{"id":1449,"date":"2026-05-07T10:40:36","date_gmt":"2026-05-07T07:40:36","guid":{"rendered":"https:\/\/gynaikologos-komotini.gr\/?p=1449"},"modified":"2026-05-07T11:49:11","modified_gmt":"2026-05-07T08:49:11","slug":"asiri-aktif-mesane","status":"publish","type":"post","link":"https:\/\/gynaikologos-komotini.gr\/tr\/asiri-aktif-mesane\/","title":{"rendered":"A\u015f\u0131r\u0131 Aktif Mesane"},"content":{"rendered":"\t\t
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A\u015f\u0131r\u0131 aktif mesane (AAM), artm\u0131\u015f idrara \u00e7\u0131kma s\u0131kl\u0131\u011f\u0131 (g\u00fcnde 8\u2019den fazla idrara \u00e7\u0131kma) ve nokt\u00fcri (gece 1\u2019den fazla idrara \u00e7\u0131kma) ile birlikte g\u00f6r\u00fclen ani idrar yapma hissi ile karakterizedir ve buna s\u0131k\u0131\u015fma tipi idrar ka\u00e7\u0131rma e\u015flik edebilir. Bu nedenle, idrar ka\u00e7\u0131rman\u0131n olup olmamas\u0131na g\u00f6re \u201c\u0131slak\u201d veya \u201ckuru\u201d tip olarak s\u0131n\u0131fland\u0131r\u0131l\u0131r. A\u015f\u0131r\u0131 aktif mesane \u015f\u00fcphesi bulunan durumlarda tan\u0131sal de\u011ferlendirme, miks tip idrar ka\u00e7\u0131rma incelemesi kapsam\u0131nda yap\u0131l\u0131r.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Konservatif \u00d6nlemler<\/strong><\/p>

E\u015flik eden di\u011fer hastal\u0131klar\u0131n d\u00fczeltilmesinin AAM semptomlar\u0131n\u0131 iyile\u015ftirdi\u011fini destekleyen kan\u0131tlar olmamas\u0131na ra\u011fmen, hastan\u0131n kulland\u0131\u011f\u0131 ve AAM\u2019ye neden olabilecek veya k\u00f6t\u00fcle\u015ftirebilecek ila\u00e7lar\u0131n yeniden de\u011ferlendirilmesi \u00f6nerilir. \u0130drar ka\u00e7\u0131rma pedleri idrar kayb\u0131n\u0131 kontrol etmeye yard\u0131mc\u0131 olur; \u00f6zel durumlarda gerekti\u011finde aral\u0131kl\u0131 kendi kendine kateterizasyon veya kal\u0131c\u0131 kateter de kullan\u0131labilir.<\/p>

Bir\u00e7ok \u00e7al\u0131\u015fmada g\u00fcnl\u00fck kafein al\u0131m\u0131n\u0131n azalt\u0131lmas\u0131 semptomlar\u0131 azaltm\u0131\u015ft\u0131r, ancak \u00e7al\u0131\u015fmalar\u0131n heterojenli\u011fi nedeniyle bu k\u0131s\u0131tlama i\u00e7in g\u00fc\u00e7l\u00fc kan\u0131t bulunmamaktad\u0131r.<\/p>

Y\u00fcksek g\u00fcvenilirli\u011fe sahip randomize bir \u00e7al\u0131\u015fmada, g\u00fcnl\u00fck s\u0131v\u0131 al\u0131m\u0131n\u0131n %25 azalt\u0131lmas\u0131 AAM semptomlar\u0131n\u0131 iyile\u015ftirmi\u015f, ancak e\u015flik eden s\u0131k\u0131\u015fma tipi idrar ka\u00e7\u0131rmay\u0131 iyile\u015ftirmemi\u015ftir.<\/p>

