Stres üriner inkontinans hastalarında midüretral transobturator bant cerrahisi: Klinik gözlem ve erken dönem sonuçları
Öz
Aim. In stress urinary incontinence patients (SUI), the evalution of the results and complications of Transobturator tape (TOT) procedure by using clinical and life quality analysis. Method. 30 patients, who are diagnosed as SUI or MUI and operated with TOT procedure were included in the study. The mean patient age was 46.5±7. Preoperative urological and gynecological histories were taken; gynecological examination, ultrasonography, stres test, Q tip test were performed. Incontinence questionnaires were filled. TOT procedure was performed to all 30 patients by using monofilament tape with outside-in technique. The mean postoperatif follow-up was 16.7 months. In the postoperative period all patients’ clinical and laboratory tests were repeated and compared with the preoperative parameters. Results were evaluated with Wilcoxon signed rank test for statistical significance. Results. Eight (26.7%) patients had SUI, 22 (73.3%) patients had MUI. No additional operations were performed to nine (30%) patients. In addition to TOT, six (20%) of patients had colporraphy anterior (CA), twelve (40%) patients had CA and colporraphy posterior (CP), 1 (3.3%) patient had CP, two (6.6%) patients had vaginal hysterectomy (VAH) and CA+CP. Intraoperative one (3.3%) bladder perforation has occured. Postoperative one patient had de nove urge. While TOT procedure was successful in 26 cases (86.7%), 4 (13.3%) of them have failed. In the life quality analysis IIQ-7 (Incontinence impact questionnaire) and UDI-6 (Urinary distress inventory) scores showed significant improvement (P<0.001 ve P=0.026). Conclusion. Our study confirmed high objective cure rate, improvement of symptoms and quality of life with TOT operation. These results suggest that the transobturator tape procedure is a valueable alternative to the other surgical procedures in SUI, with a low rate of complications and convenience of learning and application.
Anahtar Kelimeler
Kaynakça
- Abrams P, Blavias JG, Stanton SL, Andersen JT. The standardisation of terminology of lower urinary tract function. The International Continence Society Committee on Standardisation of Terminology. Scand J Urol Nephrol Suppl 1988; 114: 5-19.
- Hunskaar S, Lose G, Sykes D, Voss S. The prevalence of urinary incontinence in women in four European countries. BJU Int 2004; 93: 324-30.
- Biri A, Durukan E, Maral I, Korucuoğlu U, Biri H, Tıraş B, Bumin MA. Incidence of stress urinary incontinence among women in Turkey. Int Urogynecol J 2006; 17: 604-10.
- Dainer M, Hall CD, Choe J, Bhatia NN. The Burch procedure: a comprehensive review. Obstet Gynecol Surv 1999; 54: 49-60.
- Petros PE, Ulmsten UI. An integral theory and its method for the diagnosis and management of female urinary incontinence. Scand J Urol Nephrol 1993; 153: 19
- Ulmsten U, Falconer C, Johnson P, Jomaa M, Lannér L, Nilsson CG, Olsson I. A multicenter study of tension-free vaginal tape (TVT) for surgical treatment of stress urinary incontinence. Int Urogynecol J 1998; 9: 210-3.
- Ward KL, Hilton P; UK and Ireland TVT Trial Group. A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: Two-year follow-up. Am J Obstet Gynecol 2004; 190: 324-31.
- Wang AC, Chen MC. Comparison of tension-free vaginal taping versus modified Burch colposuspension on urethral obstruction: a randomized controlled trial. Neurourol Urodyn 2003; 22: 185-90.
- Delorme E.Transobturator urethral suspension: Mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol 2001; 11: 1306-13. Delorme E, Droupy S, de Tayrac R, Delmas V. Transobturator tape (Uratape): a new minimally-invasive procedure to treat female urinary incontinence. Eur Urol 2004; 45: 203-7.
- Costa P, Grise P, Droupy S, Monneins F, Assenmacher C, Ballanger P, Hermieu JF, Delmas V, Boccon-Gibod L, Ortuno C. Surgical treatment of female stress urinary incontinence with a trans-obturator-tape (T.O.T.) Uratape: short term results of a prospective multicentric study. Eur Urol 2004; 46: 102-6.
