Stres üriner inkontinans tedavisinde transobturator teyp ve transvajinal teyp yöntemlerinin etkinliğinin ve komplikasyonlarının karşılaştırılması

Year 2023, , 10 - 16, 21.06.2023

Ali Buhur , Ömer Ünal , Dilek Erdem

https://doi.org/10.30565/medalanya.1120024

Abstract

Amaç: Stres üriner inkontinans tedavisinde transobturator teyp ve transvajinal teyp yöntemlerinin etkinlik ve komplikasyonlarının karşılaştırılması.

Yöntem: Ocak 2015-Aralık 2016 tarihleri arasında İstanbul Kanuni Sultan Süleyman Eğitim Eğitim ve Araştırma Hastanesinde stres üriner inkontinans (SUI) nedeniyle opere edilen 106 hastanın klinik kayıtları retrospektif incelendi. Transobturator teyp (TOT) Grup 1 ve gerilimsiz trans vajinal teyp (TVT) Grup 2 olarak sınıflandırıldı. Hastalarda preoperatif ve postoperatif inkontinans şiddetini ve operasyon başarı düzeylerini değerlendirmek için Q tip test, pet test, rezidü idrar ölçümü, stres testi ve yaşam kalitesini karşılaştırmak için ürogenital distres envanteri-6 (UDI-6) ve inkontinans etki anketi-7 (IIQ-7) kullanıldı. İki gruptaki demografik bilgiler, yapılan ek cerrahiler, komplikasyonlar, preoperatif ve postoperatif altıncı aydaki başarı ve memnuniyet düzeyleri için yapılan klinik test sonuçları karşılaştırıldı.

Bulgular: Gruplar arasında ortalama parite, vücut kitle indeksi, sigara kullanımı, inkontinans tipi, preoperatif ve postoperatif altıncı ayda yapılan, klinik ve yaşam kalitesini ölçen test sonuçları ve operasyon başarı düzeyleri yönünden istatiksel olarak anlamlı fark saptanmadı (p>0.05). İki grup arasında ortalama yaş, menopoz durumu, inkontinans süresi, eş zamanlı yapılan cerrahiler, mesane perforasyonu ve ameliyat süresi açısından anlamlı fark saptandı (p<0.05). Diğer komplikasyonlar açısından anlamlı fark saptanmadı.

Sonuç: TOT ve TVT sonuçlarının değerlendirilmesinde klinik testler yanında UDI-6 ve IIQ-7 testleri kullanılabilir. SUI tedavisinde etkinlik ve başarı açısından iki yöntem arasında anlamlı fark saptanmadı. TVT yönteminde komplikasyon riski TOT yöntemine göre daha yüksek saptandı. Her iki yöntemde inkontinans şiddetinde iyileşme ve yaşam kalitesi anketi sonuçlarına göre belirgin iyileşme saptandı.

Keywords

transobturator teyp, transvaginal teyp, stres inkontinans, UDI-6, IIQ-7

Comparison of the effectiveness and complications of transobturator tape and transvaginal tape methods in the treatment of stress urinary incontinence

Abstract

Aim: Comparison of the effectiveness and complications of transobturator tape and transvaginal tape methods in the treatment of stress urinary incontinence.

Method: Clinical records of 106 patients who underwent surgery in Istanbul Kanuni Sultan Suleyman Training and Research Hospital due to stress urinary incontinence between January 2015 and December 2016 were retrospectively analyzed. The patients were divided into two groups. Trans obturator tape (TOT) was classified as Group 1, and transvaginal tape (TVT) was classified as Group 2. The urogenital distress inventory-6 (UDI-6) and the incontinence impact questionnaire-7 (IIQ-7) were used to determine the severity of preoperative and postoperative incontinence and objectively compare the quality of life in all patients. The ethics committee approval was obtained from the ethics committee of Kanuni Training and Research Hospital. Statistical analysis of data was performed using SPSS version 24 (SPSS Inc, Chicago, Illinois).

Results: There was a significant difference between the two groups in terms of mean age, menopausal status, complications, and duration of surgery (p<0.05). In both groups, there was a significant improvement in postoperative UDI-6 and IIQ-7 tests evaluating the negative effects of urinary incontinence on daily life (p=0.01* and p=0.028*, respectively).

Conclusion: A significant improvement was observed in UDI-6 and IIQ-7 scores after TOT and TVT operations. There is no significant difference between TOT and TVT methods in terms of efficacy and success in the treatment of stress urinary incontinence.

Keywords

Transobturator tape, trans vaginal tape, stress urinary incontinence, UDI-6, IIQ-7

