Cystitis cystica and recurrent urinary tract infections in children [Cistični cistitis i opetovane infekcije mokraćnog sustava u djece]

Milošević, Danko and Batinić, Danica and Tešović, Goran and Konjevoda, Paško and Kniewald , Hrvoje and Šubat-Dežulović, Mirna and Grković, Lana and Topalović-Grković, Marija and Turudić, Daniel and Spajić, Borislav (2010) Cystitis cystica and recurrent urinary tract infections in children [Cistični cistitis i opetovane infekcije mokraćnog sustava u djece]. Collegium Antropologicum, 34 (3). pp. 893-897. ISSN 0350-6134

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Abstract

The pathogenesis of recurrent urinary tract infections (UTIs) in preschool children with anatomically correct urinary tract (UT) is rather obscure. In girls, the bladder wall changes of cystitis cystica (CC) may be per se responsible for UTIs recurrence. During the 20-year period, 127 preschool children (125 girls; median age: 6.1 years) with CC, in whom UT anomalies were excluded, were diagnosed. The mean duration of UTIs symptoms prior to diagnosis was 3.31 +/- 2.51 years. Cystoscopical findings were labelled as mild, moderate and severe in 22.8%, 39.4% and 37.8% of patients, respectively. Following the confirmation of CC, long-term chemoprophylaxis with sulfamethoxazole-trimethoprim/nitrofurantoin was administered. A one year UTI-free period after chemoprophylaxis discontinuation was defined as therapeutic success. With 2.5 years median duration of regular chemoprophylaxis this goal was achieved in 58 children mainly with mild/ moderate CC. Thirty children from "improved/unchanged" group taking regular prophylaxis had significant reduction of UTIs ("improved"). Only 12 children belonging to the same group taking regular prophylaxis and all children with irregular prophylaxis had approximately the same number of UTIs as before treatment ("unchanged"). The "improved/unchanged" outcomes were predominantly found in children with severe form of CC. Although urodynamic disturbances detected in more than 50% of patients in whom urodynamics was performed were not found influential on the disease outcome, they could be responsible for its development. The results of our study suggest that regular and long-lasting chemoprophylaxis remains a basis for successful treatment for majority of patients with CC, even those with severe forms. If not treated properly with chemoprophylactic agents and without fair compliance in taking drugs, the disease is prone to recurrent UTIs.

Abstract in Croatian

Uzrok ponavljanja infekcije mokraćnog sustava (IMS) u značajnog broja predškolske djece s anatomski normalnim urotraktom (UT) ostaje nerazjašnjen. U neke od ove djece, promjene sluznice mokraćnog mjehura koje nazivamo cistični cistitis (CC) mogu per se biti odgovorne za opetovanje IMS. Tijekom 20 godina CC smo dijagnosticirali u 127 predškolske djece urednog UT (djevojčice (125/127; medijan dobi: 6.1 godina). Trajanje rekurentnih IMS prije postavljanja dijagnoze CC iznosilo je prosječno 3,31±2,51 godine. Cistoskopski nalaz kategoriziran je kao blagi, umjereni i obilan (u 22,8%, 39,4%, odnosno 37,8% bolesnika). Nakon postavljanja dijagnoze u svih je bolesnika započeta kemoprofilaksa sulfametoksazol-trimetoprimom/nitrofurantoinom. Terapijski uspjeh definirali smo razdobljem od godinu dana bez pojave recidiva IMS nakon ukidanja kemoprofilakse, a postignut je u 58 djece s uglavnom blagim i umjerenim oblikom CC. Trajanje profilakse IMS prije postignutog izlječenja, iznosilo je 2,5 godine (medijan). Povoljan učinak redovitog uzimanja kemoprofilakse uočen je i u djece u koje izlječenje nije postignuto. U djece, s uglavnom obilnim nalazom CC (30/42), uočeno je smanjenje broja IMS (»poboljšani«), dok se u njih 12, broj IMS nije smanjio (»nepromijenjeni«). U svih 27 djece u kojih se profilaksa provodila neredovito, nije došlo do promjene broja recidiva IMS. Urodinamske promjene nađene su u više od polovice djece s CC u kojih je urodinamsko ispitivanje provedeno. Premda nije dokazan, barem djelomičan doprinos patoloških urodinamskih promjena u nastanku i podržavanju cističnog cistitisa, može se pretpostaviti. Na osnovu naših rezultata, zaključujemo kako je redovita kemoprofilaksa IMS u djevojčica s CC i anatomski normalnim UT osnovni preduvjet za njihovo sprječavanje. Neprovođenje redovite kemoprofilakse uzrokuje učestalo ponavljanje IMS u ove djece.

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