Öz
SUMMARY
Objective: Examining the effects of body mass index (BMI), parity, method of delivery, defects in pelvic floor, diabetes mellitus on the types of incontinence in Urinary Incontinence (UI) cases. Method: 230 UI cases were evaluated in this study. Questions asked to the cases to determine the age, parity and the type of incontinence. Incontinence was diagnosed with history. Additionally, gynecological examination findings, fasting and postprandial blood glucose (FBG-PPG) and hemoglobin A1c(HbA1c) levels were recorded. Results: The average age was 49.63 ± 10.68; gravida 4.21 ± 2.68; parity 3.59 ± 2.51. The average BMI was determined as 29.86 ± 4.25. In 94 (40.86%) of the patients had stress incontinence(SUI), 70 (30.43%) urge incontinence(UUI) and 66 (28.69%) mixed incontinence. Pelvic floor defects was detected at 94(40.86%) of the cases. Whereas SUI was observed more prominently in juvenile cases with low parity accompanied by anatomic pelvic deformity; the divergence disappears with the introduction of no pelvic floor defect and with 5 or more instances of gestation and delivery. In 114 (49.56%) cases obesity + morbid obesity was existent. In this group, the types of incontinence were similar; in 116 (51.44%) of the cases with normal weight, SUI was more prevalent. It was observed that there was impaired fasting glucose(IFG) in 68 (29.56%) of cases impaired glucose tolerance(IGT) in 49 (21.30%) of cases and diabetes mellitus in 35 (15.21%) of cases. In IGT cases, SUI was more prevalent. UUI was observed more frequently than MUI and SUI in diabetes cases; however the divergence didn’t bear any statistical significance (p>0.05). Conclusion: SUI is prevalent in juvenile cases with IFG and IGT, low parity and delivery, anatomic defects due to traumatic birth,. The divergence disappears with advanced age, high parity and delivery. MUI is observed with advanced age more frequently. UUI is observed more frequently in advanced age patient with DM.
Keywords: Impaired glucose tolerance, urinary incontinence, risk factors
ÖZET
Amaç: Üriner inkontinanslı hastalarda vücut kitle indeksi, parite, doğum şekli,pelvik taban defektleri ve gizli veya aşikar diabetin inkontinans tiplerinin dağılımı üzerindeki etkisinin araştırılması. Yöntem: 230 üriner inkontinans olgusu değerlendirildi. Olgulara; yaş, gebelik, parite, Diabetes Mellitus(DM), gestasyonel diabet ve inkontinans tipini saptamaya yönelik soru formları dolduruldu. Ayrıca boy, kilo, jinekolojik muayene bulguları, açlık-tokluk kan şekeri(AKŞ-TKŞ) ve hemoglobin A1c(HbA1c) ölçümleri değerlendirildi. Bulgular: Olgularda ortalama yaş 49,63 ± 10,68; gravida 4,21 ± 2,68; parite 3,59 ± 2,51; vücut kitle indeksi (VKİ) ortalaması 29,86 ± 4,25 saptanmıştır. Olguların %40,9’unda (94) stres, %30,4’ünde (70) urge, %28,7’sinde (66) mikst inkontinans saptanmıştır. Pelvik taban bozukluğu 94 (%40,86) olguda tespit edildi. Pelvik anatomik bozuklukların eşlik ettiği, genç yaş, düşük parite ve doğumda stres üriner inkontinans (SUİ) baskınlığı ön plandayken; pelvik taban defekti olmayan, daha ileri yaş, 5 ve üzeri gebelik ve doğum yapanlarda bu fark ortadan alkmaktadır; 114 (%49,56) olguda obezite + morbid obezite mevcuttu. 68 (%29,56) olguda BAG, 49 (%21,30) olguda BGT ve 35 (%15,21) olguda DM tespit edildi. Bozulmuş glukoz toleransı (BGT) saptanan olgularda (SÜİ) daha yüksek orandaydı. Diabet saptanan olgularda urge üriner inkontinans (UÜİ); mikst (MÜİ) ve SÜİ’a göre daha fazla saptanmış olmakla birlikte her iki durumda da farklar istatistiksel önemde değildi (p>0,05). Sonuç: Düşük parite ve doğum, travmatik doğuma bağlı olabilecek anatomik bozukluk, bozulmuş açlık ve tokluk kan şekeri ve genç yaş SÜİ ile ilişkilidir. Daha ileri yaş, yüksek parite ve doğumda gruplar arasında bu fark ortadan kalkmaktadır. İleri yaşla birlikte MÜİ daha sık izlenir. UUİ ileri yaştaki diabetes mellituslu hastalarda sıktır.
