Stress üriner inkontinans olan bayan hastalarda dıştan içe yöntemiyle transobturator teyp tekniği

Abstract

Amaç: Stres üriner inkontinans tedavisinde kullanılan transobturator teyp TOT uygulaması ile ilgili deneyimlerimizi ve kısa dönem sonuçlarımızı paylaşmayı amaçladık.Gereç ve Yöntemler: Kliniğimize Temmuz 2011-Eylül 2013 tarihleri arasında stres üriner inkontinans SÜİ nedeniyle başvuran ve TOT uygulanan 58 hasta retrospektif olarak değerlendirildi. TOT, dışarıdan içeriye olacak şekilde I-Stop kiti ile uygulandı. Olguların demografik özellikleri, muayene bulguları, öksürük stres testi, ameliyat verileri, postoperatif komplikasyonlar ve yaşam kalite anket sonuçları kaydedildi.Bulgular: Ortalama yaşları 37-70 yıl arasında değişen toplam 58 hasta çalışmaya alındı. Ortalama ameliyat süresi 30,3±7,4 dakika, hastanede kalma süresi 2,06±1gün olarak saptandı. Olguların 8’inde %13,7 komplikasyon görüldü. Majör komplikasyon olarak 1 olguda %1,7 mesane perforasyonu görüldü. 2 olguda %3,4 bacak/kasık ağrısı, 2 olguda %3,4 idrar yolu enfeksiyonu, 3 olguda %5,1 da denovo urgency gelişti. Ortalama takip süresi 6,2±3,4 ay idi. Objektif kür oranı %86,2 olarak bulundu. Kontroller sonunda, yaşam kalite değerlendirmesinde ameliyat öncesine göre istatistiksel olarak anlamlı düzelme saptandı p

Keywords

• stres inkontinans,transobturatortape,stres teyp

Transobturator tape “outside-in” technique in surgical treatment of female stress urinary incontinence

Abstract

Objective: We aimed to share our experience and short-term outcomes related to transobturator tape TOT application in treatment of stress urinary incontinence.Materials and Methods: In this study, 58 patients who applied to our clinic between July 2011-September 2013 due to stress urinary incontinence SUI and who underwent operation for TOT were evaluated retrospectively. TOT were placed outside-in with I-STOP kit. Demographical properties, examination findings, cough stress test results, operation data, postoperative complications and life quality survey scores were recorded in each case.Results: Totally 58 patients were included in the study. Their age varied between 37-70 years. Mean operation time was 30.3±7.4 minutes, mean hospital stay was 2.06±1 days. Eight 13.7% patients had complications. As a major complication, 1 patient 1.7% had bladder perforation. Two 3.4% patients developed leg/groin pain, 2 3.4% patients developed urinary tract infection and 3 5.1% patients developed de novo urgency. Mean follow-up time was 6.2±3.4 months. Objective cure rate was calculated as 86.2%. At the end of controls, according to evaluations of life quality assessment survey results, statistically significant improvement was found compared to preoperative period p

Keywords

• stress urinary incontinence,transobturator tape,stress test

References

1. Domingo S, Alama D, Ruiz N, Lazaro G, Morell M, Pellicer A.Transobturator tape procedure outcome: a clinical and quality of lifeanalysis of a 1-year follow-up. Int Urogynecol J Pelvic Floor Dysfunct 2007;18: 895-900.
2. Latthe PM, Patodi M, Constantine G. Transobturator tapep- rocedure in stress urinary incontinence: UK experience of a district generalhospital. J Obstet Gynaecol 2007;27: 177-80.
3. Cetinel B, Demirkesen O, Tarcan T, et al. Hidden female uri- nary incontinentce in urology and obstetrics and gynecolog- youtpatient clinics in Turkey: What are the determinants of bothersome urinary incontinence and help-seeking behavi- or? Int Urogynecol J Pelvic Floor Dysfunct 2007; 18:659-664.
4. Hunskaar S, Lose G, Sykes D,Voss S. The prevalence of uri- nary incontinence in women in four European countries. BJU Int 2004; 93:324-330.
5. Ulmsten U, Petros P. Intravaginal slingplasty (IVS); an am- bulatory surgical procedure for treatment of female urinary incontinence. Scand J Urol Nephrol 1995; 29:75-82.
6. Ulmsten U, Johnson P, Rezapour M. A threeyear follow up of tension free vaginal tape for surgical treatment of fema- le stress urinary incontinence. Br J Obstet Gynaecol 1999; 106:345-350.
7. Debodinance P, Delporte P, Engrand JB, Boulogne M. Tensi- on-free vaginal tape (TVT) in the treatment of urinary stres incontinence: 3 years experience involving 256 operations. Eur J Obstet Gynecol Reprod Biol 2002; 105:49-58.
8. Kuuva N, Nilsson CG. A nationwide analysis of complicati- ons associated with the tensionfree vaginal tape (TVT) pro- cedure. Acta Obstet Gynecol Scand 2002; 81:72-77.

