Sık İdrar Yolu Enfeksiyonu ile Başvuran 7 Yaşında Kız Olgu
Özet
Yedi yaşındaki kız hasta, sık idrar yolu enfeksiyonu (İYE), gece ve gündüz idrar kaçırma ile Rome IV kriterlerine uyan fonksiyonel kabızlık şikayetleriyle kliniğe başvurmuştur. Hastanın laboratuvar tetkiklerinde hemogram, böbrek ve karaciğer fonksiyon testleri ile idrar kültürü normal saptanmıştır. Hastanın geçmişinde antenatal hidronefroz bulunmadığı, ancak yaklaşık on kez ateşli ve ateşsiz İYE geçirdiği, idrar kaçırma ve dışkı tutma davranışları sergilediği belirtilmiştir. Yapılan ileri incelemeler doğrultusunda, üriner ultrasonografide işeme sonrası 46 cc rezidü idrar miktarı saptanmış; DMSA renal sintigrafisinde sol böbrekte hafif düzeyde parankimal skar oluşumu izlenmiştir. Böbrekteki skarın değerlendirilmesi amacıyla çekilen işeme sistoüretrografisinde (İSUG) ise sol tarafta evre 3 vezikoüreteral reflü (VUR) saptanmıştır. Yapılan EMG'li üroflovmetri sonucunda disfonksiyonel işeme tablosu kesinleşen hastaya, VUR ve kabızlığın da eşlik ettiği "Mesane Bağırsak Disfonksiyonu" (MBD) tanısı konulmuştur. Tedavi planlamasında, hastaya sıvı alımı ve işeme eğitimi ile birlikte biofeedback destekli üroterapi verilmiş, kabızlığın çözümü için kapsamlı diyet önerileriyle farmakolojik tedaviye başlanmıştır. Uygulanan bu multidisipliner yaklaşımdan tam fayda sağlayan hastanın takip sürecinde yeni bir İYE geçirmediği saptanmış, yapılan kontrol İSUG incelemesinde reflünün tamamen kaybolması üzerine antibiyotik profilaksisi güvenle sonlandırılmıştır.
A seven-year-old female patient presented to the clinic with complaints of frequent urinary tract infections (UTIs), day and night urinary incontinence, and functional constipation meeting the Rome IV criteria. The patient's laboratory tests, including complete blood count, kidney and liver function tests, and urine culture, were found to be normal. She had no history of antenatal hydronephrosis, but had experienced approximately ten febrile and afebrile UTIs, demonstrating urinary incontinence and stool withholding behaviors. Following further evaluations, a post-void residual urine volume of 46 cc was detected on urinary ultrasonography, and a mild parenchymal scar was observed in the left kidney on DMSA renal scintigraphy. To evaluate the renal scar, a voiding cystourethrogram (VCUG) was performed, which revealed stage 3 vesicoureteral reflux (VUR) on the left side. Dysfunctional voiding was confirmed by EMG-uroflowmetry, leading to the diagnosis of "Bladder and Bowel Dysfunction" (BBD) accompanied by VUR and constipation. In the treatment plan, the patient received urotherapy supported by biofeedback along with fluid intake and voiding training, and pharmacological treatment was initiated with comprehensive dietary recommendations to resolve constipation. Benefiting fully from this multidisciplinary approach, the patient did not experience any new UTIs during follow-up, and antibiotic prophylaxis was safely discontinued after the control VCUG showed complete resolution of the reflux.
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