Stres Tip İdrar Kaçırma Tedavisinde Orta Üretra Askı Cerrahilerinin Uzun Dönem Etkinlik ve Güvenirliliğinin Karşılaştırılması

Öz

Giriş: Transobturator tape (TOT) ve tension free vaginal tape (TVT) operasyonları stres tipte idrar kaçırma (StİK) tedavisinde kullanılan standart orta üretra askı cerrahileridir. Çalışmamızda, TOT/TVT operasyonlarının; klinik başarı, komplikasyon ve uzun dönem etkinlik/güvenilirliğini değerlendirmeyi amaçladık. Materyal-Method: Tek bir cerrah tarafından 2011-2020 tarihleri arasında spinal anestezi altında orta üretral askı (TOT ve TVT) cerrahisi uygulanan toplam 79 hasta retrospektif olarak değerlendirildi. Hastaların pre-operatif anamnez, fizik muayene, labarotuvar değerlendirmesi ve ürodinamik incelemeleri yapıldı. Hastaların cerrahi başarısı, per-operatif komplikasyonları, post-operatif erken dönem ve geç dönem komplikasyonları değerlendirildi. Bulgular: Orta üretra askı operasyonu uygulanan 41(%51,9) hastaya TOT ve 38 (%48,1) hastaya TVT cerrahisi uygulandı. Hastaların ortalama yaşı 54,5±9,5 yıl ve ortalama takip süresi 55,4 (min 2,9-max 113,7) aydır. Cerrahi sonrası 77 hastada (%97,5) StİK şikayetinin tamamen ortadan kalktığı gözlenirken, TVT uygulanan 2 (%2,5) hastada sıklığı azalmış olsa da StİK’nın devam ettiği gözlendi. Post-operatif dönemde 4 (%5) TVT hastasında ve 5 (%6,3) TOT hastasında de-novo sıkışma tipi idrar kaçırma gözlendi. Sonuç: Orta üretra askı operasyonlarından TOT ve TVT cerrahileri StİK tedavisinde başarı oranları yüksek tedavi seçenekleridir. TVT operasyonunda TOT cerrahisine göre komplikasyon oranlarının düşük oranda da olsa yüksek olmasına rağmen uzun dönem izlem sonrası her iki operasyonun da etkili ve güvenilir olduğu tespit edildi.

Anahtar Kelimeler

• Orta üretral askı cerrrahisi
• Trans-obturator tape (TOT)
• Tension free vaginal tape (TVT)
• Stres tipte idrar kaçırma

Comparison of Long-Term Efficacy and Reliability of Mid-Urethral Sling Surgeries in Stress Type Urinary Incontinence Treatment

Öz

Objective: Trans-obturator tape (TOT) and tension free vaginal tape (TVT) operations are standard mid urethral sling surgeries used in stress type urinary incontinence (STUI) treatment. We aimed to evaluate the clinical success, complications and long-term efficacy / reliability of TOT / TVT surgeries. Materials and Methods: A total of 79 patients who underwent middle urethral sling (TOT and TVT) operation by a single surgeon under spinal anesthesia between 2011-2020 were evaluated retrospectively. Pre-operative anamnesis, physical examination, laboratory evaluation and urodynamic examinations of the patients were analysed. Surgical success, per-operative complications, post-operative early and late complications were evaluated. Results: Trans-obturator tape and TVT surgery was performed in 41 (51.9%) and 38 (48.1%) patients respectively. The average age of the patients was 54.5 ± 9.5 years and the mean follow-up period was 55.4 (min 2.9-max 113.7) months. It was observed that STUI symptoms disappeared completely in 77 patients (97.5%) after surgery, while STUI symptoms continued in 2 (2.5%) patients with TVT. De-novo urgency incontinence was observed in 4 (5%) TVT patients and 5 (6.3%) TOT patients at post-operative period. Conclusion: Mid-urethral sling operations (TOT and TVT surgeries) are the treatment options with high success rates in STUI treatment. Although complication rates were higher in TVT operation compared to TOT surgery, after long-term follow-up, it was found that both operations were effective and reliable.

Anahtar Kelimeler

• Mid-urehtral Sling Surgery,
• Trans-obturator tape (TOT),
• Tension free vaginal tape (TVT),
• Stress type urinary incontinence,

Kaynakça

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