Sekiz Aylık Huzursuzluk ve İdrarda Kötü Koku ile Başvuran Kız Olgu
Özet
Bu vaka sunumunda, sekiz aylık bir kız hastanın huzursuzluk ve idrarda kötü koku şikayetiyle başvurusu üzerine yapılan tetkikler ve tedavi süreci ele alınmaktadır. Fiziksel muayenesi normal olan ve laboratuvar sonuçlarında yüksek CRP ile idrar yolu enfeksiyonu (İYE) saptanan hastaya intravenöz seftriakson tedavisi başlanmış ve ardından profilaktik trimetoprim-sulfametoksazol tedavisine geçilmiştir. Çekilen işeme sistoüretrografisinde (İSUG) vezikoüreteral reflü izlenmemiştir. Ultrasonografide (USG) sağ böbrekte pelvikaliksiyel dilatasyon, parankimal incelme ve üreter dilatasyonu saptanması üzerine, ayırıcı tanı amacıyla Tc 99m-MAG-3 böbrek sintigrafisi çekilmiş ve sağ böbrekte ekskresyon fonksiyonunda uzama ile staz saptanmıştır. Bu bulgular ışığında hastaya üreterovezikal bileşke darlığı (primer obstrüktif megaüreter) teşhisi konulmuştur. Yaşının küçük olması ve sintigrafide kısmi ekskresyon bulunması nedeniyle cerrahi müdahale uygulanmadan iki ayda bir USG ile izleme alınan hastanın, takibinin 22. ayında hidroüreteronefrozunun tamamen gerilediği ve böbrek boyutlarının normale döndüğü saptanmıştır. Makalede ayrıca üreterovezikal bileşke darlıklarının çoğunlukla peristaltik olmayan fonksiyonel bir segmentten kaynaklandığı, çocukluk çağı obstrüktif üropatilerinin yaklaşık %25'ini oluşturduğu ve olguların çoğunda cerrahi gerekmeksizin spontan rezolüsyon gösterdiği literatür bilgileriyle desteklenerek vurgulanmaktadır.
In this case report, the examination and treatment process of an eight-month-old female patient presenting with restlessness and foul-smelling urine are presented. The patient, whose physical examination was normal and whose laboratory results indicated a urinary tract infection with high CRP, was initiated on intravenous ceftriaxone therapy followed by prophylactic trimethoprim-sulfamethoxazole. No vesicoureteral reflux was detected on the voiding cystourethrography (VCUG). Due to the presence of pelvicalyceal dilatation, parenchymal thinning, and ureteral dilatation in the right kidney on ultrasonography (USG), a Tc 99m-MAG-3 renal scintigraphy was performed for differential diagnosis, revealing prolonged excretion and stasis in the right kidney. Based on these findings, the patient was diagnosed with ureterovesical junction obstruction (primary obstructive megaureter). Because of her young age and the partial excretion observed on scintigraphy, she was monitored with USG every two months without surgical intervention, and by the 22nd month of follow-up, her hydroureteronephrosis had completely resolved with renal dimensions returning to normal. The article also emphasizes that ureterovesical junction obstructions mostly stem from an aperistaltic functional segment, constitute approximately 25% of pediatric obstructive uropathies, and resolve spontaneously in most cases without requiring surgery.
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