Tension-free Tape Ameliyatı Olan Hastalarda Yüksek Vücut Kitle İndeksinin Ameliyat Sonuçları Üzerine Etkisinin Değerlendirilmesi

Yıl 2021, Cilt: 16 Sayı: 1, 40 - 45, 08.02.2021

Hediye Dağdeviren Hüseyin Cengiz Sema Süzen Sema Baghakı Derya Ilıman Murat Ekin

https://doi.org/10.17517/ksutfd.689626

Öz

Amaç: Literatürde tension-free obturator tape (TOT) cerrahisinin kilolu ve obez kadınlardaki sonuçları ile ilgili çok az veri mevcuttur. Bu çalışmanın amacı; vücut kitle indeksinin (VKİ) TOT cerrahi başarısına olan etkisini, hasta memnuniyetini ve cerrahi sonrası 1 yıldaki komplikasyonları değerlendirmektir.
Gereç ve Yöntem: Stres üriner inkontinans (SUI) şikayeti ile TOT ameliyatı olmuş 96 hasta çalışmaya dahil edildi. Ameliyat sonrası hastalar en az 1 yıl takip edildi. Hastaları VKI’leri ile Dünya Sağlık Örgütü (WHO) sınıflandırmasına göre 3 gruba ayırdık. Grup 1 (normal VKİ <25 kg/m2), Grup 2 (kilolu VKİ 25-30 kg/m2), Grup 3 (obez VKİ > 30 kg/m2). Subjektif ve objektif sonuçlar, komplikasyonlar ve hastaların yaşam kaliteleri valide edilmiş sorgu formları ile (UDI-6, IIQ-7) değerlendirildi. Sonuçlar gruplar arasında karşılaştırıldı.
Bulgular: Çalışmaya dahil edilen 96 hastanın 32 tanesi normal kilolu, 32 tanesi kilolu ve geri kalan 32 tanesi de obez idi. Komplikasyon oranları gruplar arasında istatistiksel olarak anlamlı değildi (p>0.05). Tüm gruplarda hastaların UDI-6 ve IIQ-7 skorlarında 1 yıllık takipte başlangıç değerine belirgin düşüş izlendi. Tüm gruplarda 1 saatlik ped testi ve öküsürük testi (grup 1’de %71.8 ve grup 2 ve grup 3’de %84.3) sonuçlarına göre belirlenen toplam objektif kür oranı %80.2 (96 hastadan 77 tanesi ) idi. Gruplar arasında istatistiksel olarak anlamlı fark yok idi.
Sonuç: TOT cerrahisi objektif ve subjektif başarı oranları tüm VKİ’ne sahip hasta gruplarında benzer olarak izlendi. Artmış VKİ oranları ile komplikasyon oranları artmamaktadır.

Anahtar Kelimeler

Vücut kitle indeksi, Stres üriner inkontinans, Tension-free obturator tape

Increased Body Mass Index and Success Rate of Tension-free Tape Surgery

Öz

Objective: Only limited data are available on the outcome of tension-free obturator tape (TOT) procedures in overweight and obese women. This study aimed to assess the impact of body mass index (BMI) on TOT success rates, patient acceptability, and complications 1-year post-surgery.
Material and Methods: 96 women who suffered from stress urinary incontinence (SUI) underwent the TOT procedure were included to study. Patients were followed for at least one year. Patients were divided into three different groups related to BMI according to the World Health Organization (WHO) classification; Group 1 (healthy BMI <25 kg/m2), Group 2 (overweight BMI 25-30 kg/m2), Group 3 (obese BMI > 30 kg/m2). The subjective and objective outcomes, complications, and quality of life were assessed by validated questionnaires (UDI-6, IIQ-7). The results were compared for each group.
Results: Of the 96 women, 32 were defined as having a healthy weight, 32 were overweight, and 32 were obese. The complication rate was not significantly different between the BMI groups (p>0.05). The UDI-6 and IIQ-7 scores at a one-year follow-up showed a significant reduction versus baseline in each group without significant differences between the BMI groups. The overall objective cure rate was 80.2% (77 out of 96) by 1-hour pad test and cough test (71.8% in group 1 and 84.3% in groups 2 and 3). There were no significant differences between the groups.
Conclusion: TOT procedure has similar objectives and subjective cure rates among all the BMI groups. Elevated BMI does not increase the complication rate.

