Zeynep Kamil Med J. 2013; 44(2): 51-57

Pelvik Organ Prolapsusuna Eþlik Eden Gizli Stres Ýnkontinans Olgularýnda Profilaktik Antiinkontinans Cerrahisinin Etkinliði

Taner Günay¹, Mehmet Akif Sargýn², Iþýl Turan Bakýrcý³, Mehmet Bayrak¹, Gökçen Örgül⁴, Özgür Aydýn Tosun⁵, Alpaslan Akyol^3
1Turkish Ministry of Health Istanbul Medeniyet University Göztepe Training and Research Hospital Gynecology and Obstetrics Clinic Istanbul
²Republic of Turkey Ministry of Health Fatih Sultan Mehmet Training and Research Hospital Gynecology and Obstetrics Clinic, Istanbul
³Ministry of Health, Kanuni Sultan Süleyman Training and Research Hospital, Gynecology and Obstetrics Clinic, Istanbul
⁴Republic of Turkey Ministry of Health Kars State Hospital, Kars
⁵Republic of Turkey Ministry of Health Zeynep Kamil Obstetrics and Pediatrics Training and Research Hospital Gynecology and Obstetrics Clinic Istanbul

INTRODUCTION: Clinically continent women with severe genitourinary prolapse and occult stress incontinence are considered to be at high risk of developing symptomatic stress incontinence once the prolapse is repaired. We studied the efficacy and safety of prophylactic anti-incontinence surgery in preventing postoperative stres incontinence in these women.
METHODS: One hundred forty consecutive women with stage 3 or higher genitourinary prolapse and occult stres incontinence were enrolled
between January 2005-January 2007. This was a retrospective study that compared women underwent prolapse surgery with prophylactic antiincontinence procedure (Group 1, n=105) and only prolapse surgery (Group 2, n=35). Preoperatively,none of
the women complained of stress incontinence. Preoperative evaluation included history, physical examination and urodynamic assesment. However, all had urodynamically-confirmed occult stres incontinence, revealed by repositioning of the prolapse. The main outcome measures were postoperative stres incontinence,voiding dysfunction, de novo urgency and recurrence of prolapse.
RESULTS: IPatient characteristics and preoperative urodynamic evaluation were similar in two groups. The mean duration of follow-up was 26.5 months and all patients underwent a repeat urodynamic evaluation at 3 months postoperatively.The rate of postoperative voiding disfunction, de novo urgency and recurrent prolapsus 15.2, 9.5, 2.9% in Group 1 and 5.7, 8.6, 5.7% in Group 2, respectively.There was no statistically difference among Group 1 and Group 2 (p>0,05). Nine (%8.6) patients in Group 1 and ten (%28.6) in Group 2 developed postoperative stress incontinence (p<0,05).
DISCUSSION AND CONCLUSION: Prophylactic anti-incontinence procedure(TVT or Burch colposuspension) is effective in preventing postoperative urinary stress incontinence in clinically continent patients who undergo surgery for severe genitourinary prolapse

Keywords: Pelvic Organ Prolapse, Urinary Incontinence

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Pelvik Organ Prolapsusuna Eþlik Eden Gizli Stres Ýnkontinans Olgularýnda Profilaktik Antiinkontinans Cerrahisinin Etkinliði

