STRES ÜRİNER İNKONTİNANS HASTALARINDA MİDÜRETRAL TRANSOBTURATOR BANT (TOT) CERRAHİSİ: KLİNİK GÖZLEM ERKEN VE GEÇ DÖNEM SONUÇLARI

Arzu Değirmenci Akar; Savaş Özdemir

Research Article

STRES ÜRİNER İNKONTİNANS HASTALARINDA MİDÜRETRAL TRANSOBTURATOR BANT (TOT) CERRAHİSİ: KLİNİK GÖZLEM ERKEN VE GEÇ DÖNEM SONUÇLARI

Year 2024, Volume: 10 Issue: 3, 432 - 453, 31.12.2024

Arzu Değirmenci Akar , Savaş Özdemir

Abstract

Stres üriner inkontinans (SUI) olgularında, Transobturator bant (TOT) operasyonunun etkinliğinin, erken ve geç komplikasyonlarının literatür bilgisi ışıgında hastaların klinikleri ve yaşam kaliteleri baz alınarak retrospektif olarak değerlendirilmesi amaçlanmıştır. SUI veya Mikst üriner inkontinans (MUI) tanısı ile TOT yapılan 20 hasta çalışmaya alındı. Hastaların ortalama yaşları 49.05±8.70 yaş aralığındaydı. Hastalara yapılan preop ürolojik ve jinekolojik anamnezleri, dermografik özellikleri, nörölojik muayeneleri, jinekolojik muayene, incontinans anketleri, ultrasonografi, stres test, Q tip test, ofis sistometri sonuçları değerlendirildi. Operasyondan sonra 3.ayda ve 1. ve 2. yılda çağrılan ve tüm tetikler tekrarlanan hastaların değerleri preop parametrelerle karşılaştırıldı. TOT operasyonu, tüm hastalarda Safyre marka monofilaman tape kullanılarak dıştan içe yöntemi ile yapıldı. Sonuçlar Wilcoxon signed rank testi ile istatistiksel anlamlılık açısından değerlendirildi. 13 hastada (%65) SUI, 7 hastada (%35) MUI mevcuttu. Operasyon sırasında 6 (%30) hastaya ek olarak Kolpografi anterior (CA) veya Kolpografi posterior (CP) uygulandı. Bir hastaya sağ adnexiyal kitle nedeniyle L/S Ooferektomi uygulandı. Hastaların hiçbirinde perop komplikasyona rastlanmadı. Post op, 2 hastada işeme disfonksiyonu,1hastada yamuk işeme, 2 hastada vaginal tapeye aşırı reaksiyon ve bir hastada midüretral mesh yerinde inlamasyon görülürken, sadece bir hastada denova urge görüldü. Q tip test sonuçlarına göre mesane boynu mobilitesi operasyondan sonra anlamlı olarak değişmiş olarak gözlendi. Yaşam kalitesi değerlendirilmesinde IIQ-7 ve UDI-6 skorlarında istatistiksel olarak anlamlı düzelme saptandı. Çalışmamızda TOT operasyonu geçiren hastaların yüksek oranda iyileştiği semptomların kaybolduğu yaşam kalitesinin düzeldiği ve diğer yöntemlere üstünlüğü objektif olarak gösterilmiştir. Çalışmamız TOT tekniğinin uygulama kolaylığı ,minimal invaziv girişim olmasının hasta ve hekim açısından avantajları komplikasyon oranının da düşük olması sebebiyle SUI'nin cerrahi tedavisinde diğer tedavi yaklaşımlarına değerli bir alternatif olduğunu düşündürmektedir.

Keywords

Stres Üriner İnkontinans (SÜİ), Transobturator Bant (TOT), Cerrahi Tedavi

Ethical Statement

Bu çalışma, ikinci yazarın danışmanlığında yürütülen, birinci yazarın Tıpta Uzmanlık Tezinden üretilmiştir.

