Üriner İnkontinans Nedeni İle Yapilan Transobturatuar Tape Ve Kelly Plikasyonu Operasyonlarinin Karşılaştırılması
Öz
Amaç: Çalışmamızda üriner inkontinansı etkileyebilecek faktörleri araştırmak ve üriner inkontinans tedavisinde kullanılan cerrahi yöntemlerden TOT ve Kelly plikasyonu operasyonlarının sonuçlarını karşılaştırmak amaçlanmıştır.
Yöntem: Ocak 2016 ve Aralık 2021 tarihleri arasında Gaziantep Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniği’nde üriner inkontinans nedeni ile transobturator tape (TOT) ve Kelly Plikasyonu operasyonu uygulanan, 213 hastanın verileri ameliyattan sonraki 1 yıllık değerlendirmeleri göz önünde bulundurularak retrospektif olarak incelendi. Hastaların yaş, operasyon çeşidi, tam idrar analizi, üre, kreatinin sonuçları, kronik hastalık durumları, menopoz durumu, gravide ve pariteleri, vücut kitle indeksleri, idrar kaçırma(üriner inkontinans) tipi, stres testinin pozitif olup olmaması, vajinal prolapsus dereceleri, postoperatif kontrollerde idrar kaçırma şikayetlerinin devam edip etmemesi incelendi. Hastalar TOT ve Kelly plikasyonu operasyonu olanlar olmak üzere iki gruba ayrıldı.
Bulgular: Ameliyattan sonraki 1 yılın sonunda TOT operasyonu sonrası başarı oranı Kelly plikasyonu yapılan gruptan daha yüksekti. Ancak multivariant regresyon analizleri sonucunda TOT yapılan hastaların şikayetlerinin devam etme olasılığı Kelly plikasyonuna göre daha yüksek saptanmıştır (OR: 2.07 1.12-3.93 ) (P=0.02). Parite ve gravida sayısına bakıldığında iki grup arasında anlamlı fark varken, yaş, VKİ, menopozal durum, üriner inkontinans tipi, kronik hastalık durumu konusunda anlamlı fark izlenmedi.
Sonuç: TOT operasyonunun başarı oranı Kelly plikasyonuna göre daha yüksek bulunmuştur. Ancak, yapılan regresyon analizi sonucunda, TOT operasyonu geçiren hastalarda idrar kaçırma şikayetinin devam etme olasılığının daha fazla olduğu tespit edilmiştir.
Anahtar Kelimeler
Üriner inkontinans Stres Üriner İnkontinans Transobturator Tape kelly plikasyonu
Kaynakça
- 1. Abrams P, Cardozo L, Fall M et al. The standardisation of terminology of lower urinary tract function: Report from the standardisation sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:167-178.
- 2. Minassian VA, Yan X, Lichtenfeld MJ et al. The iceberg of health care utilization in women with urinary incontinence. Int Urogynecol J. 2012;23(8):1087.
- 3. Mardon RE, Halim S, Pawlson LG et al. Management of urinary incontinence in Medicare managed care beneficiaries: results from the 2004 Medicare Health Outcomes Survey.Arch Intern Med. 2006;166(10):1128.
- 4. Griffiths AN, Makam A, Edwards GJ. Should we actively screen for urinary and anal incontinence in the general gynaecology outpatients setting? A prospective observational study. J Obstet Gynaecol. 2006;26(5):442.
- 5. Wu JM, Matthews CA, Vaughan CP et al. Urinary, fecal, and dual incontinence in older U.S. Adults. J Am Geriatr Soc. 2015 May;63(5):947-53.
- 6. Kocak I, Okyay P, Dundar M et al. Female urinary incontinence in the west of Turkey: prevalence, risk factors and impact on quality of life. Eur Urol 2005;48: 634-41.
- 7. Nygaard IE, Lemke JH. Urinary incontinence in rural older women: prevalence, incidence and remission. J Am Geriatr Soc 1996; 44: 1049-54.
- 8. Burgio KL, Matthews KA, Engel BT. Prevalence, incidence and correlates of urinary incontinence in healthy, middle-aged women. J Urol 1991; 146: 1255-9.
- 9. Rogers RG. Clinical practice. Urinary stress incontinence in women. N Engl J Med. 2008 Mar;358(10):1029-36
- 10. Wood LN, Anger JT; Urinary incontinence in women. BMJ. 2014; 349: g4531. Epub 2014 Sep 15.
- 11. Bent A., McLennan M. Surgical management of urinary incontinence. Obstet Gynecol Clin North Am. 1998; 25: 884-906.
