Stres üriner inkontinans tedavisinde transobturator tape operasyonu etkinliğinin değerlendirilmesi ve uzun dönem sonuçları
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Tarih
2016
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info:eu-repo/semantics/openAccess
Özet
Amaç: Stres üriner inkontinansın tedavisinde birçok cerrahi yöntem tanımlanmıştır. Ancak altın standart yöntem belirlenememiştir. Bu çalışmanın amacı stres tipte idrar kaçırması olan kadın hastalarda transobturator tape prosedürünün etkinliğini incelemek, intraoperatif ve postoperatif komplikasyon sıklığını belirlemek, hastaların objektif ve sübjektif kür sonuçlarını belirlemektir. Hastalar ve Yöntem: Çalışmamıza Ocak 2010-Aralık 2014 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Hastanesi Kadın Hastalıkları ve Doğum Kliniğine üriner inkontinans şikayeti ile başvuran ve SÜİ veya MÜİ tanısı ile TOT operasyonu geçiren 46 hasta dahil edildi. Hastaların yaş ortalaması 46,35±9,27 (26-67) idi. Hastaların operasyon öncesi demografik özellikleri, fizik ve pelvik muayene bulguları, Q tip testi, stres testi, yaşam kalite anket skorları (İncontinence İmpact Questionnaire (IIQ-7) ve Urinary Distres İnventory (UDI-6)) kaydedilmişti. İntraoperatif komplikasyonları, erken postoperatif ve geç postoperatif komplikasyonları kaydedilmişti. Ortalama takip süresi 32,13±12,038 ay (12-60) olan hastalar telefonla aranarak çalışma hakkında bilgi verildi. Çalışmaya katılmayı kabul eden hastalar çağrıldı. Hastalar stres test, hasta şikayetleri, pelvik muayene, Q tip test, yaşam kalite skorları ve komplikasyonlar açısından tekrar değerlendirildi. Operasyon öncesi ve sonrası sonuçlar karşılaştırıldı. Bulgular: Operasyona alınan 46 hastadan 30'unda (%65,2) stres üriner inkontinans, 16'sında (%34,8) ise mikst üriner inkontinans mevcuttu. Hastaların hiçbirisinde mesane ya da üretrada yaralanma ya da vasküler yaralanmaya bağlı istenmeyen etkiler gözlenmemişti. Geç postoperatif dönemde ise 1 hastada (%2,2) denova urge inkontinans, 1 hastada (%2,2) vajinal erozyon gelişmişti. Ortalama izlem süresi 32,13±12,038 ay'dı (12-60). Hastalar şikayet bazında değerlendirildiğinde, 1 (%2,2) hastanın şikayetlerinde artma gözlendi. Hastalardan 4'ünün (%8,7) şikayetlerinde herhangi bir değişiklik olmamıştı. Hastaların 22'sinin (%47,8) şikayetlerinde azalma olmuştu. Hastaların 19'u (%41,3) ise şikayetlerinin tamamen geçtiğini ifade etti. Hastaların 41'inde (%89,1) operasyonun başarılı olduğu, 5'inde (%10,9) ise operasyonun başarısız olduğu tespit edildi. Preop ve postop yapılan değerlendirmede, IIQ-7 ve UDI-6 anketlerindeki tüm sorular için verilen cevaplarda anlamlı iyileşme olduğu görüldü. Sonuç: Sonuç olarak, transobturator yaklaşım uzun dönem sonuçları ve düşük morbidite sonuçları ilestres üriner inkontinans tedavisinde etkili ve güvenilir bir yöntemidir. Retropubik yaklaşıma iyi bir alternatif olarak, transobturator yaklaşımı destekleyecek literatürde yeterli veri vardır ve transobturator yaklaşım stres üriner inkontinans tedavisinde yeni altın standart olma potansiyeline sahiptir.