References

1. Abrams P, Blavias JG, Stanton SL, Andersen JT. The standardization of terminology for lower urinary tract function. Br J Obstet Gynaecol. 1990;97:1–16.
2. Kelleher C. Epidemiology and classification of urinary incontinence. In: Cordozo L, ed. Urogynecology. New York: Churchill Livingstone; 1997:3–26.
3. Falconer C, Soderberg M, Blomgren B, Ulmsten U. Influence of different sling materials on connective tissue metabolism in stress urinary incontinent women. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12:19–23.
4. Abrams P, Blavias JG, Stanton SL, Andersen JT. The standardization of terminology for lower urinary tract function. Neurourol Urodyn. 1998;7:403–427.
5. Hunskaar S, Lose G, Sykes D, et al. The prevalence of urinary incontinence in women in four European countries. BJU Int. 2004;93:324–330.
6. Demirci F, Özden S, Yücel N, Yalti S, Demirci E. Prevalence of urinary incontinence in Turkish menopausal women. I. Ulusal Ürojinekoloji Kongresi; 1999 June 8–11; İstanbul, Turkey.
7. Petros P, Ulmsten U. An integral theory and its method for the diagnosis and management of female urinary incontinence. Scand J Urol Nephrol. 1993;153:1–93.
8. Dainer M, Hall CD, Choe J, Bhatia NN. The Burch procedure: a comprehensive review. Obstet Gynecol Surv. 1999;54:49–60.
9. Wang AC. Colposuspension on urethral obstruction: a randomized controlled trial. Neurourol Urodyn. 2003;22:185–190.
10. Delorme E. La bandelette trans-obturatrice: un procédé mini-invasif pour traiter l’incontinence urinaire d’effort de la femme. Prog Urol. 2001;11:6–13.
11. Delorme E, Droupy S, de Tayrac R, et al. Transobturator Tape (Uratape®): a new minimally-invasive procedure to treat female urinary incontinence. Eur Urol. 2004;45:203–207.
12. Costa P, Grise P, Droupy S, et al. Surgical treatment of female stress urinary incontinence with a transobturator tape (TOT; Uratape®): short-term results of a prospective multicentric study. Eur Urol. 2004;46:102–107.
13. Delmas V. Anatomical risks of transobturator suburethral tape in the treatment of female stress urinary incontinence. Eur Urol. 2005;48:793–798.
14. Domingo S, Alama P, Ruiz N, Perales A, Pellicer A. Diagnosis, management and prognosis of vaginal erosion after transobturator suburethral tape procedure using a nonwoven thermally bonded polypropylene mesh. J Urol. 2005;173:1627–1630.
15. Moore KL. The pelvis and perineum. In: Moore KL, ed. Clinically Oriented Anatomy. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins; 1992:243–322.
16. Ward K, Hilton P. A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: two-year follow-up. Am J Obstet Gynecol. 2004;190:324–331.
17. Ulmsten U, Falconer C, Johnson P, et al. A multicenter study of tension-free vaginal tape (TVT) for surgical treatment of urinary stress incontinence. Int Urogynecol J. 1998;9:210–213.
18. Diokno AC. Epidemiology of female incontinence. In: Raz S, ed. Female Urology. 2nd ed. Philadelphia: WB Saunders Co.; 1996:6–73.
19. Stanton SL, Chamberlein GVP, Holmes DM. Randomised study of the anterior repair and colposuspension operation for the control of genuine stress incontinence. Proceedings of the 75th annual meeting of the International Continence Society; 1985; London. p. 236–237.
20. Cam C, Karateke A, Sakallı M. Validation of the short forms of Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) in a Turkish population. Neurourology Urodynamics. 2006;26:129–133.
21. De Lorme E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol. 2001;11:1306–1313.
22. Boyles SH, Edwards R, Gregory W. Complications associated with transobturator sling procedures. Int Urogynecol J. 2007;18:19–22.
23. Grise P, Droupy S, Saussine C, et al. Transobturator tape sling for female stress incontinence with polypropylene tape and outside-in procedure: 1 year of minimal follow-up and review of transobturator tape sling. J Urol. 2006;68:759–763.
