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

Yıl 2024, Cilt: 10 Sayı: 3, 432 - 453, 31.12.2024

Arzu Değirmenci Akar , Savaş Özdemir

Öz

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.

Anahtar Kelimeler

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

Etik Beyan

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

Kaynakça

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