Travmatik beyin hasarlı olgularda ürodinamik bulgular

Özet

Amaç: Bu çalışmada travmatik beyin hasarlı (TBH) hastalarda ürodinamik bulgulardan hareketle alt üriner sistem disfonksiyonunun özelliklerinin incelenmesi amaçlandı. Gereç ve Yöntem: Nörojenik alt üriner sistem fonksiyon bozukluğu olan TBH’li 30 hasta (25 erkek, 5 kadın) retrospektif olarak incelendi. Ürodinamik inceleme yapıldı, maksimum sistometrik kapasite, rezidü idrar, depolama (mesane kapasitesi50 ml) varlığı, mesane doluluk duyusu, detrüsör aktivitesi ve mesane boşaltım yöntemi belirlendi. Bulgular: Hastaların yaş ortalaması 31,9±16,3 yıl, maksimum sistometrik kapasite ortalama değeri 228±155 ml idi. ‹şeme sonrası rezidü idrar hastaları n 15’inde mevcuttu ve rezidü idrar ortalama değeri 128±143 ml olarak saptandı. Hastaların 16’sında (%55,2) mesane doluluk duyusu normal, 11’inde (%37,9) azalmış, 2’sinde (%6,9) ise kayıptı. Hastaların 20’sinde (%66,7) depolama sorunu, 8’inde (%26,7) ise boşaltma sorunu olduğu saptandı, 4’ünde (%13,3) ise hem depolama hem de boşaltma sorunu mevcuttu. Hastaların 3’ü (%10) normoaktif, 23’ü (%76,7) hiperaktif, 4’ü (%13,3) ise hipoaktif detrüsöre sahipti. Hastaların 25’i (%83,3) mesanesini spontan olarak boşaltırken, 4’ü (%13,3) temiz aralıklı kateterizasyon, 1’i ise (%3,3) kalıcı üretral kateter uygulamakta idi. Mesanesini spontan boşaltan 25 hastanın 9’u (%36) kondom ürinale, 2’si (%8) bez kullanmaktaydı. Antikolinerjik/antispazmodik tedavi verilerek kontrol ürodinamisi yapılan 9 hasta incelendiğinde, tedavi öncesi ve sonrası maksimum sistometrik kapasite ortanca değerleri sırasıyla 99 (min: 48-max: 420) ve 158 (min: 52-max: 448) ml olarak saptandı. Dokuz hastanın sekizinde sistometrik kapasitede artış gözlendi. Sonuç: TBH’li hastalarda çoğunlukla detrüsör aşırı aktivitesine bağlı mesane depolama bozukluğu sık görülmektedir. Hastaların çok büyük bölümünde mesane doluluk duyusu en azından kısmen korunmuştur ve yine hastaların büyük çoğunluğu spontan idrar yapabilmektedir. Türk Fiz Tıp Rehab Derg 2011;57:80-4.

Abstract

Objective: The aim of this study was to investigate the urodynamic findings and characteristics of lower urinary tract dysfunction in patients with traumatic brain injury (TBI). Materials and Methods: Thirty patients (25 male, 5 female) with TBI, who had neurogenic lower urinary tract dysfunction, were investigated retrospectively. Urodynamic examinations were performed, maximum cystometric capacity, residual urine, presence of storage dysfunction (bladder capacity50 ml), and presence of bladder filling sensation, type of detrusor activity and bladder emptying method were determined Results: The mean age of the subjects was 31.9±16.3 years. The mean maximum cystometric capacity was 228±155 ml. Postvoiding residual urine was present in 15 patients and the mean residual urine was 128±143 ml. Bladder filling sensation was normal in 16 (55.2%), diminished in 11(37.9%) and was absent in 2(6.9%). Frequencies of storage and emptying dysfunctions were 20 (66.7%) and 8 (26.7%), respectively and 4 patients (13.3%) had both storage and emptying dysfunctions. Three patients (10%) had normoactive, 23 (76.7%) had overactive and 4 (13.3%) had underactive detrusor. Twenty-five patients (83%) were emptying their bladder spontaneously, 4 (13.3%) by intermittent catheterization and 1(3.3%) by indwelling catheter. Nine (36%) of the 25 patients who were emptying their bladder spontaneously were using urinary condom, 2 (8%) were using diapers. In the evaluation of nine patients who were given anticholinergic/antispasmodic therapy and had control urodynamic investigation pre- and post-treatment, the median values of cystometric capacities were 99 (min: 48-max: 420) and 158 (min: 52-max: 448) ml, respectively. Increase in cystometric capacity was observed in eight of nine patients. Conclusion: Bladder storage dysfunction is frequent in patients with TBI which is mainly due to detrusor overactivity. Bladder filling sensation was present at least to some degree in the great majority of them and again, a great majority of the patients were able to void spontaneously. Turk J Phys Med Rehab 2011;57:80-4.