Çocuk Yaş Grubu Nörojenik Alt Üriner Sistem İşlev Bozuklukları
Özet
Nörojenik mesane (NM); serebral korteks, medulla spinalis veya periferik sinir sistemi lezyonlarına bağlı oluşan mesane-sfinkter disfonksiyonudur. Akkiz veya çoğunlukla konjenital sebeplere bağlı olarak gelişebilir. Çocukluk dönemi NM hastalarının çoğunluğunu oluşturan nöral tüp kapanma defektleri (spinal disrafizm-miyelodisplazi) farklı klinik spektrumlarla ve dinamik bir süreçle ilerleyebildiği için tüm olgularda tedavinin bireyselleştirilmesi ve ömür boyu yakın izlem gereklidir. Modern NM tedavi yaklaşımında amaç üst üriner sistemin korunması, alt üriner sistem fonksiyonlarının düzenlenerek üriner enfeksiyon ve semptomların kontrolü, idrar ve gaita kontinansının sağlanarak sosyal uyumun gerçekleştirilmesidir. Spinal disrafizm hastalarının yenidoğan döneminden başlayarak değerlendirilmesi, erken dönemde ürodinami yapılıp üst üriner sistemin risk altında olduğu çocukların belirlenmesi, erken temiz aralıklı kateterizasyon (TAK) başlanıp mesane içi basıncının-rezidüel idrarın azaltılması yani proaktif yaklaşım, beraberinde mesane botoks uygulamalarındaki başarı, ile renal hasarın engellenmesi ve ogmentasyon sistoplasti gibi morbiditesi yüksek operasyonların geciktirilmesi-önlenmesi için umut verici klinik sonuçlar sağlanmıştır.
Referanslar
Bellinger MF, Schnek FX. Neurovesical dysfunction and disordered micturition in children. In Adult and Pediatric Urology. Gillenwater JY, Grayhack JT, Howards SS, Mitchell M (editors), Lippincott Williams and Wilkins Company, Philadelphia, U.S.A. 4th edition. 2002. Vol 3. pages 2319-2357.
MacLellan DL, Bauer SB. Neuropathic dysfunction of the lower urinary tract. In Campbell’s Urology, Wein AJ (editor in chief), Saunders Company, Philadelphia, U.S.A. 10th edition. 2012. Chapter 128.pages 3431-3456.
Radmayr C(Chair), Bogaert G, (Vice-chair), Bujons A, et al. EAU Guidelines on Paediatric Urology. Management of neurogenic bladder. Limited Update April 2024. pg 54-66.
Kelly MS, Benninga MA, Yang SS, et al. Pediatric neurogenic bowel dysfunction: ICCS review document. J Pediatr Urol. 2023 Jun;19(3):232-239. doi: 10.1016/j.jpurol.2023.01.015. Epub 2023 Jan 31. PMID: 36828731.
Elzeneini W, Waly R, Marshall D, Bailie A. Early start of clean intermittent catheterization versus expectant management in children with spina bifida. J Pediatr Surg. 2019 Feb;54(2):322-325. doi: 10.1016/j.jpedsurg.2018.10.096. Epub 2018 Nov 5. PMID: 30558962.
Li Y, Stern N, Wang PZ, Braga LH, Dave S. Systematic review and meta-analysis to study the outcomes of proactive versus delayed management in children with a congenital neurogenic bladder. J Pediatr Urol. 2023 Dec;19(6):730-741. doi: 10.1016/ j.jpurol.2023.08.033. Epub 2023 Sep 7.
Lee AS, Viseshsindh W, Long CJ, et al. How early is early? Effect of oxybutynin on bladder dynamics within the first year of life in patients with spina bifida. J Pediatr Urol. 2020 Apr;16(2):168.e1-168.e6. doi: 10.1016/j.jpurol. 2019.12.008. Epub 2019 Dec 20.PMID: 32115375.
Brownrigg N, Lorenzo AJ, Rickard M, Dos Santos J. The urological evaluation and management of neurogenic bladder in children and adolescents-what every pediatric nephrologist needs to know. Pediatr Nephrol. 2024 Feb;39(2):409-421. doi: 10.1007/s00467-023-06064-z. Epub 2023 Jul 31.PMID: 375184.
Kim JK, De Jesus MJ, Lee MJ, et al. β3-Adrenoceptor Agonist for the Treatment of Bladder Dysfunction in Children: A Systematic Review and Meta-Analysis. J Urol. 2022 Mar;207(3):524-533. doi: 10.1097/JU.0000000000002361. Epub 2021 Dec 1.PMID: 34850638.
10.Alshammari D, Yadav P, Ahmad I, et al. Intradetrusor Versus Suburothelial Onabotulinum Toxin A in Adults with Neurogenic and Non-neurogenic Overactive Bladder Syndrome: A Meta-Analysis. Arch Esp Urol. 2024 May;77(4):368-377. doi: 10.56434/j.arch.esp.urol.20247704.50.
He G, Shen N, Feng S. Botulinum toxin A for the treatment of neurogenic bladder in children: systematic review and meta-analysis. ANZ J Surg. 2024 Nov 11. doi: 10.1111/ans.19309. Online ahead of print.
Gurocak S, Nuininga J, Ure I, De Gier RP, Tan MO, Feitz W. Bladder augmentation: Review of the literature and recent advances.Indian J Urol. 2007 Oct;23(4):452-7. doi: 10.4103/0970-1591.36721.
