The value of perineal nitrasonography and urodynamic evaluation in choice of surgical method and its success in cases with urinary incontinence

Abstract

Objective: To evaluate the significance of perineal ultrasonography (USG) and urodynamic test in the diagnosis of the type of urinary incontinence (I/I), the choice of medical or surgical treatment and evaluation of the success of the surgical method . Materials and methods: The study was performed prospectively on 60 cases of UI. Cases were evaluated by perineal USG and urodynamic testing before the surgical treatment. 56 cases were operated and 4 cases were treated medically. 49 of the cases were re-evaluated by perineal USG and 42, by urodynamic test after 5 months. Results: As grouped as mild and severe UI, no relation was determined between these groups with respect to demographic properties. When urodynamic test considered as 'gold standart' the predictive value of history taking for diagnosis of GSI (Genuine Stress Incontinence), Dl (Detrusor Instability); MI (Mix Incontinence) was found to be %28, %100, %87, respectively. The success rate of reconstruction in 5 months evaluated by perineal USG was found to be %63.6 in colporaphy anterior and Kelly Kennedy group, %77A in Burch group and %85.7 in sling operation group. Ten cases of incontinence due to DI were detected after Burch and Sling operations, six of which were treated successfully with medical therapy. Conclusion: Persistent and/or de novo DI, incorrect choice of surgical method and poor surgical technique were proposed to be responsible for the early recurrence of UI. Perineal USG and urodynamic testing were effective methods in diagnosis of the type of UI and choice of suitable surgical and/or medical therapy and evaluation of the success and failure of the surgical treatment of UI cases.

Keywords

• Urinary Incontinence,Prospective Studies,Urodynamics,Ultrasonography

Üriner inkontinans olgularında perineal ultrasonografi ve ürodinamik incelemenin cerrahi yöntem seçimi ve başarısındaki önemi

Öz

Amaç: Üriner inkontinansın tanısında, medikal ve cerrahi yöntemlerle tedavi seçiminde ve cerrahi sonrası başarının değerlendirilmesinde perineal ultrasonografi (USG) ve ürodinamik incelemelerin önemini değerlendirmek. Materyal ve Metod: Çalışmamız üriner inkontinans (Üİ) tanısıyla tedavi uygulanan 60 olgu üzerinde prospektif olarak yapıldı. Cerrahi tedavi öncesinde tüm olgulara perineal USG ve ürodinamik çalışma yapıldı. 56 olgu opere edildi, 4 olguya medikal tedavi uygulandı. Tedaviden ortalama 5 ay sonra, 49 olguda üretra mobilitesi perineal USG ile değerlendirildi, 42 olguda ürodinamik çalışma yapılabildi. Bulgular: Olgularımız ağır ve hafif Üİ olarak gruplandırıldığında demografik özelliklerin, inkontinans ağırlığını etkilemediği gözlendi. Ürodinamik çalışma 'gold standart' alındığında, anamnez ile doğru tanı koyma başarısı, GSl (Gerçek Stres İnkontinans)'da %28, Dİ (Detrüsör İnstabilitesi)'de %100, Mİ (Mikst İnkontinans)'de %87 idi. Cerrahi tedavinin başarısı perineal USG ile değerlendirildiğinde, ilk 5 ayda kolporafi anterior + Kelly Kennedy grubunda %63.6, Burch grubunda %77.4, Sling grubunda ise %85.7 bulundu. Burch ve Sling grubunda 10 olguda Dİ'e bağlı inkontinans devam etmekteydi; 6'sı medikal tedaviyle düzeldi. Sonuç: Erken dönemde saptanmış nüks etyolojisinde, persiste ve/veya de novo Dİ'nin, anatomik defekte uygun cerrahinin seçilememiş olması, cerrahi teknik yetersizliğin rol oynadığı düşünüldü. Perineal USG ve ürodinamik incelemenin Üİ'nin tipinin doğru tanısı, uygun medikal ve cerrahi tedavinin seçimi ve cerrahi tekniğin başarı ve başarısızlığının saptanmasında etkin yöntemler olduğu görüşüne varıldı.

Anahtar Kelimeler

• İdrar kaçırma,İleriye dönük çalışma,Ürodinamik,Ultrasonografi

Kaynakça

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