Özgür DÜNDAR, Cem KINIK, Murat MUHCU, Ferhat ATEŞ, Ali Rüştü ERGÜR, Ercüment MÜNGEN, Mehmet Vedat ATAY

Üriner stres inkontinans tedavisinde kullanılan cerrahi tedavi yöntemlerinin tedavi etkinliğinin karşılaştırılması

Amaç: idrar kaçırma şikayetiyle başvuran ve stres üriner inkontinans tanısı konan hastalarda kullanılan cerrahi tedavi yöntemlerinde tedavi etkinliğini karşılaştırmak. Materyal ve Metod: Polikliniğimize eforla idrar kaçırma şikayetiyle başvuran ve stres üriner inkontinans tanısı konan 27 olgu klinik durumlarına göre Burch ve TVT operasyonunun seçimine göre 2 gruba ayrıldı. Gruplardaki başarılı ve başarısız vakaların sonuçları birbirleriyle ve literatürdeki diğer anti-stres inkontinans operasyonlarının sonuçları ile karşılaştırıldı. Bulgular: Oniki aylık izleme sonunda başarı oranı TVT operasyonunda %90.9 ve Burch operasyonunda %87.5 olarak saptandı. Kliniğimizde elde edilen bu başarı oranları literatürlerle karşılaştırıldığında, TVT ve Burch operasyonunda yüksek bulundu. Burch ve TVT operasyonlarının başarı oranları incelendiğinde istatistiksel olarak anlamlı farklılık bulunmadı Sonuç: Tekniğin kolay olması, morbiditenin az olması, operasyon, hastanede kalış süresi, kateterizasyon ve normal aktiviteye dönüş süresinin daha az olması nedeniyle TVT operasyonu Burch operasyonuna göre ilk tercih edilecek yöntem olarak görülmektedir.

Anahtar Kelimeler:

-

Comparison of the treatment effectiviness of surgical procedures used in urinary incontinence treatment

Comparison of the treatment effectiviness of surgical procedures used in urinary incontinence treatment Objective: To compare the treatment effectiviness of surgical procedures used in urinary incontinence treatment in patients who admitted with a complaint of urinary leakage and diagnosed as urinary stres incontinence. Material and Methods : 27 cases who admitted to our outpatient clinic with urinary incontinence symptoms are included to the study. They are divided into Burch and TVT operation groups according to clinical conditions. In each group the results of succesful and unsuccesful cases are compared between each other and also between the results of other anti-stres incontinence operations in the literature. Results: After a follow-up of 12 months success rate is recorded as 90.9% in TVT operation group and 87.5% in Burch operation group. Our clinic's success rate in TVT and Burch operations are found higher when compared with those of the literature. There is no statistically significant differance between TVT and Burch operations success rates. Conclusion: TVT operations are considered to be the first preferred method instead of performing Burch operation in urinary stres incontinence treatment because of easy performance, early return to daily activity, less hospitalisation duration, catheterisation and operation time.

Keywords:

