VİTAMİN D VE UTERİN PROLAPSUS ARASINDAKİ İLİŞKİ The Association Between Vitamin D and Uterine Prolapse

Öz

ÖZET Amaç: Pelvik organ prolapsusu pelvik organların vajinal duvarlara veya ötesine herniasyonu olarak tanımlanır. Vitamin D eksikliğinin pelvik taban kas güçsüzlüğüne sebep olduğu düşünülmektedir. Çalışmamızın amacı uterin prolapsusu olan hastalarda vitamin D eksikliğini ve incelemektir. Gereç ve Yöntemler: İzmir Tepecik Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniği’nde Şubat 2015-2016 arasında peri- ve postmenapozal yaşta vajinal değerlendirmede evre 3-4 uterin prolapsusu saptanan ve opere olan hastalar; kontrol grubu olarak da aynı yaş grubunda herhangi bir jinekolojik durum nedeniyle opere olan hastalar retrospektif olarak incelendi. Vitamin D metabolizmasını etkileyecek hastalık veya fekal inkontinans sebebi olabilecek evre 3 kronik böbrek yetmezliği, kronik karaciğer hastalığı, gastric bypass, kolovajinal fistül ve pelvik radyasyon öyküsü olan kişiler çalışmadan çıkarıldı.olan kişiler çalışmadan çıkarıldı. Dahil edilen kişilerin yaş, gravida parite, doğum şekli ve 25 (OH) vitamin D, ICS prolapsus evreleri kaydedildi. Bulgular: Çalışma kriterlerine uygun 40 hasta ve 40 kişi kontrol olarak kaydedildi. Hasta grubunun 25-OH D vitamini düzeyleri (9,5±14,0 ng/ml) kontrol grubundan (15,3 ± 20,3 ng/ml) düşük olarak saptandı (p=0,140). Hasta grubunun 95,0%’i ve kontrol grubunun 77,5%’inde 25-OH D vitamini eksikliği (<20 ng/mL) saptandı (p=0,024). 25-OH D vitamini eksikliği uterin prolapsus için bağımız risk faktörü olarak saptandı (OR=5.8, 95% CI=1.0 – 33,3). Sonuç: Vitamin D eksikliği uterin prolapsus gelişimi için risk faktörü olabilir. Anahtar Kelimeler: Pelvik organ prolapsusu; Vitamin D; Risk faktörü ABSTRACT Aim: Pelvic organ prolapse, the hernniation of the pelvic organs or beyond the vaginal walls. Vitamin D deficiency appears to be cause for pelvic muscle weakness. The aim of this study is to investigate the lack of vitamin D in patients with uterine prolapse. Methods: The records of patients were evaluated retrospectively in peri- and postmenopausal age group who were diagnosed with ICS stage 3-4 uterine prolapse based on vaginal examination and operated between February 2015-2016 in Izmir Tepecik Education and Research Hospital Gyneology and Obstetrics clinic. The files of 40 patients with ICS stage 0 in the peri- and postmenopausal period, whose 25 (OH) vitamin D were measured at the same time with the patient group and who underwent surgery due to any gynecologic indication, were evaluated as control group. Women were excluded if they had any medical conditions known to impair absorption or metabolism of vitamin D, or to be a major cause of fecal incontinence including Stage ≥3 chronic kidney disease, chronic liver disease, gastric bypass, colovaginal fistula, and pelvic irradiation. Results: 40 patients’ and 40 control cases’ data who met the study criteria were recorded. The patient group had a lower level of 25 (OH) vitamin D (9,5 ± 14,0 ng/ml) than the control group (15,3 ± 20,3 ng/ml). Furthermore, 25 (OH) vitamin D deficiency (25 [OH] vitamin D level <20 ng/mL) was found in 95,0% of the patient group and 77,5% of the control group (p=0,024). A 25 (OH) vitamin D level of <20 ng/mL was found to be the independent risk factor for uterine prolapse (OR=5,8, 95% CI=1,0 – 33,3). Conclusion: Vitamin D deficiency may be a risk factor in the development of uterine prolapse. Key words: Pelvic organ prolapse; Vitamin D; Risk factor

Anahtar Kelimeler

• VİTAMİN D VE UTERİN PROLAPSUS ARASINDAKİ İLİŞKİ The Association Between Vitamin D and Uterine Prolapse

Kaynakça

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