24. De Leval J. Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol. 2003;44:724–730.
25. Spinosa JP, Dubuis PY. Suburethral sling inserted by the transobturator route in the treatment of female stress urinary incontinence: preliminary results in 117 cases. Eur J Obstet Gynecol Reprod. 2005;123:212–217.
26. Debodinance P. Trans-obturator urethral sling for the surgical correction of female stress urinary incontinence: Outside-in (Monarc®) versus inside-out (TVT-O®). Are the two ways reassuring? Eur J Obstet Gynecol Reprod Biol. 2006;135:571–577.
27. Delorme E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol. 2001;11:1306–1313.
28. Shobeiri SA, Garely AD, Chesson RR, et al. Recognition of occult bladder injury during the tension-free vaginal tape procedure. Obstet Gynecol. 2002;99:1067–1072.
29. Falconer C, Soderberg M, Blomgren B, Ulmsten U. Influence of different sling materials on connective tissue metabolism in stress urinary incontinent women. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12:19–23.
30. Domingo S, Ruiz N, Alama P, et al. Diagnosis, management and prognosis of vaginal erosion after transobturator suburethral tape procedure using a nonwoven thermally bonded polypropylene mesh. J Urol. 2005;173:1627–1630.
31. Naidu A, Lim YN, Barry C, et al. Transobturator tape for stress incontinence: the North Queensland experience. Aust N Z J Obstet Gynaecol. 2005;45:446–449.
32. But I. Vaginal wall erosion after transobturator tape procedure. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16:506–508.
33. Amid PK. Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia. 1997;1:15–21.
34. Baghi A, Trastour C, Benizri E, Bongain A. 10 cases of infections with suburethral multifilament polypropylene mesh sling requiring removal of the sling. Abstract presented at the ICS meeting in Paris, 2004. 35. Staskin DR, Plzak L. Synthetic slings: pros and cons. Curr Urol Rep. 2002;3:414–417.
36. Tamussino KF, Hanzal E, Koelle D, et al. Tension-free vaginal tape operation: results of the Austrian registry. Obstet Gynecol. 2001;98:732–736.
37. Kuuva N, Nilsson CG. A nationwide analysis of complications associated with the tension-free vaginal tape procedure. Acta Obstet Gynecol Scand. 2002;81:72–77.
38. But I. Vaginal wall erosion after transobturator tape procedure. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16:506–508.
39. Boyles SH, Edwards R, Gregory W, et al. Complications associated with transobturator sling procedures. Int Urogynecol J Pelvic Floor Dysfunct. 2006 Mar 28.
40. Bodellson G, Henriksson L, Stjernquist M. Short term complications of the tension-free vaginal tape operation for stress urinary incontinence in women. Br J Obstet Gynecol. 2002;109:566–569.
41. Mellier G, Benayed B, Bretones S, et al. Suburethral tape via the obturator route: is the TOT a simplification of the TVT? Int Urogynecol J Pelvic Floor Dysfunct. 2004;15:227–232.
42. El-Azab AS, Rackley RR, Abdelmalak JB, et al. Cystoscopic resection of tension-free vaginal tape (TVT) in the bladder. J Pelv Surg. 2004;10:85–87.
43. DeTayrac R, DeYeux X, Droupy S, et al. A prospective randomized trial comparing tension-free vaginal tape and transobturator suburethral tape for surgical treatment of stress urinary incontinence. Am J Obstet Gynecol. 2004;190:602–608.
44. Boublil V, Ciofu C, Traxer O, Sebe P, Haab F. Complications of urethral sling procedures. Curr Opin Obstet Gynecol. 2002;14:515–520.
45. Groutz A, Gordon D, Wolman I, et al. Tension-free vaginal tape for stress urinary incontinence: is there a learning curve? Neurourol Urodyn. 2002;21:470–472.
46. Levin I, Groutz A, Gold R, et al. Surgical complications and medium-term outcome results of tension-free vaginal tape: a prospective study of 313 consecutive patients. Neurourol Urodyn. 2004;23:7–9.