9. Zilbert AW, Farrell SA. External iliac artery laceration during tension-free vaginal tape procedure. Int Urogynecol J Pelvic Flor Dysfunct 2001; 12:141-143.
10. Delorme E, Droupy S, De Tayrac R, Delmas V. Trans obtu- rator tape Uratape, a new minimally invasive treatment for female urinary incontinence. Prog Urol 2003; 13: 656-659.
11. Costa P, Grise P, Droupy S, Monneins F, Assenmacher C, Bal- langer P, Hermieu JF, Delmas V, Boccon-Gibod L, Ortuno C. Surgical treatment of female stress urinary incontinence with a transobturator tape (TOT) Uratape: short term results of a prospective multicentric study. Eur Urol 2004; 46: 102-7.
12. Göynümer FG, Yücel N, Uslu GZ, Açış R, Türkgeldi E, Duru- kan B. The initial experience of a training hospital on TOT. J Turkish German Gynecol Assoc 2009;10:80-3.
13. Kennelly MJ, Myers EM. Retropubic and transobturator slings: still useful or should all patients be treated with mini- slings? Curr Urol Rep 2011; 12:316–322
14. Carpenter DA, Visovsky C. Stress urinary incontinence: a re- view of treatment options. AORN J 2010; 91: 471–478.
15. Maroto RJ, Gorraiz MO, Bueno JJ M, Perez LG, Bru JJP, Chaparro LP. Transobturator adjustable tape (TOA) permits to correct postoperatively the tension applied in stres in- continence surgery. Int Urogynecol J Pelvic Floor Dysfunct 2009;20:797-805.
16. Wang F, Song Y, Huang H. Prospective randomized trial of TVT and TOT as primary treatment for female stres urinary incontinence with or without pelvic organ prolapse in Sout- heast China. Arch Gynecol Obstet 2010;281:279-86.
17. Arrabal-Polo MÁ, Palao-Yago F, Zuluaga-Gómez A, López- León VM, Merino-Salas S, Lahoz-García C, Arrabal-Martín M. Complications from the placement of a tension-free su- burethral sling using the transobturator and retropubic met- hods for treatment of female urinary incontinence. Urol Int. 2012;89:97-102.
18. Sivanesan K, Sathiyathasan S, Ghani R. Transobturator tensi- on free vaginal tapes and bladder injury. Arch Gynecol Obs- tet 2009;279: 5-7.
19. Coyne KS, Sexton CC, Irwin DE, Kopp ZS, Kelleher CJ, Mil- som I. The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: Results from the EPIC study. BJU Int 2008, 101:1388-1395.
20. Holmgren C, Nilsson S, Lanner L, Hellberg D. Longterm re- sults with tension-free vaginal tape on mixed and stress uri- nary incontinence. Obstet Gynecol 2005; 106: 38-43.
21. Ayanoğlu HE. Stres inkontinans tedavisinde transobturator tape uygulamasıve kısa dönem sonuçları(Uzmanlık tezi). İstanbul:Taksim Eğitim ve Araştırma Hastanesi 2006.
22. Dobson A, Robert M, Swaby C, Murphy M, Birch C, Ma- inprize T, et al. Trans-obturator surgery for stress urinary incontinence: 1-year follow-up of a cohort of 52 women. Int Urogynecol J 2007;18: 27-32.
23. Rinne K, Laurikainen E, Kivela A, Aukee P, Takala T, Val- pas A, et al. A randomized trial comparing TVT with TVT- O:12-month results. Int Urogynecol J Pelvic Floor Dysfunct 2008;19: 1049-54.
24. Barry C, Naidu A, Lim Y, Corsitaans A, Muller, Rane A. Does the MONARC transobturator suburethral sling cause post-operative voiding dysfunction? A prospective study. Int Urogynecol J PelvicFloorDysfunct 2005;17: 30-34.