Journals / Türk Üroloji Dergisi/Turkish Journal of Urology / 2005 / Cilt: 31 - Sayı: 2
Comparison of urodynamic findings and clinical success rate of surgical procedures of stress incontinence: Vaginal wall sling, tension-free vaginal type and bruch colposuspension
- Pages
- 259–264
- DOI
- —
Abstract
Introduction: The number of patients with stress urinary incontinence has inclined in recent years. However the gold standard surgical procedure for stress urinary incontinence is not certain yet. In this study, we evaluated urodynamic findings, clinical success and complication rates of pubovaginal vaginal wall sling procedures, namely tension free vaginal tape (TVT), vaginal wall sling (VWS) and retropubic cystourethropexy (Burch procedure). Materials and Methods: Between February 1997 and July 2003, 70 female patients with the diagnosis of stress urinary incontinence were included into the study. VWS was performed in 28 (40%) patients while TVT was performed in 13 (18.6%) and Burch procedure in 29 (41.4%) patients. Preoperatively patient's histories were taken briefly and urethral mobility was evaluated by physical examination. Pelvic floor relaxation was evaluated by gynecological examination. Patients with high grade pelvic floor relaxation were excluded. Water cystometry was performed in all patients. Postoperative complications and hospitalization periods were recorded. Postoperative urodynamic follow-up was performed during the first year. The comparisons of success rates between groups, differences between preoperative and postoperative parameters and the correlation of the parameters with the success rates were evaluated. Results: Mean age was 47.5 years (range 40-63). Nine patients had history of previous anti-incontinence surgery and in seven of these patients VWS procedure was performed. Mean follow up time was 22 months (12-35 months) and the success rate was 69%, 71% and 69% in Burch, VWS and TVT groups, respectively. There were no statistically significant differences between the groups and the success rates, although VWS procedures had higher success rates in secondary cases (p=0.01). Conclusion: Although there are many types of surgical procedures for stress incontinence, there is no consensus on the most appropriate procedure. There were no differences in the success rates among the groups but in the secondary cases the success rate was higher in the VWS group. Although VWS procedures and especially TVT, is the most commonly preferred procedure, it is emphasized that Burch which was the most carried out procedure, still has an important place particularly in primary cases.
Özet
Kliniğimizde uyguladığımız stres inkontinans cerrahi prosedürlerinden tansiyonsuz vajinal tape (TVT), vajinal duvar askı (VWS) ve retropubik sistoüretropeksi yöntemlerinden Burch Kolposüspansiyon yöntemlerini klinik başarı, ürodinamik sonuçlar ve istenmeyen yan etki oranları açısından karşılaştırmayı amaçladık. Çalışmamıza Şubat 1997 ile Haziran 2003 tarihleri arasında kliniğimizde stres inkontinans tanısı ile öpere edilen 70 kadın hasta alındı. Hastaların 28'ine VWS (%40), 13'üne TVT (%18,6) ve 29'una Burch prosedürü (%41,4) uygulandı. Hastalar ameliyat öncesi dönemde yaş, parite, idrar kaçırma şekli, ped taşıma öyküsü, sistemik hastalıklar, geçirilmiş anti-inkontinans cerrahi varlığı, urge ve urge inkontinans durumu, postmiksiyonel rezidü açısından değerlendirildi. Ameliyat öncesinde her hastaya dolum sistometrisi uygulandı. Ameliyat sonrası erken ve geç istenmeyen yan etkiler kaydedildi. Ameliyat sonrası 1. yılda ürodinamik takipleri yapılan hastaların kaydedilen parametreler arasındaki ameliyat öncesi ve sonrası farkları ve başarı ile korelasyonu araştırıldı. Ortalama takip süresi 22 ay (12-35 ay) olan Burch grubundaki 29 hastadan 20'sinde, VWS grubundaki 28 hastadan 20'sinde, TVT grubunda ise 13 hastanın 9'unda tam iyileşme görüldü. Operasyon tiplerine göre iyileşme oranlarında anlamlı bir fark saptanmazken sekonder olgularda TVT ve VWS daha üstün bulundu. Stres inkontinansın cerrahi tedavisinde farklı birçok yöntem olmasına karşın, yöntemlerin başarı oranlan birbirlerine yakındır.