Stres Üriner İnkontinans Tedavisinde Transvajinal Tape (TVT) ve Fasyal Sling Yöntemlerinin Uzun Dönem Sonuçlarının Karşılaştırılması

Year 2014, Volume: 15 Issue: 1, 41 - 47, 01.04.2014

Galip Dedekargınoğlu Bekir Aras

Abstract

Objective: To compare the long term results of the Tension free Vaginal Tape (TVT) and fascial sling in treatment with stress urinary incontinence. Material and Methods: A total of 113 patients treated with Tension free vaginal tape (TVT) and fascial sling between May 2002 and July 2008 were included into the study. Complete dryness was accepted as success, 50% reduction in pad number was evaluated as partial success, and reduction less than 50% in number of pad was evaluated as failure. Statistical analysis was performed using SPSS®18.0 for Windows with the student t test for parametric variables, and the chi-square test for categorical variables. Statistical significance was considered at p<0.05. Results: Average of age was 52.94 , and follow-up periods for TVT and fascial sling were 44.3±8.7 months and 74.7±12.4 months, respectively. Mixed incontinence was present in 79.5% patients. Number of patients in menopause, type of incontinence, severity of incontinence, and age were similar in both groups (p>0.05). Success ratio was detected as 96% in TVT group and 77% in fascial sling group p<0.001. In TVT group bleeding, operation time and hospital stay were less than fascial sling group (p<0.05). In fascial group, obstruction and postvoiding residual urine were higher than TVT group (p<0.05). Bladder perforation was similar in both groups (p>0.05) and major complication was not detected in both groups. Tape erosion was not detected in follow-up period. Conclusion: TVT is superior to fascial sling with less operation time, less bleeding and short hospital stay, and preferable with high success rate

Keywords

Stress urinary incontinence; tension free vaginal tape; fascial sling

Stres Üriner İnkontinans Tedavisinde Transvajinal Tape (TVT) ve Fasyal Sling Yöntemlerinin Uzun Dönem Sonuçlarının Karşılaştırılması

Abstract

Amaç: İdrar inontinans tedavisinde uygulanan fasyal sling ve transvaginal tape (TVT) operasyonlarının sonuçlarını karşılaştırmaktır. Gereç ve Yöntem: Çalışmaya Mayıs 2002- Temmuz 2008 tarihleri arasında inkontinansları fasyal sling ve TVT ile tedavi edilen 113 kadın hasta dahil edildi. Postoperatif ped kullanmama ve tam kuruluk hali başarı olarak kabul edildi. Ped sayısında %50 azalma kısmi başarı, ped sayısında %50’den az azalma başarısızlık olarak kabul edildi. İstatistiksel analizde student t test ve ki-kare testi kullanıldı ve SPSS®18.0 paket programı ile yapıldı. p<0.05 istatistiksel olarak anlamlı olarak kabul edildi. Bulgular: Yaş ortalaması 52.94 , takip süresi TVT için 44.3±8.7 ay, fasyal sling için ise 74.7±12.4 idi. Hastaların %79.5’inde mikst tip inkontinans mevcuttu. Her iki grupta hastaların inkontinans tipi, inkontinans şiddeti ve yaş dağılımları benzerdi (p>0.05). Başarı oranları TVT grubunda %96 ve fasyal sling grubunda %77 olarak saptandı (p<0.001). TVT yapılan hastalarda kanama daha az saptandı, operasyon süresinin ve hastanede kalış süresinin daha kısa saptandı ve bu bulgular istatistiksel olarak anlamlı idi (p<0.05). Obstruktif bulgular ve postmiksiyonel rezidüel idrar oranları fasyal sling grubunda daha fazla olarak saptandı (p<0.05). Her iki grupta da mesane perforasyon oranlarına birbirine yakın saptandı (p>0.005) ve majör komplikasyon izlenmedi. Takip süresince hiçbir hastada teyp erozyonu saptanmadı. Sonuç: TVT, fasyal sling operasyonlarına göre daha kısa sürede yapılması, daha az kanamaya yol açması, hastanede kalış süresini kısaltması ve yüksek başarı oranı ile tercih sebebi olabilir

