Üriner İnkontinans Tedavisinde Posterior Tibial Sinir Stimülasyonun Etkinliği

Yıl 2022, Cilt: 5 Sayı: 3, 577 - 584, 01.09.2022

Musa Çankaya , Maria Ciorbadji

https://doi.org/10.19127/bshealthscience.1084661

Öz

Üriner İnkontinans (Üİ) istemli olarak idrar tutamama ya da istemsiz idrar kaçırma olarak bilinir. Üİ üretral yoluyla veya ektopik üretra nedeniyle olabilir. Konservatif tedavi, üriner inkontinans hastalarının birçoğunda minimum yan etki ve semptomları kötüleştirmemesi nedeniyle birinci basamak tedavi yöntemi olarak kabul edilir. Fizyoterapi yaklaşımında mesane eğitimi, pelvik taban kaslarının eğitimi, biofeedback, elektrik stimülasyonu yer alır. Elektrik stimülasyonu, fizyoterapi klinik uygulamada Üİ tedavisi için kullanılabilecek yöntemler arasındadır. Transkutanöz tibial sinir stimülasyonu (TTNS), tibial sinir yolundaki elektrostimülasyon yoluyla detrusor kasının inhibisyonunu kolaylaştırmayı amaçlar. TTNS, hastalar için konservatif ve etkili tedavi olarak kabul edilen basit, non-invaziv, iyi tolere edilebilen bir tekniktir. Ayrıca bu tedavi yönteminin kolay uygulanabilir olması, cihazın kolay taşınabilir olması ve hastalarda ağrıya neden olmaması gibi avantajları mevcuttur. Posterior tibial sinir medial malleolusun üstüne boyunca uzanan bölgede, yüksek yanıt ve geleneksel olarak çeşitli üriner şikayetlerin giderilmesini amaçlayan akupunktur noktasına (spleen-6) karşılık gelen bir alan belirlenmiştir. Trankutanöz Posterior Tibial Sinir Stimülasyonu (TPTSS) non-invaziv bir girişimdir ve sistemik bir yan etkisi bulunmamaktadır. Tarama başlangıç tarihi 2012 yılından itibaren (son on yıl) belirlenen veri tabanlarında Şubat 2022 tarihine kadar yer alan konuyla ilgili tüm araştırmalar incelenmiştir. Tibial sinir ve üriner inkotinans ‘‘tibial nerve and urinary incotinence’’ anahtar kelimeleri yazılarak arama yapıldığında, Pubmed, Science Direct ve Google Scholar’ da gelişmiş aramalarda sadece başlıklar seçilerek yapılan taramada 29 çalışmaya rastlanmıştır. Yapılan tarama sonucunda ilgili makaleler detaylı olarak incelenmiş ve yedi makalenin dahil edilme kriterlerine uygun olduğu belirlenmiştir. İncelenen çalışmalarda TPTSS tedavi yönteminin daha çok kullanıldığı, bu yöntemin plasebo gruplarıyla veya farklı bölgelere uygulanarak kıyaslandığı belirlenmiştir. Genel olarak TPTSS tedavi yönteminin uygulandığı grubun sonuçlarının, diğer karşılaştırılan gruplara göre daha anlamlı olduğu saptanmıştır (P<0.05). TPTSS, tam olarak standardize edilmemiş bir tedavi tekniğidir. Bu bağlamda elektrik stimülasyonun optimal parametrelerini, en etkili tedavi protokollerini, tedavi yönteminin uzun vadeli etkinliğini ve hastalara uygulanabilirliğini belirlemek amacıyla yeni çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Posterior, Transkutanöz, Tibial sinir stimulayonu, Üriner inkotinans

Efficacy of Posterior Tibial Nerve Stimulation in the Treatment of Urinary Incontinence

Öz

Urinary Incontinence (UI) is known as voluntary urinary incontinence or involuntary urinary incontinence.UI may be via the urethra or due to the ectopic urethra. Conservative treatment is considered first-line therapy for most urinary incontinence patients, as it has minimal side effects and does not worsen the patient's symptoms. The physiotherapy approach includes bladder training, pelvic floor muscle training, biofeedback, and electrical stimulation. Electrical stimulation physiotherapy is one of the methods that can be used for the treatment of UI in clinical practice. Transcutaneous tibial nerve stimulation (TTNS) aims to facilitate the inhibition of the detrusor muscle through electrostimulation in the tibial nerve pathway. TTNS is a simple, non-invasive, well-tolerated technique that is considered a conservative and effective treatment for patients. In addition, it has advantages such as being easy to apply, being easily portable and not causing pain in patients. In the region extending along the posterior tibial nerve above the medial malleolus, an area corresponding to the acupuncture point (spleen-6), aimed at the high response and the traditional relief of various urinary complaints, has been identified. TPTSS is a non-invasive procedure and has no systemic side effects.All researches related to the subject in 2012 (last ten years) and until February 2022 in the determined databases were examined. When searching by typing "tibial nerve and urinary incotinence", 29 studies were found by selecting only titles in advanced searches in PubMed, Science Direct, and Google Scholar.These results have been studied in detail. At the end of the review, seven articles were found to be suitable. TPTSS was used more in studies and compared with placebo or application to another site. In general, the results of the TPTSS group were more significant than the other groups (p<0.05). TPTSS is not a fully standardized technique. In this context, new studies are needed to determine the optimal parameters of electrical stimulation, the most effective treatment protocols and long-term efficacy and applicability to patients.

Anahtar Kelimeler

Posterior, Transcutaneous, Tibial nerve stimulation, Urinary incontinence

Kaynakça

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