The Effectiveness And Complications of Transobturator Tape Operation: Analysis of 120 cases

Year 2012, , 125 - 128, 01.09.2012

Selim Afşar Uğur Üyetürk Adnan Dilli Eren Haytoğlu Ayşe Yiğit Eray Kemahlı

https://doi.org/10.5505/abantmedj.2012.46229

Abstract

OBJECTIVE: The aim of this study is to evaluate the effectiveness and complications of TOT trans-obturator tape operation which is an minimally-invasive tecnique. METHODS: 120 patients who had suburethral tension-free vaginal TOT operation due to pure stress urinary incontinence SUI or mixt urinary incontinence MUI between 2011-2012 were reviewed. All of the operations were performed outside to inside with the Obtryx™ Boston Scientific, Natick, MA, USA trademark kit. Postoperatively patients were called at 1st and 3rd months; urogynecologic examinations were done, the success and perioperative complications of the operations were evaluatedRESULTS: All of the patients were multiparaous and median age was 49,6±11,3 years. Forty-seven %39.2 patients were postmenaupausal and thirty-six patients %30 who had TOT operation had extra surgery. Objective cure rates of the patients were %91.7 and subjective cure rates of the patients were %88.3. Treatment failure was %8.3. Only one patient had blood transfusion requirement due to TOT operation. Intraoperatively, 4 patients had bleeding more than 200 ml. Three patients had vaginal fornix perforation. Two patients had perineal pain. De novo urge incontinence was seen in 5 patients postoperatively and was treated with anticholinergic drugs. Mesh excisions were done for 4 patients who had vaginal erosion and vaginal mucosa was sutured again.CONCLUSION: TOT operation is a minimally invasive operation which overcomes all the other techniques for the surgical treatment of SUI with its lower complication rates and higher curability rates. Complication rates decrease with surgical experience so the management of complications simplify with experience.

Keywords

Stress urinary incontinence, transobturator tape method, effectiveness, complications

Transobturator Tape Operasyonunun Etkinliği ve Komplikasyonları: 120 Vakanın Analizi

Abstract

AMAÇ: Bu çalışmanın amacı; minimal-invazif bir teknik olarak tanımlanan transobturator tape TOT operasyonunun etkinliğinin ve komplikasyonlarının değerlendirilmesidir.YÖNTEMLER: 2011-2012 yılları arasında saf stres üriner inkontinans SÜİ veya mikst üriner inkontinans MÜİ nedeniyle subüretral gergisiz vajinal TOT operasyonu yapılan 120 hasta çalışmaya alındı. Tüm operasyonlar dıştan-içe Obtryx™ Boston Scientific, Natick, MA, USA marka kit ile gerçekleştirildi. Hastalar postoperatif 1. ve 3. aylarda kontrollere çağrılarak ürojinekolojik muayeneleri yapıldı, operasyon başarısı ve perioperatif komplikasyonları değerlendirildi. BULGULAR: Olguların tamamı multipardı ve yaş ortalaması 49,6±11,3 idi. Hastaların 47 %39,2 tanesi postmenopozal, 73 %60,8 tanesi ise premenopozal idi. TOT operasyonu olan olgulardan 36 %30 tanesi ek cerrahi operasyon geçirdi. Olguların objektif kür oranı %91,7 ve subjektif kür oranı %88,3 idi. Tedavi başarısızlığı %8,3 olarak bulundu. TOT operasyonuna bağlı kan transfüzyonu gereksinimi sadece 1 hastada gerekli oldu. İntraoperatif 200ml üzerinde kanama 4 hastada izlendi. Vajinal forniks perforasyonu sadece 3 vakada izlendi. Perineal ağrı 2 olguda mevcuttu. De novo urge inkontinans postoperatif 5 hastada izlendi ve antikolinerjikler ile tedavi edildi. Vajinal erozyon görülen 4 hastada mesh eksize edildi ve vajen mukozası tekrar sütüre edildi.SONUÇ: SÜİ cerrahi tedavisinde minimal-invazif, komplikasyon oranı düşük ve kür oranı yüksek bir yöntem olan TOT operasyonu diğer tekniklere üstünlük sağlamıştır. Cerrahi tecrübe arttıkça komplikasyon oranları azalmakta ve bunların yönetimi kolaylaşmaktadır.

Keywords

Stres üriner inkontinans, transobturator tape yöntemi, etkinlik, komplikasyonlar

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