Year 2024, Volume: 10 Issue: 3, 432 - 453, 31.12.2024

Arzu Değirmenci Akar , Savaş Özdemir

Abstract

References

1. Abrams P, Blavias JG, Stanton SL, Andersen JT. The standardization of terminology for lower urinary tract function. Br J Obstet Gynaecol. 1990;97:1–16.
2. Kelleher C. Epidemiology and classification of urinary incontinence. In: Cordozo L, ed. Urogynecology. New York: Churchill Livingstone; 1997:3–26.
3. Falconer C, Soderberg M, Blomgren B, Ulmsten U. Influence of different sling materials on connective tissue metabolism in stress urinary incontinent women. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12:19–23.
4. Abrams P, Blavias JG, Stanton SL, Andersen JT. The standardization of terminology for lower urinary tract function. Neurourol Urodyn. 1998;7:403–427.
5. Hunskaar S, Lose G, Sykes D, et al. The prevalence of urinary incontinence in women in four European countries. BJU Int. 2004;93:324–330.
6. Demirci F, Özden S, Yücel N, Yalti S, Demirci E. Prevalence of urinary incontinence in Turkish menopausal women. I. Ulusal Ürojinekoloji Kongresi; 1999 June 8–11; İstanbul, Turkey.
7. Petros P, Ulmsten U. An integral theory and its method for the diagnosis and management of female urinary incontinence. Scand J Urol Nephrol. 1993;153:1–93.
8. Dainer M, Hall CD, Choe J, Bhatia NN. The Burch procedure: a comprehensive review. Obstet Gynecol Surv. 1999;54:49–60.
9. Wang AC. Colposuspension on urethral obstruction: a randomized controlled trial. Neurourol Urodyn. 2003;22:185–190.
10. Delorme E. La bandelette trans-obturatrice: un procédé mini-invasif pour traiter l’incontinence urinaire d’effort de la femme. Prog Urol. 2001;11:6–13.
11. Delorme E, Droupy S, de Tayrac R, et al. Transobturator Tape (Uratape®): a new minimally-invasive procedure to treat female urinary incontinence. Eur Urol. 2004;45:203–207.
12. Costa P, Grise P, Droupy S, et al. Surgical treatment of female stress urinary incontinence with a transobturator tape (TOT; Uratape®): short-term results of a prospective multicentric study. Eur Urol. 2004;46:102–107.
13. Delmas V. Anatomical risks of transobturator suburethral tape in the treatment of female stress urinary incontinence. Eur Urol. 2005;48:793–798.
14. Domingo S, Alama P, Ruiz N, Perales A, Pellicer A. Diagnosis, management and prognosis of vaginal erosion after transobturator suburethral tape procedure using a nonwoven thermally bonded polypropylene mesh. J Urol. 2005;173:1627–1630.
15. Moore KL. The pelvis and perineum. In: Moore KL, ed. Clinically Oriented Anatomy. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins; 1992:243–322.
16. Ward K, Hilton P. A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: two-year follow-up. Am J Obstet Gynecol. 2004;190:324–331.
17. Ulmsten U, Falconer C, Johnson P, et al. A multicenter study of tension-free vaginal tape (TVT) for surgical treatment of urinary stress incontinence. Int Urogynecol J. 1998;9:210–213.
18. Diokno AC. Epidemiology of female incontinence. In: Raz S, ed. Female Urology. 2nd ed. Philadelphia: WB Saunders Co.; 1996:6–73.
19. Stanton SL, Chamberlein GVP, Holmes DM. Randomised study of the anterior repair and colposuspension operation for the control of genuine stress incontinence. Proceedings of the 75th annual meeting of the International Continence Society; 1985; London. p. 236–237.
20. Cam C, Karateke A, Sakallı M. Validation of the short forms of Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) in a Turkish population. Neurourology Urodynamics. 2006;26:129–133.
21. De Lorme E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol. 2001;11:1306–1313.
22. Boyles SH, Edwards R, Gregory W. Complications associated with transobturator sling procedures. Int Urogynecol J. 2007;18:19–22.
23. Grise P, Droupy S, Saussine C, et al. Transobturator tape sling for female stress incontinence with polypropylene tape and outside-in procedure: 1 year of minimal follow-up and review of transobturator tape sling. J Urol. 2006;68:759–763.
24. De Leval J. Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol. 2003;44:724–730.
25. Spinosa JP, Dubuis PY. Suburethral sling inserted by the transobturator route in the treatment of female stress urinary incontinence: preliminary results in 117 cases. Eur J Obstet Gynecol Reprod. 2005;123:212–217.