Taner Günay¹, Mehmet Akif Sargýn², Iþýl Turan Bakýrcý³, Mehmet Bayrak¹, Gökçen Örgül⁴, Özgür Aydýn Tosun⁵, Alpaslan Akyol^3
1T.C.Saðlýk Bakanlýðý Ýstanbul Medeniyet Üniversitesi Göztepe Eðitim ve Araþtýrma Hastanesi Kadýn hastalýklarý ve Doðum Kliniði Ýstanbul
²T.C.Saðlýk Bakanlýðý Fatih Sultan Mehmet Eðitim ve Araþtýrma Hastanesi Kadýn Hastalýklarý ve Doðum Kliniði,Ýstanbul
³T.C.Saðlýk Bakanlýðý Kanuni Sultan Süleyman Eðitim ve Araþtýrma Hastanesi Kadýn Hastalýklarý ve Doðum Kliniði,Ýstanbul
⁴T.C.Saðlýk Bakanlýðý Kars Devlet Hastanesi, Kars
⁵T.C.Saðlýk Bakanlýðý Zeynep Kamil Kadýn Hastalýklarý ve Çocuk Hastalýklarý Eðitim ve Araþtýrma Hastanesi Kadýn Hastalýklarý ve Doðum Kliniði Ýstanbul

GÝRÝÞ ve AMAÇ: En az üçüncü derece pelvik organ prolapsusu olan ve Gizli Stres Ýnkontinans tanýsý konulan hastalarda prolapsus cerrahisi sonrasýnda ortaya çýkabilecek stres inkontinanstan korunmak için yapýlacak eþ zamanlý profilaktik antiinkontinans cerrahisinin etkinliðini deðerlendirmek.
YÖNTEM ve GEREÇLER: Ocak 2005-Ocak 2007 tarihleri arasýnda 3.derece ve üzerindeki pelvik organ prolapsusu nedeniyle hastanemize baþvuran ve yapýlan incelemeler sonucunda Gizli Stres Ýnkontinans tanýsý konulan 140 hasta çalýþmamýza dahil edildi. Hastalar iki gruba ayrýldý. Grup 1: Prolapsus cerrahisine ek olarak profilaktik antiinkontinans cerrahisi yapýlan hastalar (n=105) ve Grup 2: Sadece prolapsus cerrahisi yapýlan, antiinkontinans cerrahisi yapýlmayan hastalar (n=35).Hastalarýn hiçbirinde preoperatif inkontinans þikayeti yoktu.Preoperatif
muayenede anamnez,fizik muayene ve ürodinamik incelemeler yapýldý.Prolapsusu redükte edildikten sonra inkontinans varlýðý ürodinamik incelemeylede gösterildi.Postoperatif kontrollerinde stres inkontinans, de novo sýkýþma hissi, iþeme zorluðu ve
rekürren prolapsus açýsýndan deðerlendirildi.
BULGULAR: Ocak 2005-Ocak 2007 tarihleri arasýnda 3.derece ve üzerindeki pelvik organ prolapsusu nedeniyle hastanemize baþvuran ve yapýlan incelemeler sonucunda Gizli Stres Ýnkontinans tanýsý konulan 140 hasta çalýþmamýza dahil edildi. Hastalar iki gruba ayrýldý. Grup 1: Prolapsus cerrahisine ek olarak profilaktik antiinkontinans cerrahisi yapýlan hastalar (n=105) ve Grup 2: Sadece prolapsus cerrahisi yapýlan, antiinkontinans cerrahisi yapýlmayan hastalar (n=35).Hastalarýn hiçbirinde preoperatif inkontinans þikayeti yoktu.Preoperatif
muayenede anamnez,fizik muayene ve ürodinamik incelemeler yapýldý.Prolapsusu redükte edildikten sonra inkontinans varlýðý ürodinamik incelemeylede gösterildi.Postoperatif kontrollerinde stres inkontinans, de novo sýkýþma hissi, iþeme zorluðu ve rekürren prolapsus açýsýndan deðerlendirildi.
TARTIÞMA ve SONUÇ: Ýleri derecede pelvik organ prolapsusu olan hastalar operasyon sonrasýnda ortaya çýkabilecek stres inkontinansý açýsýndan risklidirler. Bu nedenle hastalara prolapsus cerrahisine ek olarak yapýlacak profilaktik antiinkontinans cerrahisi hastalarý önemli bir problemden kurtaracaktýr.

Anahtar Kelimeler: Pelvik Organ Prolapsusu, Üriner Ýnkontinans

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