Anahtar sözcükler: Bozulmuş glukoz toleransı, üriner inkontinans, risk faktörleri
Anahtar Kelimeler
Impaired glucose tolerance urinary incontinence risk factors
Kaynakça
- Abrams P, Blavias JG, Stanton SL, Andersen JT. The standardization ofterminology for lower urinary tract function. Br J Obstet Gynae- col 1990; 97: 1-16.
- Hunskaar S, Sandvik H. One hun- dred and fifty men with urinary in- continence. III. Psychosocial con- sequences. Scand J Prim Health Care 1993; 11: 193-6.
- Lawson JO. Pelvic anatomy. I. Pelvic floor muscles. Ann R Coll Surg Engl 1974; 54: 244-52.
- Minassian VA, Drutz HP, Al-Badr A. Urinary incontinence as a worldwide problem. Int J Gynae- col Obstet 2003; 82: 327-38.
- Kumbasar AB: Impaired glucose tolerance, impaired fasting glu- cose. Ed: Altuntaş Y, Yenigun M: All Aspects of Diabetes Mellitus. 2001; 236-45.
- Devore EE, Townsend MK, Res- nick NM, Grodstein F. The epide- miology of urinary incontinence in women with Type 2 diabetes. J Urol 2012; 188: 1816-21.
- Ozerdogan N, Beji NK, Yalcin O. Urinary incontinence: Its preva- lence, risk factors and effects on the quality of life of women living in a region of Turkey. Gynecol Obstet Invest 2004; 58: 145-50.
- Maral I, Ozkardes H, Peskircioglu L, Bumin MA. Prevalence of stress urinary incontinence in both sexes at or after age 15 years: A cross-sectional study. J Urol 2001; 165: 408-12.
- Kök G, Şenel N, Akyüz A. The evaluation of the awareness level for urinary incontinence in women over 20 years old who refer to GATA gynecology outpatient clin- ic. Gulhane Medical Journal 2006; 48: 132-6.
- Burgio KL, Matthews KA, Engel BT. Prevalence, incidence and cor- relates of urinary incontinence in healthy, middle-aged women. J Urol 1991; 146: 1255-9.
- Subak LL, Richter HE, Hunskaar S. Obesity and urinary inconti- nence: Epidemiology and clinical research update. J Urol. 2009; 182: 2-7.
- Burti JS, Santos AM, Pereira RM, Zambon JP, Marques AP. Preva- lence and clinical characteristics of urinary incontinence in elderly in- dividuals of a low income. Arch Gerontol Geriatr 2012; 54: 42-6.
- Bruce RG, El-Galley RE, Gallo- way NT. Paravaginal defect repair in the treatment of female stress urinary incontinence and cysto- cele. Urology 1999; 54: 647-51.
- Izci Y, Topsever P, Filiz TM, Ci- nar ND, Uludağ C, Lagro-Janssen T. The association between diabe- tes mellitus and urinary inconti- nence in adult women. Int Uro- gynecol J Pelvic Floor Dysfunct 2009; 20: 947-52.
- Dass AK, Lo TS, Khanueng- kitkong S, Tan YL. Diagnosis and conservative management of fe- male stress urinary incontinence. Gynecology and Minimally Inva- sive Therapy, In Press, Corrected Proof, Available online 2013.
- Ashton-Miller JA, Howard D, De Lancey JO. The functional anato- my of the female pelvic flor and stres continence control system. Scand J Urol Nephrol suppl 2001; 207: 1-7.
- Leijonhufvud A, Lundholm C, Cnattingius S, Granath F, Andolf E, Altman D. Risks of stress uri- nary incontinence and pelvic organ prolapse surgery in relation to mode of childbirth. American Journal of Obstetrics and Gyne- cology 2011; 204: 71-7.
