi başarısız olursa, cerrahi tedavi seçenekleri; sakral sinir stimülasyonu veya mesane augmentasyonu gibi yöntemlerdir.
Referanslar
Marinkovic SP, Badlani G. Voiding and sexual dysfunction after cerebrovascular accidents. The Journal of urology. 2001;165(2):359-70.
Mehdi Z, Birns J, Bhalla A. Post‐stroke urinary incontinence. International Journal of Clinical Practice. 2013;67(11):1128-37.
Rotar M, Blagus R, Jeromel M, Škrbec M, Tršinar B, Vodušek DB. Stroke patients who regain urinary continence in the first week after acute first‐ever stroke have better prognosis than patients with persistent lower urinary tract dysfunction. Neurourology and urodynamics. 2011;30(7):1315-8.
Agapiou E, Pyrgelis E-S, Mavridis IN, Meliou M, Wimalachandra WSB. Lower urinary tract dysfunction following stroke: From molecular mechanisms to clinical anatomy. Journal of Biological Methods. 2024;11(4): e99010024.
Han KS, Heo SH, Lee SJ, Jeon SH, Yoo KH. Comparison of urodynamics between ischemic and hemorrhagic stroke patients; can we suggest the category of urinary dysfunction in patients with cerebrovascular accident according to type of stroke? Neurourology and Urodynamics: Official Journal of the International Continence Society. 2010;29(3):387-90.
Tibaek S, Gard G, Klarskov P, Iversen HK, Dehlendorff C, Jensen R. Prevalence of lower urinary tract symptoms (LUTS) in stroke patients: a cross‐sectional, clinical survey. Neurourology and Urodynamics: Official Journal of the International Continence Society. 2008;27(8):763-71.
Moussa M, Papatsoris A, Abou Chakra M, Fares Y, Dellis A. Lower urinary tract dysfunction in common neurological diseases. Turkish journal of urology. 2020;46(Suppl 1):S70.
Gelber DA, Good DC, Laven LJ, Verhulst SJ. Causes of urinary incontinence after acute hemispheric stroke. Stroke. 1993;24(3):378-82.
Thomas LH, Coupe J, Cross LD, Tan AL, Watkins CL. Interventions for treating urinary incontinence after stroke in adults. Cochrane Database of Systematic Reviews. 2019(2).
Patel M, Coshall C, Rudd AG, Wolfe CD. Natural history and effects on 2-year outcomes of urinary incontinence after stroke. Stroke. 2001;32(1):122-7.
Williams MP, Srikanth V, Bird M, Thrift AG. Urinary symptoms and natural history of urinary continence after first-ever stroke—a longitudinal population-based study. Age and Ageing. 2012;41(3):371-6.
Williams JE, Perry L, Watkins C. Acute stroke nursing: Wiley Online Library; 2010.
Finazzi-Agrò E. Conservative management of adult neurogenic lower urinary tract dysfunction. European Journal of Physical and Rehabilitation Medicine. 2017;53(6):981-90.
Kuo HC. Lower urinary tract dysfunction in the central nervous system neurogenic bladder and the real-life treatment outcome of botulinum toxin A. Tzu Chi Med J. 2024 May 24;36(3):260-270.
Rasmussen NT, Guralnick ML, O'Connor RC. Successful use of sacral neuromodulation after failed bladder augmentation. Can Urol Assoc J. 2009 Oct;3(5): E49-50.
Referanslar
Marinkovic SP, Badlani G. Voiding and sexual dysfunction after cerebrovascular accidents. The Journal of urology. 2001;165(2):359-70.
Mehdi Z, Birns J, Bhalla A. Post‐stroke urinary incontinence. International Journal of Clinical Practice. 2013;67(11):1128-37.
Rotar M, Blagus R, Jeromel M, Škrbec M, Tršinar B, Vodušek DB. Stroke patients who regain urinary continence in the first week after acute first‐ever stroke have better prognosis than patients with persistent lower urinary tract dysfunction. Neurourology and urodynamics. 2011;30(7):1315-8.
Agapiou E, Pyrgelis E-S, Mavridis IN, Meliou M, Wimalachandra WSB. Lower urinary tract dysfunction following stroke: From molecular mechanisms to clinical anatomy. Journal of Biological Methods. 2024;11(4): e99010024.
Han KS, Heo SH, Lee SJ, Jeon SH, Yoo KH. Comparison of urodynamics between ischemic and hemorrhagic stroke patients; can we suggest the category of urinary dysfunction in patients with cerebrovascular accident according to type of stroke? Neurourology and Urodynamics: Official Journal of the International Continence Society. 2010;29(3):387-90.
Tibaek S, Gard G, Klarskov P, Iversen HK, Dehlendorff C, Jensen R. Prevalence of lower urinary tract symptoms (LUTS) in stroke patients: a cross‐sectional, clinical survey. Neurourology and Urodynamics: Official Journal of the International Continence Society. 2008;27(8):763-71.
Moussa M, Papatsoris A, Abou Chakra M, Fares Y, Dellis A. Lower urinary tract dysfunction in common neurological diseases. Turkish journal of urology. 2020;46(Suppl 1):S70.
Gelber DA, Good DC, Laven LJ, Verhulst SJ. Causes of urinary incontinence after acute hemispheric stroke. Stroke. 1993;24(3):378-82.
Thomas LH, Coupe J, Cross LD, Tan AL, Watkins CL. Interventions for treating urinary incontinence after stroke in adults. Cochrane Database of Systematic Reviews. 2019(2).
Patel M, Coshall C, Rudd AG, Wolfe CD. Natural history and effects on 2-year outcomes of urinary incontinence after stroke. Stroke. 2001;32(1):122-7.
Williams MP, Srikanth V, Bird M, Thrift AG. Urinary symptoms and natural history of urinary continence after first-ever stroke—a longitudinal population-based study. Age and Ageing. 2012;41(3):371-6.
Williams JE, Perry L, Watkins C. Acute stroke nursing: Wiley Online Library; 2010.
Finazzi-Agrò E. Conservative management of adult neurogenic lower urinary tract dysfunction. European Journal of Physical and Rehabilitation Medicine. 2017;53(6):981-90.
Kuo HC. Lower urinary tract dysfunction in the central nervous system neurogenic bladder and the real-life treatment outcome of botulinum toxin A. Tzu Chi Med J. 2024 May 24;36(3):260-270.
Rasmussen NT, Guralnick ML, O'Connor RC. Successful use of sacral neuromodulation after failed bladder augmentation. Can Urol Assoc J. 2009 Oct;3(5): E49-50.