- Delmas V. Anatomical risks of transobturator suburethral tape in the treatment of female stress urinary incontinence. Eur Urol 2005; 48: 793-8.
- Ward KL, Hilton P, Browning J. A randomized trial of colposuspension and tension free vaginal tape for primary genuine stress incontinence. Neurourology urodynamics 2000; 19: 386-8.
- Latthe PM, Singh P, foon R, Toozs-Hobson P. Two routes of transobturator tape procedures in stress urinary incontinence: A meta-analysis with direct and indirect comparison of randomized trials. BJU Int 2011; 106: 68-76.
- Grise P, Droupy S, Saussine C, Ballanger P, Monneins F, Hermieu JF, Serment G, Costa P. Transobturator tape sling for female stress incontinence with polypropylene tape and outside-in procedure: prospective study with 1 year of minimal follow-up and review of transobturator tape sling. J Urol 2006; 68: 7596
- Fitzgerald MP, kenton K, Shott S, Brubaker L. Responsiveness of quality of life measurements to change after reconstructive pelvic surgery.Am J Obstet Gynecol 2001; 185: 20-4.
- Klutke C, Siegel S, Carlin B, Paszkiewicz E, Kirkemo A, Klutke J. Urinary retention after tension-free vaginal tape procedure: Incidence and treatment. Urology 2001; 58: 697-701.
- Lo TS, Wang AC, Horng SG, Liang CC, Soong YK. Ultrasonographic and urodynamic evaluation after tension free vagina tape procedure (TVT). Acta Obstet Gynecol Scand 2001; 80: 65-70.
- Deval B, Ferchaux J, Berry R, Gambino S, Ciofu C, Rafii A, Haab F. Objective and subjective cure rates after trans-obturator tape (OBTAPE) treatment of female urinary incontinence. European Urology 2006; 49: 373-7.
- Kaelin-Gambirasio I, Jacob S, Boulvain M, Dubuisson JB, Dallenbach P. Complications associated with transobturator sling procedures: analysis of 233 consecutive cases with a 27 months follow-up. BMC Womens Health 2009; 9: Holmgren C, Nilsson S, Lanner L, Hellberg D. Long-Term Results With TensionFree Vaginal Tape on Mixed and Stress Urinary Incontinence. Obstet Gynecol 2005; 106: 38-43.
- Levin I, Groutz A, Gold R, Pauzner D, Lessing JB, Gordon D. Surgical complications and medium-term outcome results of tension-free vaginal tape: a prospective study of 313 consecutive patients. Neurourol Urodyn 2004; 23: 7-9. Minaglia S, Ozel B, Klutke C. Bladder injury during transobturator sling. Urology 2004; 64: 3761-2.
- Krauth JS, Rasoamiaramanana H, Barletta H, Barrier PY, Grisard-Anaf M, Lienhart J, Mermet J, Vautherin R, Frobert JL. Sub-urethral tape treatment of female urinary incontinence--morbidity assessment of the trans-obturator route and a new tape (I-STOP): a multi-centre experiment involving 604 cases. Eur Urol 2005; 47: 102-6.
- Houwert RM, Renes-Zijl C, Vos MC, Vervest HA. TVT-O versus Monarc after a 2-4-year follow-up: a prospective comparative study. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20: 1327-33.
- Rinne K, Laurikainen E, Kivelä A, Aukee P, Takala T, Valpas A, Nilsson CG. A randomized trial comparing TVT with TVT-O: 12-month results. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19: 1049-54.
- Liapis A, Bakas P, Giner M, Creatsas G. Tension-free vaginal tape versus tension-free vaginal tape obturator in women with stress urinary incontinence. Gynaecol Obstet Invest 2006; 62: 160-4.