Genel olarak, g\u00fcnl\u00fck s\u0131v\u0131 al\u0131m\u0131n\u0131n 2 litrenin alt\u0131na d\u00fc\u015f\u00fcr\u00fclmesi s\u0131k\u0131\u015fma tipi idrar ka\u00e7\u0131rmaya yard\u0131mc\u0131 olur ve nokt\u00fcri varsa son s\u0131v\u0131 al\u0131m\u0131 ge\u00e7 \u00f6\u011fleden sonra yap\u0131lmal\u0131d\u0131r. Mesaneyi uyaran asidik i\u00e7eceklerin (gazl\u0131 i\u00e7ecekler gibi) ve di\u00fcretik etkisi olan, detr\u00fcs\u00f6r kas\u0131 instabilitesine ve a\u015f\u0131r\u0131 aktif mesane sendromuna neden olan kafeinin (<1\u20132 fincan kahve \/ 200 mg\/g\u00fcn) azalt\u0131lmas\u0131 \u00f6nerilir.<\/p>

Kilo kayb\u0131, stres tipi idrar ka\u00e7\u0131rmas\u0131 olan kad\u0131nlarda AAM ve s\u0131k\u0131\u015fma tipi idrar ka\u00e7\u0131rmaya g\u00f6re daha faydal\u0131d\u0131r; bu nedenle sonu\u00e7lar s\u0131n\u0131rl\u0131 olabilir.<\/p>

Sigaran\u0131n b\u0131rak\u0131lmas\u0131n\u0131n etkisi belirsizdir.<\/p>

Ba\u015flang\u0131\u00e7ta her 15\u201330 dakikada bir mesanenin bo\u015falt\u0131lmas\u0131 ve zamanla bu s\u00fcrenin 2\u20133 saate \u00e7\u0131kar\u0131lmas\u0131 \u015feklindeki mesane e\u011fitimi, s\u0131k idrara \u00e7\u0131kma ve s\u0131k\u0131\u015fma tipi idrar ka\u00e7\u0131rmaya yard\u0131mc\u0131 olur. Zamanl\u0131 i\u015feme, g\u00fcn\u00fcn b\u00fcy\u00fck b\u00f6l\u00fcm\u00fcnde mesanenin bo\u015f kalmas\u0131na yard\u0131mc\u0131 olur ve bir\u00e7ok kad\u0131nda mesanedeki idrar miktar\u0131 belirli bir hacmi a\u015ft\u0131\u011f\u0131nda ortaya \u00e7\u0131kan efor s\u0131ras\u0131nda idrar ka\u00e7\u0131rmay\u0131 azalt\u0131r.<\/p>

Pelvik taban kas egzersizleri baz\u0131 \u00e7al\u0131\u015fmalarda AAM semptomlar\u0131n\u0131 (s\u0131kl\u0131k ve s\u0131k\u0131\u015fma tipi ka\u00e7\u0131rma) \u00f6nemli \u00f6l\u00e7\u00fcde azalt\u0131rken, di\u011ferlerinde terap\u00f6tik fayda g\u00f6stermemi\u015ftir. Bu \u00e7eli\u015fkinin nedeni, \u00e7al\u0131\u015fmalarda kullan\u0131lan egzersiz protokollerinin farkl\u0131 olmas\u0131d\u0131r.<\/p>

Posterior Tibial Sinir Stim\u00fclasyonu<\/strong><\/p>

Posterior tibial sinir stim\u00fclasyonu hem afferent hem de efferent sinir liflerini etkiler. Efferent uyar\u0131 ayak ba\u015fparma\u011f\u0131nda fleksiyona neden olurken, afferent uyar\u0131 ayak taban\u0131nda kar\u0131ncalanma hissi olu\u015fturur. Stim\u00fclasyon teorisi, sempatik ve parasempatik sinir u\u00e7lar\u0131 aras\u0131ndaki \u00e7apraz ileti\u015fim sonucu geli\u015fen n\u00f6romod\u00fclasyona dayan\u0131r ve bu durum idrar yapma refleksiyle ili\u015fkili sinir sinyallerinde de\u011fi\u015fikli\u011fe yol a\u00e7ar.<\/p>