Ludwikowski BM, Bieda JC, Lingnau A, González R. Surgical Management of Neurogenic Sphincter Incompetence in Children.Front Pediatr. 2019 Mar 26;7:97. doi: 10.3389/fped.2019.00097. eCollection 2019.PMID: 30984720
Johnston AW, Wiener JS, Todd Purves J. Pediatric Neurogenic Bladder and Bowel Dysfunction: Will My Child Ever Be out of Diapers? Eur Urol Focus. 2020 Sep 15;6(5):838-867. doi: 10.1016/j.euf.2020.01.003. Epub 2020 Jan 22.PMID: 31982364.
St-Laurent MP, Chavez-Munoz C, Black PC. Is engineered tissue the future of bladder Reconstruction. Con. Eur Urol Focus. 2024 Jul;10(4):668-669. doi: 10.1016/j.euf.2023.10.008. Epub 2023 Oct 21. PMID: 3787208.
Nassiri N, Cacciamani G, Gill IS. Robotic bladder autotransplantation: preclinical studies in preparation for first-inhuman bladder transplant. J Urol 2023;210:600–10.
Referanslar
Bellinger MF, Schnek FX. Neurovesical dysfunction and disordered micturition in children. In Adult and Pediatric Urology. Gillenwater JY, Grayhack JT, Howards SS, Mitchell M (editors), Lippincott Williams and Wilkins Company, Philadelphia, U.S.A. 4th edition. 2002. Vol 3. pages 2319-2357.
MacLellan DL, Bauer SB. Neuropathic dysfunction of the lower urinary tract. In Campbell’s Urology, Wein AJ (editor in chief), Saunders Company, Philadelphia, U.S.A. 10th edition. 2012. Chapter 128.pages 3431-3456.
Radmayr C(Chair), Bogaert G, (Vice-chair), Bujons A, et al. EAU Guidelines on Paediatric Urology. Management of neurogenic bladder. Limited Update April 2024. pg 54-66.
Kelly MS, Benninga MA, Yang SS, et al. Pediatric neurogenic bowel dysfunction: ICCS review document. J Pediatr Urol. 2023 Jun;19(3):232-239. doi: 10.1016/j.jpurol.2023.01.015. Epub 2023 Jan 31. PMID: 36828731.
Elzeneini W, Waly R, Marshall D, Bailie A. Early start of clean intermittent catheterization versus expectant management in children with spina bifida. J Pediatr Surg. 2019 Feb;54(2):322-325. doi: 10.1016/j.jpedsurg.2018.10.096. Epub 2018 Nov 5. PMID: 30558962.
Li Y, Stern N, Wang PZ, Braga LH, Dave S. Systematic review and meta-analysis to study the outcomes of proactive versus delayed management in children with a congenital neurogenic bladder. J Pediatr Urol. 2023 Dec;19(6):730-741. doi: 10.1016/ j.jpurol.2023.08.033. Epub 2023 Sep 7.
Lee AS, Viseshsindh W, Long CJ, et al. How early is early? Effect of oxybutynin on bladder dynamics within the first year of life in patients with spina bifida. J Pediatr Urol. 2020 Apr;16(2):168.e1-168.e6. doi: 10.1016/j.jpurol. 2019.12.008. Epub 2019 Dec 20.PMID: 32115375.
Brownrigg N, Lorenzo AJ, Rickard M, Dos Santos J. The urological evaluation and management of neurogenic bladder in children and adolescents-what every pediatric nephrologist needs to know. Pediatr Nephrol. 2024 Feb;39(2):409-421. doi: 10.1007/s00467-023-06064-z. Epub 2023 Jul 31.PMID: 375184.
Kim JK, De Jesus MJ, Lee MJ, et al. β3-Adrenoceptor Agonist for the Treatment of Bladder Dysfunction in Children: A Systematic Review and Meta-Analysis. J Urol. 2022 Mar;207(3):524-533. doi: 10.1097/JU.0000000000002361. Epub 2021 Dec 1.PMID: 34850638.
10.Alshammari D, Yadav P, Ahmad I, et al. Intradetrusor Versus Suburothelial Onabotulinum Toxin A in Adults with Neurogenic and Non-neurogenic Overactive Bladder Syndrome: A Meta-Analysis. Arch Esp Urol. 2024 May;77(4):368-377. doi: 10.56434/j.arch.esp.urol.20247704.50.
He G, Shen N, Feng S. Botulinum toxin A for the treatment of neurogenic bladder in children: systematic review and meta-analysis. ANZ J Surg. 2024 Nov 11. doi: 10.1111/ans.19309. Online ahead of print.
Gurocak S, Nuininga J, Ure I, De Gier RP, Tan MO, Feitz W. Bladder augmentation: Review of the literature and recent advances.Indian J Urol. 2007 Oct;23(4):452-7. doi: 10.4103/0970-1591.36721.
Ludwikowski BM, Bieda JC, Lingnau A, González R. Surgical Management of Neurogenic Sphincter Incompetence in Children.Front Pediatr. 2019 Mar 26;7:97. doi: 10.3389/fped.2019.00097. eCollection 2019.PMID: 30984720
Johnston AW, Wiener JS, Todd Purves J. Pediatric Neurogenic Bladder and Bowel Dysfunction: Will My Child Ever Be out of Diapers? Eur Urol Focus. 2020 Sep 15;6(5):838-867. doi: 10.1016/j.euf.2020.01.003. Epub 2020 Jan 22.PMID: 31982364.
St-Laurent MP, Chavez-Munoz C, Black PC. Is engineered tissue the future of bladder Reconstruction. Con. Eur Urol Focus. 2024 Jul;10(4):668-669. doi: 10.1016/j.euf.2023.10.008. Epub 2023 Oct 21. PMID: 3787208.
Nassiri N, Cacciamani G, Gill IS. Robotic bladder autotransplantation: preclinical studies in preparation for first-inhuman bladder transplant. J Urol 2023;210:600–10.