Stres üriner inkontinans hastalarında midüretral transobturator bant cerrahisi: Klinik gözlem ve erken dönem sonuçları
Öz
Amaç. Stres üriner inkontinans (SUI) olgularında, Transobturator bant (TOT) operasyonunun sonuçlarının ve komplikasyonlarının, klinik ve yaşam kalitesi analizi yapılarak değerlendirilmesi. Yöntem. SUI veya mikst üriner inkontinans (MUI) tanısı ile TOT yapılan 30 hasta çalışmaya alındı. Hastaların yaş ortalaması 46,5±7 idi. Preoperatif ürolojik ve jinekolojik anamnez alındı ve jinekolojik muayene, ultrasonografi, stres test, Q tip test yapıldı, inkontinans anketleri dolduruldu. TOT operasyonu monoflaman tape kullanılarak dıştan içe yöntem kullanılarak yapıldı. Hastaların postoperatif dönemde tüm klinik ve laboratuar bulguları değerlendirilerek preoperatif parametreler ile karşılaştırıldı. Operasyondan sonra hastaların ortalama takip süresi 16,7 aydı. Sonuçlar Wilcoxon signed rank testi ile istatistiksel anlamlılık açısından değerlendirildi. Bulgular. Sekiz hastada (%26,7) SUI, 22 hastada (%73,3) MUI mevcuttu. TOT ameliyatına ek olarak 6 (%30) hastaya kolporafi anterior (KA), 1 (%3,3) hastaya kolporafi posterior (KP), 12 (%40) hastaya KA ve KP 2 (%6,6) hastaya vaginal histerektomi, KA, KP uygulanmıştır. Bir hastada mesane perforasyonu, bir hastada postoperatif urge inkontinans görüldü. TOT operasyonu ile hastaların 26’sında (%86,7) başarılı olunurken, dördünde (%13,3) başarısız olunmuştur. Yaşam kalitesi değerlendirilmesinde IIQ-7 (Incontinence impact questionnaire) ve UDI-6 (Urinary distress inventory) skorlarında istatistiksel olarak anlamlı düzelme saptanmıştır (P<0,001 ve P=0,026). Sonuç. Bu çalışmada, SUI tedavisinde TOT uygulaması ile yüksek objektif iyileşme ve yaşam kalitesinde anlamlı düzelme sağlandığı saptanmıştır. Uygulama kolaylığı ve komplikasyon oranının düşük olması sebebiyle TOT operasyonunun diğer inkontinans cerrahi prosedürlerine iyi bir alternatif olduğu sonucuna varılmıştır.
Anahtar Kelimeler
Kaynakça
- Abrams P, Blavias JG, Stanton SL, Andersen JT. The standardisation of terminology of lower urinary tract function. The International Continence Society Committee on Standardisation of Terminology. Scand J Urol Nephrol Suppl 1988; 114: 5-19.
- Hunskaar S, Lose G, Sykes D, Voss S. The prevalence of urinary incontinence in women in four European countries. BJU Int 2004; 93: 324-30.
- Biri A, Durukan E, Maral I, Korucuoğlu U, Biri H, Tıraş B, Bumin MA. Incidence of stress urinary incontinence among women in Turkey. Int Urogynecol J 2006; 17: 604-10.
- Dainer M, Hall CD, Choe J, Bhatia NN. The Burch procedure: a comprehensive review. Obstet Gynecol Surv 1999; 54: 49-60.
- Petros PE, Ulmsten UI. An integral theory and its method for the diagnosis and management of female urinary incontinence. Scand J Urol Nephrol 1993; 153: 19
- Ulmsten U, Falconer C, Johnson P, Jomaa M, Lannér L, Nilsson CG, Olsson I. A multicenter study of tension-free vaginal tape (TVT) for surgical treatment of stress urinary incontinence. Int Urogynecol J 1998; 9: 210-3.
- Ward KL, Hilton P; UK and Ireland TVT Trial Group. A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: Two-year follow-up. Am J Obstet Gynecol 2004; 190: 324-31.
- Wang AC, Chen MC. Comparison of tension-free vaginal taping versus modified Burch colposuspension on urethral obstruction: a randomized controlled trial. Neurourol Urodyn 2003; 22: 185-90.
- Delorme E.Transobturator urethral suspension: Mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol 2001; 11: 1306-13. Delorme E, Droupy S, de Tayrac R, Delmas V. Transobturator tape (Uratape): a new minimally-invasive procedure to treat female urinary incontinence. Eur Urol 2004; 45: 203-7.