References

• 1. Trowbridge ER, Hoover EF. Evaluation and Treatment of Urinary Incontinence in Women. Gastroenterol Clin North Am. 2022;51(1):157-75. doi: 10.1016/j.gtc.2021.10.010.
• 2. Nambiar AK, Arlandis S, Bø K, Cobussen-Boekhorst H, Costantini E, de Heide M. et al. European Association of Urology Guidelines on the Diagnosis and Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 1: Diagnostics, Overactive Bladder, Stress Urinary Incontinence, and Mixed Urinary Incontinence. Eur Urol. 2022;82(1):49-59 doi: 10.1016/j.eururo.2022.01.045
• 3. Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for the treatment of female urinary incontinence. Int Urogynecol Pelvic Floor Dysfunct. 1996;7(2):81-5. doi: 10.1007/BF01902378.
• 4. Delorme E, Droupy S, de Tayrac R., Delmas V. Transobturator tape (Uratape). A new minimally invasive method in the treatment of urinary incontinence. Eur Urol. 2004;45(2):203-7. doi: 10.1016/j.eururo.2003.12.001.
• 5. Leone Roberti Maggiore U, Finazzi Agrò E, Soligo M, Li Marzi V, Digesu A, et al. Long-term outcomes of TOT and TVT procedures for the treatment of female stress urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J. 2017;28(8):1119-30. doi: 10.1007/s00192-017-3275-x.
• 6. Skorupska K, Grzybowska ME, Kubik-Komar A, Rechberger T, Miotla P. Identification of the Urogenital Distress Inventory-6 and the Incontinence Impact Questionnaire-7 cutoff scores in urinary incontinent women. Health Qual Life Outcomes. 2021;19(1):87. doi: 10.1186/s12955-021-01721-z
• 7. Mangano E, Campagne-Loiseau S, Curinier S, Botchrosvili R, Canis M, Chauvet P, et al. Transobturator Vaginal Tape in 10 Steps. J Minim Invasive Gynecol. 2020;27(1):27-8. doi: 10.1016/j.jmig.2019.06.016.
• 8. Rodrigues CA, Bianchi-Ferraro AMHM, Zucchi EVM, Sartori MGF, Girão MJBC, Jarmy-Di Bella ZIK. Pelvic Floor 3D Ultrasound of Women with a TVT, TVT-O, or TVT-S for Stress Urinary Incontinence at the Three-year Follow-up. Rev Bras Ginecol Obstet. 2017;39(9):471-479. doi: 10.1055/s-0037-1606125.
• 9. FitzGerald MP, Kenton K, Shott S, Brubaker L. Responsiveness of quality of life measurements to change after reconstructive pelvic surgery. Am J Obstet Gynecol. 2001;185(1):20-4. doi: 10.1067/mob.[phone].
• 10. Ford AA, Taylor V, Ogah J, Veit-Rubin N, Khullar V, Digesu GA. Midurethral slings for treatment of stress urinary incontinence review. Neurourol Urodyn. 2019;38 Suppl 4:S70-S75. doi: 10.1002/nau.24030.
• 11. Meyer F, Hermieu JF, Boyd A, Dominique S, Peyrat L, Haab F, et al. Repeat mid-urethral sling for recurrent female stress urinary incontinence. Int Urogynecol J. 2013;24(5):817-22. doi: 10.1007/s00192-012-1941-6.
• 12. Yalcin Y, Eris Yalcin S. Comparison of Success and Complication Rates of Tension-free Vaginal Tape (TVT) and Transobturator Tape (TOT) Operations in the Treatment of Stress Urinary Incontinence. Med J SDU 2020;27(3):267-272. doi: 10.17343/sdutfd.593764
• 13. Cubuk A, Yanaral F, Savun M, Ayranci A, Erbin A, Yazici O, et al. Modified autologous trans obturator tape surgery - evaluation of short term results. Ginekol Pol. 2020;91(2):51-6. doi: 10.5603/GP.2020.0016.
• 14. Verbrugghe A, De Ridder D, Van der Aa F. A repeat mid-urethral sling as a valuable treatment for persistent or recurrent stress urinary incontinence. Int Urogynecol J. 2013;24(6):999-1004. doi: 10.1007/s00192-012-1971-0.
• 15. Bakali E, Buckley BS, Hilton P, Tincello DG.Treatment of recurrent stress urinary incontinence after failed minimally invasive synthetic suburethral tape surgery in women. Cochrane Database Syst Rev. 2013;28;(2):CD009407. doi: 10.1002/14651858.CD009407.pub2.
• 16. Hickling DR, Steele SS. The role of preoperative urodynamics in stress urinary incontinence surgery. Can Urol Assoc J. 2017;11(6Suppl2):S113-S115. doi: 10.5489/cuaj.4581.
• 17. But I. Vaginal wall erosion after transobturator tape procedure. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(6):506-8. doi: 10.1007/s00192-004-1266-1.
• 18. Larsson PG, Teleman P, Persson J. A serious bleeding complication with injury of the corona mortis with the TVT-Secur procedure. Int Urogynecol J. 2010;21(9):1175-7. doi: 10.1007/s00192-010-1103-7.
• 19. Abdel-Fattah M, Ramsay I, Pringle S. Lower urinary tract injuries after transobturator tape insertion by different routes: a large retrospective study. BJOG. 2006;113(12):1377-81. doi: 10.1111/j.1471-0528.2006.01097.x. 20. McLennan MT, Melick CF. Bladder perforation during tension-free vaginal tape procedures: analysis of learning curve and risk factors. Obstet Gynecol. 2005;106(5 Pt 1):1000-4. doi: 10.1097/01.AOG.0000185256.32405.76.
• 21. Tamussino K. F, Hanzal E, Kölle D, Ralph, G, Riss P. A, Austrian Urogynecology Working Group. Tension-free vaginal tape operation: results of the Austrian registry. Obstetrics & Gynecology. 2001;98(5):732-6. doi: 10.1016/s0029-7844(01)01565-4.
• 22. Porena M, Costantini E, Free B, Giannantoni A, Ranzoni S, Marini l, et al. Tension-Free Vaginal Tape Versus Transobturator Tape as Surgery For Stress Urinary Incontinence: Results Of A Multicentre Randomised Trial. Eur Urol .2007;52(5):1481-90. doi: 10.1016/j.eururo.2007.04.059.
• 23. Cholhan HJ, Hutchings TB, Rooney KE. Dyspareunia associated with paraurethral banding in the transobturator sling. Am J Obstet Gynecol. 2010;202(5):481.e1-5. doi: 10.1016/j.ajog.2010.01.061.
• 24. Zengin K, Kara M, Tanik S, Sertcelik MN, Eraslan A. Comparison of Transobturator Tape and Mini-Sling Tissue Fixation in Female Patients Who Had Stress Urinary Incontinence. Adv Clin Exp Med. 2015;24(5):851-5. doi: 10.17219/acem/60568.