Anoreksiya Nervoza Tanısı Alan Ergenlerde Mesane ve İşeme Disfonksiyonunun Değerlendirilmesi

Abstract

Studies have shown that protein-energy malnutrition in adolescents with anorexia nervosa (AN) is an under-recognized cause of muscle dysfunction. However, the detrusor instability in adolescents with AN has never, to our knowledge, been examined. In this study it was aimed to assess the bladder capacity (BC) and bladder dynamics, and to investigate the detrusor dysfunction of adolescents with AN. Adolescents diagnosed with AN according to the DSM-5 criteria between April and December 2016 were included in the study. Symptoms of voiding dysfunction and incontinence were questioned. Both functional bladder capacity and the voided volume in uroflowmetry were measured and the larger one was accepted to stand for the BC. BC within 50-115 % of the expected bladder capacity (EBC) for age was considered to be normal whereas BC < 50% of the EBC and >115% of the EBC were considered decreased and increased, respectively. Uroflowmetry curves except bell-shaped ones were deemed as pathologic and voiding patterns were interpreted for each patient. A total of fifteen patients, 66.6% (n=10) female and 33.4% (n=5) male adolescents, were included in the study and their mean age was 15+1.2 (12.25-16.75) years and mean BMI was 16.9+2.9 (13.2-23.7) kg/m2. At least one Lower Urinary Tract dysfunction symptom was observed in 93.3% (n=14) and BC was increased in 86.6% (n=13) of the patients. It was found that the other two patients could not cooperate to wait for a full bladder. The uroflowmetry curve of the 80% (n=12) of the patients was evaluated to be pathological. Girls with pathologic uroflowmetry (n=7) were all found to be amenorrhoeic. On the other hand, all male patients’ (n=5) uroflowmetry curves were found to be pathological. Pathological uroflowmetry curves showed that, during voiding, the patients’ bladder muscles were not able to contract or relax the urethra sufficiently. No statistically significant relationship was observed between the pathological features of the uroflowmetry curves and gender, duration of illness, BMI, body weight change rate during the illness, constipation, and amenorrhea (p> 0.05). Increased BC and pathological uroflowmetry curves in adolescents with AN during the acute weight deteriorated phase of the disease indicate a causal relationship between detrussor muscle pathology and AN. These results warrant that clinicians who work with adolescents with AN should screen for Lower Urinary Tract dysfunction and investigate bladder dynamics by uroflowmetry, a noninvasive method, when indicated.