- Costa P, Grise P, Droupy S, Monneins F, Assenmacher C, Ballanger P, Hermieu JF, Delmas V, Boccon-Gibod L, Ortuno C. Surgical treatment of female stress urinary incontinence with a trans-obturator-tape (T.O.T.) Uratape: short term results of a prospective multicentric study. Eur Urol 2004; 46: 102-6.
- Delmas V. Anatomical risks of transobturator suburethral tape in the treatment of female stress urinary incontinence. Eur Urol 2005; 48: 793-8.
- Ward KL, Hilton P, Browning J. A randomized trial of colposuspension and tension free vaginal tape for primary genuine stress incontinence. Neurourology urodynamics 2000; 19: 386-8.
- Latthe PM, Singh P, foon R, Toozs-Hobson P. Two routes of transobturator tape procedures in stress urinary incontinence: A meta-analysis with direct and indirect comparison of randomized trials. BJU Int 2011; 106: 68-76.
- Grise P, Droupy S, Saussine C, Ballanger P, Monneins F, Hermieu JF, Serment G, Costa P. Transobturator tape sling for female stress incontinence with polypropylene tape and outside-in procedure: prospective study with 1 year of minimal follow-up and review of transobturator tape sling. J Urol 2006; 68: 7596
- Fitzgerald MP, kenton K, Shott S, Brubaker L. Responsiveness of quality of life measurements to change after reconstructive pelvic surgery.Am J Obstet Gynecol 2001; 185: 20-4.
- Klutke C, Siegel S, Carlin B, Paszkiewicz E, Kirkemo A, Klutke J. Urinary retention after tension-free vaginal tape procedure: Incidence and treatment. Urology 2001; 58: 697-701.
- Lo TS, Wang AC, Horng SG, Liang CC, Soong YK. Ultrasonographic and urodynamic evaluation after tension free vagina tape procedure (TVT). Acta Obstet Gynecol Scand 2001; 80: 65-70.
- Deval B, Ferchaux J, Berry R, Gambino S, Ciofu C, Rafii A, Haab F. Objective and subjective cure rates after trans-obturator tape (OBTAPE) treatment of female urinary incontinence. European Urology 2006; 49: 373-7.
- Kaelin-Gambirasio I, Jacob S, Boulvain M, Dubuisson JB, Dallenbach P. Complications associated with transobturator sling procedures: analysis of 233 consecutive cases with a 27 months follow-up. BMC Womens Health 2009; 9: Holmgren C, Nilsson S, Lanner L, Hellberg D. Long-Term Results With TensionFree Vaginal Tape on Mixed and Stress Urinary Incontinence. Obstet Gynecol 2005; 106: 38-43.
- Levin I, Groutz A, Gold R, Pauzner D, Lessing JB, Gordon D. Surgical complications and medium-term outcome results of tension-free vaginal tape: a prospective study of 313 consecutive patients. Neurourol Urodyn 2004; 23: 7-9. Minaglia S, Ozel B, Klutke C. Bladder injury during transobturator sling. Urology 2004; 64: 3761-2.
- Krauth JS, Rasoamiaramanana H, Barletta H, Barrier PY, Grisard-Anaf M, Lienhart J, Mermet J, Vautherin R, Frobert JL. Sub-urethral tape treatment of female urinary incontinence--morbidity assessment of the trans-obturator route and a new tape (I-STOP): a multi-centre experiment involving 604 cases. Eur Urol 2005; 47: 102-6.
- Houwert RM, Renes-Zijl C, Vos MC, Vervest HA. TVT-O versus Monarc after a 2-4-year follow-up: a prospective comparative study. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20: 1327-33.
- Rinne K, Laurikainen E, Kivelä A, Aukee P, Takala T, Valpas A, Nilsson CG. A randomized trial comparing TVT with TVT-O: 12-month results. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19: 1049-54.
- Liapis A, Bakas P, Giner M, Creatsas G. Tension-free vaginal tape versus tension-free vaginal tape obturator in women with stress urinary incontinence. Gynaecol Obstet Invest 2006; 62: 160-4.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Cerrahi Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 5 Mart 2013 |
| Yayımlandığı Sayı | Yıl 2013Cilt: 35 Sayı: 4 |