Disfonksiyonel işemeli çocuklarda üriner biofeedback tedavisinin
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Tarih
2014
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Özet: Giriş: İşeme disfonksiyonları (İD), çocuk üroloji polikliniklerindeki hastaların yaklaşık %40’ını oluşturan
oldukça yaygın bir problemdir. Üroflometri tanı ve takipte kullanılabilen non invaziv bir testtir. Bu çalışmada,
İD tedavisinde aktif pelvik taban kaslarının (PTK) gevşetilmesini amaçlayan biofeedback ve Kegel egzersizleri
kombinasyon tedavisinin etkinliğini göstermeyi amaçladık.
Gereç ve Yöntem: Bu retrospektif çalışma da elektromyografi (EMG)’li üroflometride ile işeme esnasında
EMG’de PTK aktif olarak saptanan İD tanısı konan hastalar çalışmaya dahil edildi. İşeme paternleri stacatto,
interrupted, plato ve normal olarak sınıflandırıldı. Biofeedback tedavisinde çocuklara gluteal ve karın kaslarını
kullanmadan sadece sfinkter kontraksiyonu yapması öğretildi. Her seans 3 saniye kontraksiyon ve 10 sn
gevşeme peryotları şeklinde 10 dakika uygulandı. Ayrıca kombine tedavi olarak Kegel egzersizleriyle aktif PTK
gevşetilmesi öğretildi. Sonrasında evlerinde egzersizlere, günde 2 defa 10’ar dakika 3 sn sıkma 10 sn gevşeme
seanslarına ebeveyn gözetiminde 6 ay boyunca devam edildi.
Bulgular: Gündüz idrar kaçırması, ani işeme ihtiyacı, kaka yapmada zorluk, gece idrar kaçırması, tekrarlayan
İYE, işeme esnasında ıkınma şikayetleriyle başvuran 150 hastadan EMG’li üroflometrilerinde aktif PTK tespit
edilen 78 hasta İD tanısıyla çalışmaya dahil edildi. Olguların yaşları 6 ile 17 yıl arasında değişmekte olup,
ortalama yaş 6,5 yıl idi. Olguların 31 (%39,7)’i erkek, 47 (%60,3)’si kız idi. Üroflometride 78 hastanın; 37
(%47,4) staccato, 24 (%30,7) normal, 12 (%15,3) plato ve 5 (%6,4)’inde interrupted işeme paternleri saptandı. 6
aylık tedavi sonrasında uykuda işeme şikayeti olan olguların %68,8’inde, urge inkontinanslıların %72,8’inde,
tekrarlayan idrar yolu enfeksiyonluların %81’inde, kabızlığı olanların %85’inde, vezikoüreteralreflüsü
olanların %77’inde, rezidü idrar saptanan olguların %79’unda tam düzelme sağlandı.
Sonuç: İD kliniğine kabızlık, üriner inkontinans, enürezis noktürna, tekrarlayan idrar yolu enfeksiyonları eşlik
edebilir. Dikkatli bir planlama ve düzenli kontrollerle 5 yaş ve üzeri çocuklarda uygulanacak biofeedback ve
Kegel egzersizlerinin kombine tedavisi ile hastaların çoğunu bir kısmını tedavi edebiliriz.
Abstract: Aim: Voiding dysfunction (VD) are the most common problem among patients admitted to pediatric urology outpatient clinic which account for 40% of total admissions. Uroflowmeter is a noninvasive tool used for diagnosis and follow up. We aimed to demonstrate the effectiveness of biofeedback and Kegel exercises in the treatment of VD by using uroflowmeter. Material-Method: A total of 78 patients diagnosed as VD using uroflowmeteri with electromyography (EMG) were enrolled to this retrospective study. Voiding pattern of the patients was categorized into four; stacatto, interrupted, plato and normal. Children were asked to make sphincter contraction without gluteal or abdominal muscles according to the feedback treatment. Each seans was performed for 10 minutes with cyclic 3 seconds of contraction and 10 seconds of relaxation periods. In addition, Kegel exercises were teached to children by a physiotherapist in order to relax pelvic base muscles(PBM) actively. Later on parents were encouraged to continue this 10 minutes contractionrelaxation exercise twice a day for 6 months. Results: Ages of 78 patients with VD were in a range between 6 to 17 years, and with a median age of 6.5 years. Thirty-one patients were male, 47 were female. On uroflowmeter, 37 (47%) patients were voiding in staccato pattern, 24 (31%) in normal pattern, 12 (15%) in plato pattern and 5 (6%) in interrupted pattern. Complete improvement was observed in 69% of patients with enuresis nocturna, 73% of patients with urgency incontinence, 81% of patients with recurrent urinary tract infection, 85% of patients with constipation, 77% of patients with vesicourethral reflux, and 79% of patients with residual urine at 6 months after treatment. Conclusion: Urinary incontinence, enuresis nocturna, recurrent urinary tract infection and constipation may accompany to VD. Significant improvement in VD of the children above 5 years of age can be achieved with planning and combination of biofeedback and Kegel exercises with regular followup.
Abstract: Aim: Voiding dysfunction (VD) are the most common problem among patients admitted to pediatric urology outpatient clinic which account for 40% of total admissions. Uroflowmeter is a noninvasive tool used for diagnosis and follow up. We aimed to demonstrate the effectiveness of biofeedback and Kegel exercises in the treatment of VD by using uroflowmeter. Material-Method: A total of 78 patients diagnosed as VD using uroflowmeteri with electromyography (EMG) were enrolled to this retrospective study. Voiding pattern of the patients was categorized into four; stacatto, interrupted, plato and normal. Children were asked to make sphincter contraction without gluteal or abdominal muscles according to the feedback treatment. Each seans was performed for 10 minutes with cyclic 3 seconds of contraction and 10 seconds of relaxation periods. In addition, Kegel exercises were teached to children by a physiotherapist in order to relax pelvic base muscles(PBM) actively. Later on parents were encouraged to continue this 10 minutes contractionrelaxation exercise twice a day for 6 months. Results: Ages of 78 patients with VD were in a range between 6 to 17 years, and with a median age of 6.5 years. Thirty-one patients were male, 47 were female. On uroflowmeter, 37 (47%) patients were voiding in staccato pattern, 24 (31%) in normal pattern, 12 (15%) in plato pattern and 5 (6%) in interrupted pattern. Complete improvement was observed in 69% of patients with enuresis nocturna, 73% of patients with urgency incontinence, 81% of patients with recurrent urinary tract infection, 85% of patients with constipation, 77% of patients with vesicourethral reflux, and 79% of patients with residual urine at 6 months after treatment. Conclusion: Urinary incontinence, enuresis nocturna, recurrent urinary tract infection and constipation may accompany to VD. Significant improvement in VD of the children above 5 years of age can be achieved with planning and combination of biofeedback and Kegel exercises with regular followup.
Açıklama
Anahtar Kelimeler
Disfonksiyonel işeme, Üriner biofeedback, Voiding dysfunction, Urinary biofeedback
Kaynak
Tıp Araştırmaları Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
12
Sayı
3
Künye
Okur, M. H., Arslan, M. Ş., Aydoğdu, B., Arslan, S., Zeytun, H., Basuguy, E. ve diğerleri. (2014). Disfonksiyonel işemeli çocuklarda üriner biofeedback tedavisinin. Tıp Araştırmaları Dergisi, 12(3), 108-112.