Objective: Many surgical procedures have been described for the treatment of stress urinary incontinence. However, the gold standard method could not be determined. The aim of thisstudy was to investigatethe effectiveness of the transobturator tape procedure in women with stress urinary incontinence, determine the frequency of intraoperative and postoperative complications and evaluate the results ofobjective and subjective cure. Patients and Methods: 46 patients who Admitted to Dicle University Medical Faculty Hospitalof Obstetrics and Gynecology Clinic between January 2010 and December 2014, with complaints of urinary incontinence diagnosed as stress urinary incontinence or mixed urinary incontinence and operated were included in the study. The mean patient age was 46,35±9,27 (26-67) years. Demographic characteristics, physical and pelvic examination, Q tip test, stress testing, quality of life scores (Incontinence Impact Questionnaire (IIQ-7) and Urinary distress inventory (UDI-6)) was recorded. Intraoperative complications, postoperative and late postoperative complications were recorded. The patients who mean follow up was 32.13±12.038 (12-60) months, were informed about thestudy by calling. Patients who accept to participate in the study was called. Patients were evaluated for stress testing, patient complaints, pelvic examination, Q type testing, quality of life scores and complications. The results were compared before and after the operation. Results: 46 patients were operated and 30 (65,2%) patients had stress urinary incontinence, 16 (34,8%) patients had mixed urinary incontinence. Bladder, uretral or vascular damage were not seen in any patients. Late postoperatively in 1 patient (2.2%) denova urge incontinence, in 1 patient (2.2%) had vaginal erosion. Mean follow-up of patients was 32.13±12.038 months. When analyzed according to complaints of patients, 1 of the patients (%2,2) complaints has been increased. 4 of the patients (%4,3) complaints has been no change. 22 of the patients (%47,8) complaints has been decreased. 19 of the patients (%41,3) complaints completely passed. Concluded that, 41patients (89.1%) the operation was successful, 5 (10.9%) were unsuccessfull. Preoperative and postoperative evaluation in the control period; In answer to all the questions in the questionnaire IIQ-7 and UDI-6 was found to be a significant improvement. Conclusion: The transobturator approach is a safe and effective treatment of stress urinary incontinence with its long term outcomes and low morbidity. There are enough data in the literature to support the use of the transobturator approach as a good alternative to the retropubic access, and it has all the potential to be the new Gold Standard in the treatment of stress urinary incontinence.
Objective: Many surgical procedures have been described for the treatment of stress urinary incontinence. However, the gold standard method could not be determined. The aim of thisstudy was to investigatethe effectiveness of the transobturator tape procedure in women with stress urinary incontinence, determine the frequency of intraoperative and postoperative complications and evaluate the results ofobjective and subjective cure. Patients and Methods: 46 patients who Admitted to Dicle University Medical Faculty Hospitalof Obstetrics and Gynecology Clinic between January 2010 and December 2014, with complaints of urinary incontinence diagnosed as stress urinary incontinence or mixed urinary incontinence and operated were included in the study. The mean patient age was 46,35±9,27 (26-67) years. Demographic characteristics, physical and pelvic examination, Q tip test, stress testing, quality of life scores (Incontinence Impact Questionnaire (IIQ-7) and Urinary distress inventory (UDI-6)) was recorded. Intraoperative complications, postoperative and late postoperative complications were recorded. The patients who mean follow up was 32.13±12.038 (12-60) months, were informed about thestudy by calling. Patients who accept to participate in the study was called. Patients were evaluated for stress testing, patient complaints, pelvic examination, Q type testing, quality of life scores and complications. The results were compared before and after the operation. Results: 46 patients were operated and 30 (65,2%) patients had stress urinary incontinence, 16 (34,8%) patients had mixed urinary incontinence. Bladder, uretral or vascular damage were not seen in any patients. Late postoperatively in 1 patient (2.2%) denova urge incontinence, in 1 patient (2.2%) had vaginal erosion. Mean follow-up of patients was 32.13±12.038 months. When analyzed according to complaints of patients, 1 of the patients (%2,2) complaints has been increased. 4 of the patients (%4,3) complaints has been no change. 22 of the patients (%47,8) complaints has been decreased. 19 of the patients (%41,3) complaints completely passed. Concluded that, 41patients (89.1%) the operation was successful, 5 (10.9%) were unsuccessfull. Preoperative and postoperative evaluation in the control period; In answer to all the questions in the questionnaire IIQ-7 and UDI-6 was found to be a significant improvement. Conclusion: The transobturator approach is a safe and effective treatment of stress urinary incontinence with its long term outcomes and low morbidity. There are enough data in the literature to support the use of the transobturator approach as a good alternative to the retropubic access, and it has all the potential to be the new Gold Standard in the treatment of stress urinary incontinence.
Açıklama
Anahtar Kelimeler
Cerrahi tedavi, Surgical treatment, Üriner inkontinans, Urinary incontinence, Üriner sistem, Urinary tract, İdrar, Urine
