Urinary Tract Infection (UTI) (Urinary infection)
While cystitis, or bladder infection, is a milder problem, usually without fever, pyelonephritis, or kidney infection, is a much more serious disease with fever. . The importance of febrile UTI in children is that it causes serious and permanent damage to the kidney. Urinary infection in a child is not considered a disease by itself. It is mostly the result of an existing problem in the urinary system. It is necessary to investigate the cause of these serious infections that cause kidney damage and to identify the underlying disease. Vesicoureteral reflux, hydroureteronephrosis, neuropathic bladder or bladder-bowel dysfunction are most commonly associated with UTI.
Enuresis (Bed Wetting) (Urinary Incontinence Under Sleep at Night)
It is called Enuresis when the child involuntarily and unconsciously wets the bed with urine during sleep.
Enuresis is a genetically inherited disorder. There are organic problems in enuresis. The cause of enuresis is organic, not psychological, but if it is not treated, their psychology will deteriorate. In other words, psychological problems are a consequence of enuresis, not a cause. Enuresis is not the fault of the family or the fault of the child, but it is a problem that needs to be treated.
Due to the production of more urine than normal at night as a result of low secretion of antidiuretic hormone at night or the heavy sleep due to the overactive bladder being small for age at night, bladder fullness is not felt during sleep, and the child who is stuck in urine urinates reflexively before waking up. It is associated with a delay in maturation of organs that control the bladder and urine.
Detailed anamnesis and questioning with structured scales or forms are very important. In addition, detailed examination of the child's abdomen, back, perianal and genital area is very important. Bladder ultrasound and voiding test can provide important information, especially in children with accompanying daytime problems.
Bladder-Bowel-Sphincter Disorder (Pelvic Floor Dysfunction) (Voiding Dysfunction)
Incorrectly acquired poor voiding in neurologically normal children during the toilet habit acquisition period occurs as a result of habit. It is common in primary school children. It is the most common cause of urinary incontinence in children.
Daytime voiding disorder in a single patient It can be a symptom of many problems, not just one. It may be accompanied by urinary infection, vesicoureteral reflux and constipation, mostly with voiding disorder.
There are signs of urgency and urinary retention (incontinence) and impaired urination. Recurrent urinary tract infections occur frequently.
The bladder becomes smaller or too large. Intra-bladder pressure rises. My work is disrupted. It cannot fully relax its sphincter during voiding. The bladder is not fully emptied and residual urine remains.
Clinical complaints should be questioned in detail with symptom scale, careful abdominal, back, anus and neurological examination, urinary ultrasound and urination test (uroflowmeter) should be performed.
Simple behavioral treatments and toilet habits we call urotherapy should be done. Most can be fixed with the right arrangement. However, sometimes drug therapy or even surgical treatment may be required.
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The lower urinary system should be evaluated as a whole; The condition of the bladder, bladder neck, sphincter, urethra, and rectum should be considered. These structures should be evaluated not only in terms of anatomy, but also in terms of maturation, i.e. development, maturation and function (working).
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Urinary infection should be questioned about the child's urination and defecation both day and night. During the examination, the examination of the back and genital area should not be forgotten. Both empty and full bladder, ureters, and rectum should also be evaluated on urinary ultrasound.
Medical or surgical treatment should not be performed without rehabilitating the bladder because it may fail. We cannot give medicine to children for life; Rational eating and toilet habits should be made a way of life. Pelvic floor muscles should be trained and developed in children older than 5 years whose mental motor development is appropriate.
Neuropathic (Neurogenous) Bladder
(Neuropathic Bladder-Bowel-Sphincter Dysfunction)
Neuropathic bladder is the malfunctioning of the bladder due to congenital or subsequent damage to the nervous system. In neuropathic disorder, the relationship between the bladder and the sphincter is disrupted.
As age progresses, pathology increases and serious damage occurs. Therefore, follow-up and treatment should be started from the neonatal period.
In pregnancy, Folic acid deficiency may lead to these anomalies. The most common causes are the mass holding the nerves in the lumbar region called Myelomeningocele and closed nerve disorders called Spina bifida. disruption occurs.
In most of them, the diagnosis is made by seeing a mass and disorder in the lumbar region with examination. However, the type and severity of the disorder should be determined with important tests.
Neuropathic bladder is a very serious disease that needs to be followed and treated for life. The main goal in these children is to preserve kidney function and restore bladder function. A large capacity and low pressure bladder is created to protect the kidneys. Also, around the age of 5, when bladder development is complete, the bladder outlet is narrowed to stop urinary incontinence.
Is the doctor's experience important?
Because it is a very complex disease group, complications can be significantly reduced if experienced specialists who have received the necessary specific training are treated and followed. This serious disease requires many different branches to work together.
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