26. Debodinance P. Trans-obturator urethral sling for the surgical correction of female stress urinary incontinence: Outside-in (Monarc®) versus inside-out (TVT-O®). Are the two ways reassuring? Eur J Obstet Gynecol Reprod Biol. 2006;135:571–577.
27. Delorme E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol. 2001;11:1306–1313.
28. Shobeiri SA, Garely AD, Chesson RR, et al. Recognition of occult bladder injury during the tension-free vaginal tape procedure. Obstet Gynecol. 2002;99:1067–1072.
29. Falconer C, Soderberg M, Blomgren B, Ulmsten U. Influence of different sling materials on connective tissue metabolism in stress urinary incontinent women. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12:19–23.
30. Domingo S, Ruiz N, Alama P, et al. Diagnosis, management and prognosis of vaginal erosion after transobturator suburethral tape procedure using a nonwoven thermally bonded polypropylene mesh. J Urol. 2005;173:1627–1630.
31. Naidu A, Lim YN, Barry C, et al. Transobturator tape for stress incontinence: the North Queensland experience. Aust N Z J Obstet Gynaecol. 2005;45:446–449.
32. But I. Vaginal wall erosion after transobturator tape procedure. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16:506–508.
33. Amid PK. Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia. 1997;1:15–21.
34. Baghi A, Trastour C, Benizri E, Bongain A. 10 cases of infections with suburethral multifilament polypropylene mesh sling requiring removal of the sling. Abstract presented at the ICS meeting in Paris, 2004. 35. Staskin DR, Plzak L. Synthetic slings: pros and cons. Curr Urol Rep. 2002;3:414–417.
36. Tamussino KF, Hanzal E, Koelle D, et al. Tension-free vaginal tape operation: results of the Austrian registry. Obstet Gynecol. 2001;98:732–736.
37. Kuuva N, Nilsson CG. A nationwide analysis of complications associated with the tension-free vaginal tape procedure. Acta Obstet Gynecol Scand. 2002;81:72–77.
38. But I. Vaginal wall erosion after transobturator tape procedure. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16:506–508.
39. Boyles SH, Edwards R, Gregory W, et al. Complications associated with transobturator sling procedures. Int Urogynecol J Pelvic Floor Dysfunct. 2006 Mar 28.
40. Bodellson G, Henriksson L, Stjernquist M. Short term complications of the tension-free vaginal tape operation for stress urinary incontinence in women. Br J Obstet Gynecol. 2002;109:566–569.
41. Mellier G, Benayed B, Bretones S, et al. Suburethral tape via the obturator route: is the TOT a simplification of the TVT? Int Urogynecol J Pelvic Floor Dysfunct. 2004;15:227–232.
42. El-Azab AS, Rackley RR, Abdelmalak JB, et al. Cystoscopic resection of tension-free vaginal tape (TVT) in the bladder. J Pelv Surg. 2004;10:85–87.
43. DeTayrac R, DeYeux X, Droupy S, et al. A prospective randomized trial comparing tension-free vaginal tape and transobturator suburethral tape for surgical treatment of stress urinary incontinence. Am J Obstet Gynecol. 2004;190:602–608.
44. Boublil V, Ciofu C, Traxer O, Sebe P, Haab F. Complications of urethral sling procedures. Curr Opin Obstet Gynecol. 2002;14:515–520.
45. Groutz A, Gordon D, Wolman I, et al. Tension-free vaginal tape for stress urinary incontinence: is there a learning curve? Neurourol Urodyn. 2002;21:470–472.
46. Levin I, Groutz A, Gold R, et al. Surgical complications and medium-term outcome results of tension-free vaginal tape: a prospective study of 313 consecutive patients. Neurourol Urodyn. 2004;23:7–9.

There are 45 citations in total.

Details

Primary Language	Turkish
Subjects	Obstetrics and Gynaecology
Journal Section	Research Article
Authors	Arzu Değirmenci Akar 0009-0004-3487-1012 Savaş Özdemir 0000-0003-3028-5804
Early Pub Date	January 3, 2025
Publication Date	December 31, 2024
Submission Date	October 6, 2024
Acceptance Date	October 6, 2024
Published in Issue	Year 2024 Volume: 10 Issue: 3

Cite

APA	Değirmenci Akar, A., & Özdemir, S. (2024). STRES ÜRİNER İNKONTİNANS HASTALARINDA MİDÜRETRAL TRANSOBTURATOR BANT (TOT) CERRAHİSİ: KLİNİK GÖZLEM ERKEN VE GEÇ DÖNEM SONUÇLARI. International Anatolia Academic Online Journal Health Sciences, 10(3), 432-453.