- 12. Kelly’s H.A., Dumm W.M.Urinary incontinence in women, without manifest injury to the bladder. Surg Gynecol Obstet.1914.;18:444-450.
- 13. Delorme E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol 2001;11:1306-13.
- 14. Hannestad Y, Rortveit G, Sandvik H et al. A communitybased epidemiological survey of female urinary incontinence. The Norwegian EPINCONT study. J Clin Epidemiol 2000;53: 1150-7.
- 15. Aghdas F.S. Surgical Management of Stress Urinary Incontinence. Urology Journal. 2005:2;175-182.
- 16. Danuser H., Bemis K., Thor K.B. Pharmacological analysis of the noradrenergic control of central sympathetic and somatic reflexes controlling the lower urinary tract in the anesthetised cat. The Journal of Pharmacology and Experimental Therapeutics. 1995; 274: 820- 825.
- 17. Olsen A.L., Smith V.J., Bergstrom J.O. et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997; 89: 501-506.
- 18. Bump R.C., Norton P.A. Epidemiology and natural history of pelvic floor dysfunction. Obstetrics and Gynecology Clinics of North America 1998; 25:723- 746.
- 19. Weber A.M., Walters M.D. Epidemiology and Social Impact of Urinary and Fecal Incontinence, Urogynecology and Reconstructive Pelvic Surgery (Ed. Walters M.D., Karram M.M), Mosby Inc., St. Louis, 1999; 25-33.
- 20. Rortveit G, Daltveit AK, Hannestad YS, et al.EPINCONT Study. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med. 2003; 348: 900-7.
- 21. Walters M.D., Karram M.M. (eds.). Anatomy of the lower urinary tract and pelvic floor. Clinical Urogynecology. St. Louis. Mosby-Year Book. 1993:3-16.
- 22. Ramírez Melgar E, Iris de la Cruz S, Martínez González L, et al. [Obesity as a risk factor in surgery for urinary incontinence]. Ginecol Obstet Mex. Kasım 1997; 65: 458-60.
- 23. Ku JH, Oh JG, Shin JW, et al. Outcome of mid-urethral sling procedures in Korean women with stress urinary incontinence according to body mass index. Int J Urol. Nisan 2006; 13:379-84.
- 24. Sohbati S, Salari Z, Eftekhari N. Comparison Between the Transobturator Tape Procedure and Anterior Colporrhaphy With the Kelly’s’s Plication in the Treatment of Stress Urinary Incontinence: a Randomized Clinical Trial. Nephrourol Mon. 2015;7: e32046.
Transobturator Tape and Kelly’s Plication Procedures Comparison: A Case-Control Study with One-Year Follow-Up
Öz
Objective: To investigate the factors that may affect urinary incontinence and compare the outcomes of surgical methods used to treat it, specifically Transobturator Tape (TOT) and Kelly’s plication procedures.
Method: The data of 213 patients who underwent TOT and Kelly’s Plication procedures for urinary incontinence at the Department of Obstetrics and Gynecology, Gaziantep University Faculty of Medicine, between January 2016 and December 2021, were retrospectively analyzed with consideration of their evaluations one year postoperatively. The patients were divided into two groups: those who underwent TOT and those who underwent Kelly’s’s Plication. The differences between the two groups were evaluated. Subsequently, the urinary incontinence complaints of both groups were assessed one year later, and the risk factors for patients whose complaints persisted were examined using logistic regression analysis.
Results: One year postoperatively, the success of the TOT procedure was higher than that of the Kelly’s’s Plication. However, multivariate regression analysis revealed that patients who underwent the TOT procedure had a higher likelihood of persistent complaints compared to those who underwent Kelly’s’s Plication (OR: 2.07 [1.12-3.93], P=0.02). While there was a significant difference between the two groups in terms of parity and gravidity, no significant differences were observed in terms of age, BMI, menopausal status, type of urinary incontinence, and the presence of chronic diseases.
Conclusion: The success rate of the TOT procedure was found to be higher compared to Kelly’s’s Plication. However, regression analysis indicated that patients who underwent the TOT procedure were more likely to have persistent urinary incontinence complaints.
Keywords: Urinary Incontinence, Stress Urinary Incontinence , Transobturator Tape, Kelly’s’s Plication
Anahtar Kelimeler
Urinary Incontinence Stress Urinary Incontinence Transobturator Tape Kelly’s’s Plication
Kaynakça
- 1. Abrams P, Cardozo L, Fall M et al. The standardisation of terminology of lower urinary tract function: Report from the standardisation sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:167-178.
