Nörolojik Hastalıklarda İşeme ve Defekasyon Bozuklukları
Özet
Nörolojik hastalıklar, sfinkter kontrolünü sağlayan otonom ve somatik sinir sistemindeki koordinasyon bozukluklarına bağlı olarak işeme ve defekasyon disfonksiyonlarına yol açmaktadır. Mesane ve bağırsak yönetiminde tanısal incelemelerle (ürodinami, sistometri) temellendirilen tedavi yaklaşımları; davranışsal terapiler, kateterizasyon, medikal ilaç tedavileri, botulinum toksin uygulamaları ve ileri aşamalarda cerrahi müdahaleleri içermektedir. Bu süreçlerdeki temel hedef, nörolojik hasara bağlı gelişen inkontinans, retansiyon veya hiperaktif mesane gibi komplikasyonların yönetilerek hastanın yaşam kalitesinin artırılmasıdır.
Neurological diseases lead to urination and defecation dysfunctions due to coordination disorders in the autonomic and somatic nervous systems that regulate sphincter control. Treatment approaches for bladder and bowel management, based on diagnostic evaluations such as urodynamics and cystometry, include behavioral therapies, catheterization, medical therapy, botulinum toxin injections, and surgical interventions in advanced stages. The primary goal of these processes is to manage complications such as incontinence, retention, or overactive bladder caused by neurological damage, thereby improving the patient's quality of life.
Referanslar
Ruffion A, Castro-Diaz D, Patel H, et al. Systematic review of the epidemiology of urinary incontinence and detrusor overactivity among patients with neurogenic overactive bladder. Neuroepidemiology. 2013;41(3-4):146-155.
Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. Jan 2003;61(1):37-49.
Kohli N, Patterson D. InterStim Therapy: A Contemporary Approach to Overactive Bladder. Reviews in obstetrics & gynecology. Winter 2009;2(1):18-27.
Cortes GA, Flores JL. Physiology, Urination. StatPearls. Treasure Island (FL)2021.
Yao J, Zhang Q, Liao X, et al. A corticopontine circuit for initiation of urination. Nature neuroscience. Nov 2018;21(11):1541-1550.
Cetinel B, Tarcan T, Demirkesen O, et al. Management of lower urinary tract dysfunction in multiple sclerosis: a systematic review and Turkish consensus report. Neurourology and urodynamics. Nov 2013;32(8):1047-1057.
Siegel AL. Pelvic floor muscle training in males: practical applications. Urology. Jul 2014;84(1):1-7.
Li L, Ye W, Ruan H, Yang B, Zhang S. Impact of hydrophilic catheters on urinary tract infections in people with spinal cord injury: systematic review and meta-analysis of randomized controlled trials. Archives of physical medicine and rehabilitation. Apr 2013;94(4):782-787.
Sarica S, Akkoc Y, Karapolat H, Aktug H. Comparison of the use of conventional, hydrophilic and gel-lubricated catheters with regard to urethral micro trauma, urinary system infection, and patient satisfaction in patients with spinal cord injury: a randomized controlled study. European journal of physical and rehabilitation medicine. Dec 2010;46(4):473-479.
Madhuvrata P, Singh M, Hasafa Z, Abdel-Fattah M. Anticholinergic drugs for adult neurogenic detrusor overactivity: a systematic review and meta-analysis. European urology. Nov 2012;62(5):816-830.
Madersbacher H, Murtz G, Stohrer M. Neurogenic detrusor overactivity in adults: a review on efficacy, tolerability and safety of oral antimuscarinics. Spinal cord. Jun 2013;51(6):432-441.
Nitti VW, Rosenberg S, Mitcheson DH, He W, Fakhoury A, Martin NE. Urodynamics and safety of the beta(3)-adrenoceptor agonist mirabegron in males with lower urinary tract symptoms and bladder outlet obstruction. The Journal of urology. Oct 2013;190(4):1320-1327.
Gaziev G, Topazio L, Iacovelli V, et al. Percutaneous Tibial Nerve Stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions: a systematic review. BMC urology. Nov 25 2013;13:61.
Mangera A, Apostolidis A, Andersson KE, et al. An updated systematic review and statistical comparison of standardised mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders. European urology. May 2014;65(5):981-990.
Ardelt PU, Woodhouse CR, Riedmiller H, Gerharz EW. The efferent segment in continent cutaneous urinary diversion: a comprehensive review of the literature. BJU international. Jan 2012;109(2):288-297.
Mawer S, Alhawaj AF. Physiology, Defecation. StatPearls. Treasure Island (FL)2021.
Coggrave M, Wiesel PH, Norton C. Management of faecal incontinence and constipation in adults with central neurological diseases. The Cochrane database of systematic reviews. Apr 19 2006(2):CD002115.
Vande Velde S, Van Renterghem K, Van Winkel M, De Bruyne R, Van Biervliet S. Constipation and fecal incontinence in children with cerebral palsy. Overview of literature and flowchart for a stepwise approach. Acta gastro-enterologica Belgica. Jul-Sep 2018;81(3):415-418.