Anahtar Kelimeler

Body mass index, Stress urinary incontinence, Transobturator tape

Kaynakça

• 1. Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A, Goldman HB, Huser M, Milani AL, Moran PA: An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). International urogynecology journal 2016; 27(2):165-194. 2. Parazzini F, Colli E, Origgi G, Surace M, Bianchi M, Benzi G, Artibani W: Risk factors for urinary incontinence in women. European urology 2000; 37(6):637-643. 3. Park YK: Female Stress Urinary Incontinence. Journal of the Korean Continence Society 2008; 12(1):1-9. 4. Edwall L, Carlström K, Jonasson AF: Markers of collagen synthesis and degradation in urogenital tissue from women with and without stress urinary incontinence. Neurourology and Urodynamics: Official Journal of the International Continence Society 2005; 24(4):319-324. 5. Hunskaar S: A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women. Neurourology and Urodynamics: Official Journal of the International Continence Society 2008; 27(8):749-757. 6. Cummings J, Rodning C: Urinary stress incontinence among obese women: review of pathophysiology therapy. International Urogynecology Journal 2000; 11(1):41-44. 7. Delorme E, Droupy S, de Tayrac R, Delmas V: Transobturator tape (Uratape®): a new minimally-invasive procedure to treat female urinary incontinence. European urology 2004; 45(2):203-207. 8. Shumaker SA, Wyman JF, Uebersax J, McClish D, Fantl JA: Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Quality of life Research 1994; 3(5):291-306. 9. Uebersax J, Wyman J, Shumaker S, McClish D, Fantl J: Continence Program for Women Research Group Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Neurourol Urodyn 1995; 14(2):131-139. 10. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL: Epidemiology of surgically managed pelvic-organ prolapse and urinary incontinence. Obstetrics and gynecology 1997; 89(4):501-506. 11. Noblett K, Jensen J, Ostergard D: The relationship of body mass index to intra-abdominal pressure as measured by multichannel cystometry. International urogynecology journal 1997; 8(6):323-326. 12. Killingsworth LB, Wheeler TL, Burgio KL, Martirosian TE, Redden DT, Richter HE: One-year outcomes of tension-free vaginal tape (TVT) mid-urethral slings in overweight and obese women. International Urogynecology Journal 2009; 20(9):1103-1108. 13. Subak LL, Richter HE, Hunskaar S: Obesity and urinary incontinence: epidemiology and clinical research update. The Journal of urology 2009; 182(6S):S2-S7. 14. Gillon G, Engelstein D, Servadio C: Risk factors and their effect on the results of Burch colposuspension for urinary stress incontinence. Israel journal of medical sciences 1992; 28(6):354-356. 15. CUMMINGS JM, BOULLIER JA, PARRA RO: Surgical correction of stress incontinence in morbidly obese women. The Journal of urology 1998; 160(3):754-755. 16. Skriapas K, Poulakis V, Dillenburg W, de Vries R, Witzsch U, Melekos M, Becht E: Tension-free vaginal tape (TVT) in morbidly obese patients with severe urodynamic stress incontinence as last option treatment. European urology 2006; 49(3):544-550. 17. Hellberg D, Holmgren C, Lanner L, Nilsson S: The very obese woman and the very old woman: tension-free vaginal tape for the treatment of stress urinary incontinence. International Urogynecology Journal 2007; 18(4):423-429. 18. Rechberger T, Futyma K, Jankiewicz K, Adamiak A, Bogusiewicz M, Skorupski P: Body mass index does not influence the outcome of anti-incontinence surgery among women whereas menopausal status and ageing do: a randomised trial. International urogynecology journal 2010; 21(7):801-806. 19. Liu P-E, Su C-H, Lau H-H, Chang R-J, Huang W-C, Su T-H: Outcome of tension-free obturator tape procedures in obese and overweight women. International urogynecology journal 2011; 22(3):259-263. 20. Liapis A, Bakas P, Creatsas G: Efficacy of inside-out transobturator vaginal tape (TVTO) at 4 years follow up. European Journal of Obstetrics & Gynecology and Reproductive Biology 2010; 148(2):199-201. 21. Yonguc T, Gunlusoy B, Degirmenci T, Kozacioglu Z, Bozkurt IH, Arslan B, Minareci S, Yılmaz Y: Are the outcomes of transobturator tape procedure for female stress urinary incontinence durable in long-term follow-up? International urology and nephrology 2014; 46(7):1295-1300.