- 2. Minassian VA, Yan X, Lichtenfeld MJ et al. The iceberg of health care utilization in women with urinary incontinence. Int Urogynecol J. 2012;23(8):1087.
- 3. Mardon RE, Halim S, Pawlson LG et al. Management of urinary incontinence in Medicare managed care beneficiaries: results from the 2004 Medicare Health Outcomes Survey.Arch Intern Med. 2006;166(10):1128.
- 4. Griffiths AN, Makam A, Edwards GJ. Should we actively screen for urinary and anal incontinence in the general gynaecology outpatients setting? A prospective observational study. J Obstet Gynaecol. 2006;26(5):442.
- 5. Wu JM, Matthews CA, Vaughan CP et al. Urinary, fecal, and dual incontinence in older U.S. Adults. J Am Geriatr Soc. 2015 May;63(5):947-53.
- 6. Kocak I, Okyay P, Dundar M et al. Female urinary incontinence in the west of Turkey: prevalence, risk factors and impact on quality of life. Eur Urol 2005;48: 634-41.
- 7. Nygaard IE, Lemke JH. Urinary incontinence in rural older women: prevalence, incidence and remission. J Am Geriatr Soc 1996; 44: 1049-54.
- 8. Burgio KL, Matthews KA, Engel BT. Prevalence, incidence and correlates of urinary incontinence in healthy, middle-aged women. J Urol 1991; 146: 1255-9.
- 9. Rogers RG. Clinical practice. Urinary stress incontinence in women. N Engl J Med. 2008 Mar;358(10):1029-36
- 10. Wood LN, Anger JT; Urinary incontinence in women. BMJ. 2014; 349: g4531. Epub 2014 Sep 15.
- 11. Bent A., McLennan M. Surgical management of urinary incontinence. Obstet Gynecol Clin North Am. 1998; 25: 884-906.
- 12. Kelly’s H.A., Dumm W.M.Urinary incontinence in women, without manifest injury to the bladder. Surg Gynecol Obstet.1914.;18:444-450.
- 13. Delorme E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol 2001;11:1306-13.
- 14. Hannestad Y, Rortveit G, Sandvik H et al. A communitybased epidemiological survey of female urinary incontinence. The Norwegian EPINCONT study. J Clin Epidemiol 2000;53: 1150-7.
- 15. Aghdas F.S. Surgical Management of Stress Urinary Incontinence. Urology Journal. 2005:2;175-182.
- 16. Danuser H., Bemis K., Thor K.B. Pharmacological analysis of the noradrenergic control of central sympathetic and somatic reflexes controlling the lower urinary tract in the anesthetised cat. The Journal of Pharmacology and Experimental Therapeutics. 1995; 274: 820- 825.
- 17. Olsen A.L., Smith V.J., Bergstrom J.O. et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997; 89: 501-506.
- 18. Bump R.C., Norton P.A. Epidemiology and natural history of pelvic floor dysfunction. Obstetrics and Gynecology Clinics of North America 1998; 25:723- 746.
- 19. Weber A.M., Walters M.D. Epidemiology and Social Impact of Urinary and Fecal Incontinence, Urogynecology and Reconstructive Pelvic Surgery (Ed. Walters M.D., Karram M.M), Mosby Inc., St. Louis, 1999; 25-33.
- 20. Rortveit G, Daltveit AK, Hannestad YS, et al.EPINCONT Study. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med. 2003; 348: 900-7.
- 21. Walters M.D., Karram M.M. (eds.). Anatomy of the lower urinary tract and pelvic floor. Clinical Urogynecology. St. Louis. Mosby-Year Book. 1993:3-16.
- 22. Ramírez Melgar E, Iris de la Cruz S, Martínez González L, et al. [Obesity as a risk factor in surgery for urinary incontinence]. Ginecol Obstet Mex. Kasım 1997; 65: 458-60.
- 23. Ku JH, Oh JG, Shin JW, et al. Outcome of mid-urethral sling procedures in Korean women with stress urinary incontinence according to body mass index. Int J Urol. Nisan 2006; 13:379-84.
- 24. Sohbati S, Salari Z, Eftekhari N. Comparison Between the Transobturator Tape Procedure and Anterior Colporrhaphy With the Kelly’s’s Plication in the Treatment of Stress Urinary Incontinence: a Randomized Clinical Trial. Nephrourol Mon. 2015;7: e32046.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Kadın Hastalıkları ve Doğum |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Erken Görünüm Tarihi | 28 Nisan 2025 |
| Yayımlanma Tarihi | |
| Gönderilme Tarihi | 16 Ağustos 2024 |
| Kabul Tarihi | 19 Mart 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 6 Sayı: 1 |