34G\u2019lik bir i\u011fne, medial malleol\u00fcn \u00fc\u00e7 parmak yukar\u0131s\u0131na, tibian\u0131n arka y\u00fczeyi ile soleus kas\u0131 aras\u0131na yerle\u015ftirilir. Ama\u00e7, i\u011fne ucunun posterior tibial sinire temas etmeden ona yak\u0131n olmas\u0131d\u0131r. Genel ba\u015far\u0131 (ya\u015fam kalitesinde art\u0131\u015f ve tedaviye devam etme iste\u011fi olarak tan\u0131mlanan) hastalar\u0131n %56\u201363\u2019\u00fcnde g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Objektif ba\u015far\u0131 (ani s\u0131k\u0131\u015fma ve s\u0131k\u0131\u015fma tipi ka\u00e7\u0131rma ataklar\u0131nda %50\u2019den fazla azalma ve g\u00fcnd\u00fcz\/gece idrara \u00e7\u0131kma s\u0131kl\u0131\u011f\u0131nda %25 azalma olarak tan\u0131mlanan) toplamda hastalar\u0131n %33\u201371\u2019inde g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Ancak s\u0131k n\u00fcksler nedeniyle, tedavi seans protokollerinin daha iyi netle\u015ftirilmesi gerekmektedir.<\/p>

Sakral Sinir Stim\u00fclasyonu<\/strong><\/p>

Sakral sinirler, sakral omurgaya yerle\u015ftirilen ve ge\u00e7ici bir denemeden sonra kal\u0131c\u0131 implant olarak b\u0131rak\u0131lan bir pil arac\u0131l\u0131\u011f\u0131yla uyar\u0131l\u0131r. Bu y\u00f6ntem, mesanenin dolma ve bo\u015falma ile ilgili patolojik reflekslerini bask\u0131lar. Sakral sinir stim\u00fclasyonu (SNS), kombine idrar ve d\u0131\u015fk\u0131 ka\u00e7\u0131rma vakalar\u0131nda veya kronik sinir yetersizli\u011fine ba\u011fl\u0131 sfinkter eksikli\u011fi bulunan durumlarda \u00e7ok iyi sonu\u00e7lar (%62) g\u00f6stermektedir.<\/p>

Mesane duvar\u0131na yap\u0131lan botulinum toksin A enjeksiyonlar\u0131, antimuskarinik ila\u00e7lardan daha etkilidir (%27\u2019ye kar\u015f\u0131 %13) ve idrar tutma kontrol\u00fcnde daha iyi sonu\u00e7lar sa\u011flar (%5\u2019e kar\u015f\u0131 %0).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Farmakolojik Tedavi<\/strong><\/p>

Antikolinerjik (Antimuskarinik) \u0130la\u00e7lar<\/strong><\/p>

Bu ila\u00e7lar tercih edilen tedavilerdir; iyile\u015fme oranlar\u0131 d\u00fc\u015f\u00fck olsa da plaseboya k\u0131yasla \u00e7ok daha iyi sonu\u00e7 verirler. Bu ila\u00e7lar ilgili resept\u00f6rleri bloke ederek mesane a\u015f\u0131r\u0131 aktivitesini azalt\u0131r ve b\u00f6ylece s\u0131k\u0131\u015fma tipi idrar ka\u00e7\u0131rma semptomlar\u0131n\u0131 iyile\u015ftirir.<\/p>

Bu gruptaki ila\u00e7lar aras\u0131nda darifenacin, fesoterodine (Toviaz), flavoxate, oxybutynin (Ditropan), phenylpropanolamine, pilocarpine, propantheline, propiverine, solifenacin (Vesicare, Sivenacin), tolterodine (DETRUSITOL, DETRULET, DETRULON, CINTEROL) ve trospium bulunmaktad\u0131r. Bu ila\u00e7lar\u0131n miks tip idrar ka\u00e7\u0131rmada etkin oldu\u011funu g\u00f6steren \u00e7al\u0131\u015fmalar vard\u0131r.<\/p>

Ancak y\u00fcksek kaliteli iki \u00e7al\u0131\u015fma, uzun s\u00fcreli antikolinerjik kullan\u0131m ile bili\u015fsel bozukluklar aras\u0131nda ili\u015fki g\u00f6stermi\u015ftir.<\/p>

\u03b2<\/strong>3-Adrenerjik Resept\u00f6r Agonistleri<\/strong><\/p>

\u03b23-adrenerjik resept\u00f6r agonistleri, mesane detr\u00fcs\u00f6r kas\u0131ndaki \u03b23 resept\u00f6rlerini aktive ederek kas gev\u015femesi ve mesane kapasitesinde art\u0131\u015f sa\u011flar. Bu gruba, s\u0131k\u0131\u015fma tipi ka\u00e7\u0131rma ataklar\u0131n\u0131, i\u015feme hacmini ve nokt\u00fcriyi iyile\u015ftiren yeni bir ila\u00e7 olan mirabegron (Betmiga) dahildir.<\/p>