- Keane DP, Sims TJ, Abrams P, Bailey AJ. Analysis of collagen status in premenopausal nullipa- rous women with genuine stres in- continence. Br J Obstet Gynaecol 1997; 104: 994-8.
- Parazzini F, Colli E, Origgi G. Which women with stres inconti- nence require urodynamic evalua- tion? Am J Obstet Gynecol 2001; 184; 20-7.
- McKinnie V, Swift SE, Wang W, Woodman P, O’Boyle A, Kahn M, Valley M, Bland D, Schaffer J. The effect of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence. American Journal of Obstetrics and Gynecology 2005; 193; 512-7.
- Doshi AM, Van Den Eeden SK, Morrill MY, Schembri M, Thom DH, Brown JS. Women with dia- betes: Understanding urinary in- continence and help seeking be- havior. J Urol 2010; 184: 1402-7.
Öz
Amaç: Üriner inkontinanslı hastalarda vücut kitle indeksi, parite, doğum şekli, pelvik taban defektleri ve gizli veya aşikar diabetin inkontinans tiplerinin dağılımı üzerindeki etkisinin araştırılması. Yöntem: Toplam 230 üriner inkontinans olgusu değerlendirildi. Olgulara; yaş, gebelik, parite, Diabetes Mellitus(DM), gestasyonel diabet ve inkontinans tipini saptamaya yönelik soru formları dolduruldu. Ayrıca boy, kilo, jinekolojik muayene bulguları, açlık-tokluk kan şekeri (AKŞ-TKŞ) ve hemoglobin A1c(HbA1c) ölçümleri değerlendirildi. Bulgular: Olgularda ortalama yaş 49,63 ± 10,68; gravida 4,21 ± 2,68; parite 3,59 ± 2,51; vücut kitle indeksi (VKİ) ortalaması 29,86 ± 4,25 saptanmıştır. Olguların %40,9’unda (94) stres, %30,4’ünde (70) urge, %28,7’sinde (66) mikst inkontinans saptanmıştır. Pelvik taban bozukluğu 94 (%40,86) olguda tespit edildi. Pelvik anatomik bozuklukların eşlik ettiği, genç yaş, düşük parite ve doğumda stres üriner inkontinans (SUİ) baskınlığı ön plandayken; pelvik taban defekti olmayan, daha ileri yaş, 5 ve üzeri gebelik ve doğum yapanlarda bu fark ortadan kalkmaktadır; 114 (%49,56) olguda obezite + morbid obezite mevcuttu. 68 (%29,56) olguda BAG, 49 (%21,30) olguda BGT ve 35 (%15,21) olguda DM tespit edildi. Bozulmuş glukoz toleransı (BGT) saptanan olgularda (SÜİ) daha yüksek orandaydı. Diabet saptanan olgularda urge üriner inkontinans (UÜİ); mikst (MÜİ) ve SÜİ’a göre daha fazla saptanmış olmakla birlikte her iki durumda da farklar istatistiksel önemde değildi (p>0,05). Sonuç: Düşük parite ve doğum, travmatik doğuma bağlı olabilecek anatomik bozukluk, bozulmuş açlık ve tokluk kan şekeri ve genç yaş SÜİ ile ilişkilidir. Daha ileri yaş, yüksek parite ve doğumda gruplar arasında bu fark ortadan kalkmaktadır. İleri yaşla birlikte MÜİ daha sık izlenir. UUİ ileri yaştaki diabetes mellituslu hastalarda sıktır
Anahtar Kelimeler
Bozulmuş glukoz toleransı üriner inkontinans risk faktörleri
Kaynakça
- Abrams P, Blavias JG, Stanton SL, Andersen JT. The standardization ofterminology for lower urinary tract function. Br J Obstet Gynae- col 1990; 97: 1-16.
- Hunskaar S, Sandvik H. One hun- dred and fifty men with urinary in- continence. III. Psychosocial con- sequences. Scand J Prim Health Care 1993; 11: 193-6.