-,

PDF

___

1. Comiter CV. Sacral neuromodulation fort he symptomatic treatment of refractory interstitial cystitis: a prospective study. J Urol 2003;169:1369-73
2. Nager CW, Albo ME. Testing in women with lower urinary tract dysfunction. Clin Obstet Gynecol 2004;47:53-69
3. Blaives JG, Olsan CA. Stres incontinence: Classification and surgical approach. J Urol 1988;131:727-31
4. Liu CY. Laparoscopic treatment of stress urinary incontinence. Obstet Gynecol Clin North Am 1999;26:149-67
5. Gomella LG, Albala DM. Laparoscopic urological surgery:1994. Br J Urol 1994;74:267-73
6. Monyak MJ.The light at the end ofthe tunnel: One view of the future oflaparoscopy. Semin Urol 1992;10:205-12
7. Sakti D, Keith JP. Laparoscopic colposuspension. J Urol 1995;154:1119-21
8. Bergman A, Elia G. Three surgical procedures for genuine stress incontinence: five-year follow-up of a prospective randomized study. Am J Obstet Gynecol 1995;173:66-71
9. Leach GE, Dmochowski RR, Appell RA, Blaivas JG, Hadley HR, Luber KMet all.. Female stress urinary incontinence clinical guidelines panel summary report on surgical management of female stress urinary incontinence. The American Urological Association. J Urol l997;l58:875-8O
10. Ulmsten U, Henrikson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for the treatment of female urinary incontinence. Int Urogynecol J Pelvic Flor Dysfunct l996;7:8l-5
11. Ulmsten U, Hilton P, Ferrari A, Fischer W, Jacquetin B. TVT procedure: a micro-invasive surgical technique for GUI. 22nd Annual meeting of The International Urogynecological Association JulySO-August2, l997Amsterdam
12. Klutke JJ, Carlin BI, Klutke CG. The tensionfree vaginal tapeprocedure: correction ofstress incontinence with minimal alteretion in proximal urethral mobility. Urology 2OOO;55:5l2-4
lS. Atherton MJ, Stanton SL. A comparison of bladder neck movement and elevation after TVT and colposuspension. BJOG 2OOO;lO7:lS66-7O
14. Ulmsten U, Falconer C, Johnson P, Jomaa M, LannerL, Nilsson CG, Olsson I. A multicenter study of TVT for surgical treatment of stress urinary incontinence. Int Urogynecol J Pelvic Flor Dysfunct l998;9:2lO-S
15. Ulmsten U, Johnson P, RezapourM. A three-year follow up of TVTfor surgical treatment of female stress urinary incontinence. BJOG l999;lO6:S45-5O
16. Peschers UM, Tunn R, Buczkowski M, Perucchini D. TVT for the treatment of stress urinary incontinence. Clin Obstet Gynecol 2OOO;4S:67O-5
17. Deval B, Jeffry L, Al Najjar F, Soriano D, Darai E. Determinants of patient dissatisfaction after a TVT procedure for urinary incontinence. J Urol 2OO2;l67:2O9S-7
18. Güney S, Duman İ, Sönmez CN, Arısan S, Dalkılıç A, Ergenekon E. Stres inkontinans cerrahi yaklaşımlardan vajinal duvar askı, tansiyonsuz vaginal tape ve Burch kolposüspansiyon yönteminin klinik başarı ve ürodinamik bulgular açısından karşılaştırılması. Türk Üroloji Dergisi 2OO5;Sl:259-64
19. Doğan E, Erata Y Güçlü S, Göl M, Karas Ç, Alpaydın O. Gerçek: stres inkontinansın tedavisinde genel anestezi altında uygulanan gerilimsiz vajinal bant (TVT) operasyonunun sonuçları. Jinekolojik ve Obstetrik Dergisi 2004;18:215-20
20. Weber AM, Walters MD. Burch procedure compared with sling for stress urinary incontinence: a decision analysis. Obstet Gynecol 2000;96:867-73
21. AşkarN. Üriner inkontinans vepelvikorgan prolapsusunda epidemiyoloji. Turkiye Klinikleri JSurg Med Sci 2007;3(48):1-4.) 22 Colombo M, Vitobello D, Proietti F, Milani R. Randomised comparison of Burch colposuspension versus anterior colporrhaphy in women with stress urinary incontinence and anterior vaginal wall prolapse. BJOG 2000;107:544-51
23. Ward KL, Hilton P: UK and Ireland TVT Trial Group. A prospective multicentre randomised trial of TVT and colposuspension as primary treatment for stress incontinence: two-year follow up. Am J Obstet Gynecol 2004;190:324-31
24. Liapis A, Bakas P, Creatsas G. Burch colposuspension and TVT in the management of stress urinary incontinence in women. Eur Urol 2002;41:469-73
25. Lose G, Rosenkilde P, Gammelgaard J, Schroeder T. Pad-weighing test performed with standardized bladder volume. Urology 1988;32:78-80
26. Lin LY, Sheu BC, Lin HH. Sequental assessment of urodynamic findings before and after TVT operation for female genuine stress incontinence. Eur Urol 2004;45:362-6
27. Moran PA, WardKL, Johnson D, Smirni WE, Hilton P, Bibby J. TVT for primary genuine stress incontinence: a two-centrefollow up study. BJU Int 2000;86:39-42
28. Maher C, DwyerP, Carey M, Gilmour D. The Burch colposuspension for recurrent urinary stress incontinence following retropubic continence surgery. BJOG 1999;106:719-24
29. DainerM, Hall CD, ChoeJ,BhatiaNN.The Burch procedure: a comprehensive review. Obstet Gynecol 1998;54:49-60
30. Ostegard DR. Primary slings for everyone with genuine stress incontinence? The argument against. Int Urogynecol J Pelvic Dysfunct 1997;8:321-2
31. Enzelberger H, Hemler H, Schatten C. Comparison of the Burch and lyodura sling procedures for repair of unsuccessful incontinence surgery. Obstet Gynecol 1996;88:251-6
32. Appell RA. Primary slingsfor everyone with genuine stress incontinence? The argument for.... Int Urogynecol J Pelvic Dysfunct 1998;9:249-51
33. Ward KL, Hilton P; UK and Ireland TVT Trial Group. Tension-free vaginal tape versus colposuspension for primary urodynamic stress incontinence: 5-year follow up. BJOG 2008;115:226-33
34. Liapis A, Bakas P, Creatsas G. Long-term efficacy of tension-free vaginal tape in the management of stress urinary incontinence in women: efficacy at 5- and 7-year follow up. Int UrogynecolJPelvic FlorDysfmct 2008;Jun 10. (Epub ahead of print) 35. Nilsson CG, Palva K, Rezapour M, Falconer C. Eleven years prospective follow-up of the TVT procedure for treatment of stress urinary incontinence. Int Urogynecol J Pelvic Flor Dysfunct 2008;Jun 6. (Epub ahead of print)