Bu ila\u00e7, antikolinerjikler kadar etkilidir; en s\u0131k g\u00f6r\u00fclen yan etkileri hipertansiyon, nazofarenjit ve idrar yolu enfeksiyonlar\u0131d\u0131r. \u00c7al\u0131\u015fmalar, solifenacin 5 mg (Vesicare) tedavisinin ba\u015far\u0131s\u0131z oldu\u011fu durumlarda mirabegron 50 mg ile kombinasyonun, solifenacin dozunu art\u0131rmaktan daha etkili oldu\u011funu g\u00f6stermi\u015ftir.<\/p>

Menopozun genito\u00fcriner sendromunda, alt \u00fcriner sistem semptomlar\u0131n\u0131n e\u015flik etti\u011fi durumlarda lokal \u00f6strojen kullan\u0131m\u0131 da faydal\u0131d\u0131r.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Genel Sonu\u00e7<\/strong><\/p>

Genel olarak tercih edilen tedavi \u00f6ncelikle konservatif tedavidir; mesane e\u011fitimi ve ya\u015fam tarz\u0131 de\u011fi\u015fiklikleriyle (kahve, kilo, s\u0131v\u0131 al\u0131m\u0131) ba\u015flan\u0131r. Daha sonra antikolinerjikler veya mirabegron ile ila\u00e7 tedavisi uygulan\u0131r. Bunlar\u0131n ba\u015far\u0131s\u0131z olmas\u0131 durumunda posterior tibial sinir stim\u00fclasyonu veya implantlarla sakral sinir stim\u00fclasyonu faydal\u0131 olabilir. Daha ileri a\u015famada botulinum toksin A uygulanabilir; ancak bunun tekrarlayan uygulamalar gerektirdi\u011fi, idrar yolu enfeksiyonu riskini art\u0131rd\u0131\u011f\u0131 ve bazen mesane kateterizasyonu gerekebilece\u011fi hastaya anlat\u0131lmal\u0131d\u0131r.<\/p>

stimulation or sacral nerve stimulation with implants may be useful, and later botulinum toxin A injections, while informing patients that repeat treatments are required, with increased risks of urinary tract infections and possibly bladder catheterization.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

A\u015f\u0131r\u0131 aktif mesane (AAM), artm\u0131\u015f idrara \u00e7\u0131kma s\u0131kl\u0131\u011f\u0131 (g\u00fcnde 8\u2019den fazla idrara \u00e7\u0131kma) ve nokt\u00fcri (gece 1\u2019den fazla idrara \u00e7\u0131kma) ile birlikte g\u00f6r\u00fclen ani idrar yapma [\u2026]<\/span><\/p>\n","protected":false},"author":3,"featured_media":-1,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[81,78],"tags":[82,83],"class_list":["post-1449","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-inkontinans","category-jinekoloji","tag-asiri-aktif-mesane","tag-nokturi"],"yoast_head":"\nA\u015f\u0131r\u0131 Aktif Mesane - \u0391\u03bb\u03ad\u03be\u03b1\u03bd\u03b4\u03c1\u03bf\u03c2 \u039c\u03ac\u03b9\u03bd\u03b1\u03c2 MD, PhD<\/title>\n<meta name=\"description\" content=\"A\u015f\u0131r\u0131 aktif mesane (AAM), artm\u0131\u015f idrara \u00e7\u0131kma s\u0131kl\u0131\u011f\u0131 (g\u00fcnde 8\u2019den fazla idrara \u00e7\u0131kma) ve nokt\u00fcri (gece 1\u2019den fazla idrara \u00e7\u0131kma) ile birlikte g\u00f6r\u00fclen ani idrar yapma hissi ile karakterizedir ve buna s\u0131k\u0131\u015fma tipi idrar ka\u00e7\u0131rma e\u015flik edebilir.\" \/>\n<meta name=\"robots\" content=\"noindex, follow\" \/>\n<meta property=\"og:locale\" content=\"tr_TR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"A\u015f\u0131r\u0131 Aktif Mesane - 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