- Lawson JO. Pelvic anatomy. I. Pelvic floor muscles. Ann R Coll Surg Engl 1974; 54: 244-52.
- Minassian VA, Drutz HP, Al-Badr A. Urinary incontinence as a worldwide problem. Int J Gynae- col Obstet 2003; 82: 327-38.
- Kumbasar AB: Impaired glucose tolerance, impaired fasting glu- cose. Ed: Altuntaş Y, Yenigun M: All Aspects of Diabetes Mellitus. 2001; 236-45.
- Devore EE, Townsend MK, Res- nick NM, Grodstein F. The epide- miology of urinary incontinence in women with Type 2 diabetes. J Urol 2012; 188: 1816-21.
- Ozerdogan N, Beji NK, Yalcin O. Urinary incontinence: Its preva- lence, risk factors and effects on the quality of life of women living in a region of Turkey. Gynecol Obstet Invest 2004; 58: 145-50.
- Maral I, Ozkardes H, Peskircioglu L, Bumin MA. Prevalence of stress urinary incontinence in both sexes at or after age 15 years: A cross-sectional study. J Urol 2001; 165: 408-12.
- Kök G, Şenel N, Akyüz A. The evaluation of the awareness level for urinary incontinence in women over 20 years old who refer to GATA gynecology outpatient clin- ic. Gulhane Medical Journal 2006; 48: 132-6.
- Burgio KL, Matthews KA, Engel BT. Prevalence, incidence and cor- relates of urinary incontinence in healthy, middle-aged women. J Urol 1991; 146: 1255-9.
- Subak LL, Richter HE, Hunskaar S. Obesity and urinary inconti- nence: Epidemiology and clinical research update. J Urol. 2009; 182: 2-7.
- Burti JS, Santos AM, Pereira RM, Zambon JP, Marques AP. Preva- lence and clinical characteristics of urinary incontinence in elderly in- dividuals of a low income. Arch Gerontol Geriatr 2012; 54: 42-6.
- Bruce RG, El-Galley RE, Gallo- way NT. Paravaginal defect repair in the treatment of female stress urinary incontinence and cysto- cele. Urology 1999; 54: 647-51.
- Izci Y, Topsever P, Filiz TM, Ci- nar ND, Uludağ C, Lagro-Janssen T. The association between diabe- tes mellitus and urinary inconti- nence in adult women. Int Uro- gynecol J Pelvic Floor Dysfunct 2009; 20: 947-52.
- Dass AK, Lo TS, Khanueng- kitkong S, Tan YL. Diagnosis and conservative management of fe- male stress urinary incontinence. Gynecology and Minimally Inva- sive Therapy, In Press, Corrected Proof, Available online 2013.
- Ashton-Miller JA, Howard D, De Lancey JO. The functional anato- my of the female pelvic flor and stres continence control system. Scand J Urol Nephrol suppl 2001; 207: 1-7.
- Leijonhufvud A, Lundholm C, Cnattingius S, Granath F, Andolf E, Altman D. Risks of stress uri- nary incontinence and pelvic organ prolapse surgery in relation to mode of childbirth. American Journal of Obstetrics and Gyne- cology 2011; 204: 71-7.
- Keane DP, Sims TJ, Abrams P, Bailey AJ. Analysis of collagen status in premenopausal nullipa- rous women with genuine stres in- continence. Br J Obstet Gynaecol 1997; 104: 994-8.
- Parazzini F, Colli E, Origgi G. Which women with stres inconti- nence require urodynamic evalua- tion? Am J Obstet Gynecol 2001; 184; 20-7.
- McKinnie V, Swift SE, Wang W, Woodman P, O’Boyle A, Kahn M, Valley M, Bland D, Schaffer J. The effect of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence. American Journal of Obstetrics and Gynecology 2005; 193; 512-7.
- Doshi AM, Van Den Eeden SK, Morrill MY, Schembri M, Thom DH, Brown JS. Women with dia- betes: Understanding urinary in- continence and help seeking be- havior. J Urol 2010; 184: 1402-7.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Bölüm | Cerrahi Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 27 Mart 2015 |
| Yayımlandığı Sayı | Yıl 2015 |