Keywords

Stres üriner inkontinans; gergisiz vajinal teyp; fasyal sling

References

• Cetinel B, Demirkesen O, Tarcan T, et al. Hidden female urinary incontinence in urology and obstetrics and gynecology outpatient clinics in Turkey: what are the determinants of bothersome urinary incontinence and help-seeking behavior? Int Urogynecol J Pelvic Floor Dysfunct 2007;18(6):659-64.
• Abrams P, Blaivas 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(1):5-19.
• Carlin BI, Klutke JJ, Klutke CG. The tension-free vaginal tape procedure for the treatment of stress incontinence in the female patient. Urology 2000;56(6 Suppl 1):28-31.
• McGuire EJ, Bennett CJ, Konnak JA, Sonda LP, Savastano JA. Experience with pubovaginal slings for urinary incontinence at the University of Michigan. J Urol 1987;138(3):525-6.
• Chaikin DC, Rosenthal J, Blaivas JG. Pubovaginal fascial sling for all types of stress urinary incontinence: 1998;160(4):1312-6. analysis. J Urol
• Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 1996;7(2):81- 5;discussion 85-6.
• Nilsson CG, Kuuva N, Falconer C, Rezapour M, Ulmsten U. Long-term results of the tension-free vaginal tape (TVT) procedure for surgical treatment of female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2001;12(Suppl 2):5-8.
• Nilsson CG, Kuuva N. The tension-free vaginal tape procedure is successful in the majority of women with indications for surgical treatment of urinary stress incontinence. BJOG 2001;108(4):414-9.
• Debodinance P, Delporte P, Engrand JB, Boulogne M. Tension-free vaginal tape (TVT) in the treatment of urinary stress incontinence: 3 years experience involving 256 operations. Eur J Obstet Gynecol Reprod Biol 2002;105(1):49-58.
• Meschia M, Pifarotti P, Bernasconi F, et al. Tension-free vaginal tape: analysis of outcomes and complications in 404 stress incontinent women. Int Urogynecol J Pelvic Floor Dysfunct 2001;12(Suppl 2):24
• Nygaard IE, Heit M. Stress urinary incontinence. Obstet Gynecol 2004;104(3):607-20.
• Zaragoza MR. Expanded indications for the pubovaginal sling: treatment of type 2 or 3 stress incontinence. J Urol 1996;156(5):1620-2.
• Alan C, Demirkesen O, Seçkin B, Örs AÖ, Tahmaz L, Erten K. Pubovajinal sling uzun dönem sonuçları. Gülhane Tıp Dergisi 2007;49(2):101-5.
• Albo ME, Richter HE, Brubaker L, et al. Urinary Incontinence colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med 2007;356(21):2143- Network. Burch
• Ghoniem GM. Surgical management of intrinsic sphincter deficiency in women. Curr Opin Urol 2000;10(3):245-50.
• Abdel-Fattah M, Barrington JW, Arunkalaivanan AS. Pelvicol pubovaginal sling versus tension-free vaginal tape for treatment of urodynamic stress incontinence: a prospective randomized three-year follow-up study. Eur Urol 2004;46(5):629-35.
• Wadie BS, Edwan A, Nabeeh AM. Autologous fascial sling vs polypropylene tape at short-term follow-up: a prospective randomized study. J Urol 2005;174(3):990–3.
• Sharifiaghdas F, Mortazavi N. Tension-free vaginal tape and autologous rectus fascia pubovaginal sling for the treatment of urinary stress incontinence: a medium-term 2008;17(3):209-14. Med Princ Pract
• Nilsson CG, Falconer C, Rezapour M. Seven-year follow-up of the tension-free vaginal tape procedure for treatment of urinary incontinence. Obstet Gynecol 2004;104(6):1259-62.
• Sander P, Mİller LM, Rudnicki PM, Lose G. Does the tension-free vaginal tape procedure affect the voiding phase? Pressure-flow studies before and 1 year after surgery. BJU Int 2002;89(7):694-8.