Dergiler / GORM:Gynecology Obstetrics & Reproductive Medicine / 2002 / Cilt: 8 - Sayı: 3
A clinical study concerning sacrocolpopexy with prolene mesh and combinated operations in cases with vaginal vault eversion
- Sayfa
- 223–225
- DOI
- —
Özet
Vaginal kaf prolapsuslarında kullanılan operasyonlardan biri sakrokolpopeksidir. Vaginal kaf prolapsus tanısı konulan altı olgunun ortalama yaşı 68,83±12,79 (49-77), ortalama gravidası 5,67±1,75(3-8) , ortalama paritesi 3,16±1.16(2-5) idi. 4 olguda vaginal histerektomi, 2 olguda total abdominal histerektomi ve bilateral salpingooferektomi sonrasında vaginal kaf prolapsusu oluşmuştu. Operasyon öncesi iki olguda stress üriner inkontinans mevcuttu. Tüm olgulara sakrokolpopeksi yanında Moschcowitz+paravaginal defekt onarımı+ Burch operasyonu ve kolporafi posterior operasyonu uygulandı. Operasyon öncesi üriner inkontinansı olmayan bir olguda postoperatif 3.günde minimal stres ile idrar kaçağı gözlendi. Hasta yürürken bile idrar kaçağı oluştu. Hastaya ilk operasyondan bir ay sonra spinal anestezi ile tension free vaginal tape (TVT) operasyonu yapıldı. Hasta post operatif 1. günde kuru idi. Vaginal kaf prolapsuslarında, vaginal kafın prolen mesh ile sakruma askısı ve pelvik relaksasyona neden olan tüm defektlerin kombine onarılmasının , operasyon sonrası üretral açılanmanın giderilmesine bağlı operasyon sonrası gelişebilecek üriner inkontinansın engellenmesinde daha başarılı sonuçlar sağlayacağını düşünmekteyiz. Bu üretral açılanma varlığı, operasyon öncesi vaginal pesser (Gehrung) ile vaginal kafın anatomik pozisyonu sağlanarak belirlenebilir.
Abstract
OBJECTIVE: Analysis of cases in which vaginal vault eversion has been treated via sacrocolpopexy with prolene mesh and combinated operations. STUDY DESIGN:In our Gynecology Clinic, 6 cases with diagnosis of vaginal vault eversion were treated between February 2001-February 2002 by sacrocolpopexy with prolene mesh and combinated operations and these cases were analyzed for their age, parity, previous operations, urinary incontinence status and their surgical outcome. RESULTS: Six cases with diagnosis of vaginal vault eversion had a mean age of 68.83±12.79 (49-77) and their mean gravida was 5.67±1.75 (3-8) and their mean parity was 3.16±1.16 (2-5).In four of these patients, vaginal vault eversion had occurred following vaginal hysterectomy; in the remaining two patients, vaginal vault eversion had occurred following total abdominal hysterectomy and bilateral salpingo-oopherectomy. Two patients had stress urinary incontinence preoperatively. For all of our patients, sacrocolpopexy operation, Moschowitz operation, paravaginal defect reperation, Burch operation and posterior colporaphy operation in the same sitting were chosen. In one patient without urinary incontinence preoperatively, urinary leak with minimal stress was observed in the third postoperative day. Urinary leakage occurred even when this patient was walking. One month after the first operation, this patient underwent Tension-free Vaginal Tape (TVT) operation under spinal anesthesia. The patient was continent in the first postoperative day. CONCLUSION:Concerning vaginal vault eversion, we think of gaining better results in preventing urinary incontinence caused by postoperative derangement of urethral kinking, via suspending the vaginal vault to sacrum with prolene mesh and adding combinated reparations of all defects causing pelvic relaxations in the same sitting. When preoperatively anatomical position of vaginal vault is provided by vaginal pesser (Gehrung ), the existence of this urethral kinking can be determined.