Hüseyin Alperen YILDIZ, Emrullah SOGUTDELEN

POST-PROSTATEKTOMİ İNKONTİNANSTA İNTRİNSİK SFİNKTER DİSFONKSİYONU DIŞINDAKİ NEDENLER DE AKILDA BULUNDURULMALIDIR

Amaç: Bu çalışmada radikal prostatektomiden 12 ay sonra persistan inkontinansı olan hastalarda üriner inkontinans nedenleri ve eşlik eden mesane patolojilerinin belirlenmesi amaçlanmıştır. Yöntem: Ocak 2015 ile Aralık 2020 tarihleri arasında lokalize prostat kanseri nedeniyle açık radikal retropubik prostatektomi (RRP) uygulanan ve cerrahiden sonra inkontinansı olan ve urodinami yapılmış olan 34 hasta retrospektif olarak incelendi. Tüm ürodinamik çalışmalar, iyi ürodinamik uygulama ICS protokolüne göre yapıldı ve değerlendirmeleri aynı doktor tarafından yapıldı. Hastalar vücut kitle indeksi, komorbidite, ameliyat öncesi PSA düzeyi, prostat hacmi, prostat, prostat biyopsi Gleason skoru, klinik evre, patolojik ISUP grade, patolojik evre, kaçırma anket lenf nodu pozitifliği, uluslararası inkontinans sorgulama formu–kısa form ve ped kullanımı için öznel anket dahil olmak üzere demografik ve klinik parametreleri ile değerlendirildi. Bulgular: Ürodinamik çalışmalar 29 hastada (%85.2) intrinsik sfinkter yetersizliği (ISY) olduğunu gösterdi. Bu 29 hastanın 9’unda (%26,4); sekonder aşırı aktif mesane (AAM), bozulmuş detrusör kontraktilitesi (BDK) ve AAM+BDK, sırasıyla 9 (%11,6), 4 (%11,6), 1 (%2,9) hastada saptandı. On dokuz hastada (%55.8) tek ISY tanısı varken, 15 hastada (%44.1) ISY dışında başka bir birincil tanı veya ikincil tanı vardı. Sonuç: Radikal prostatektomi sonrası hastalarda persistan üriner inkontinansın en sık nedeni intrinsik sfinter yetmezliği olmasına rağmen, hastaların önemli bir kısmında aşırı aktif mesane ve bozulmuş detrüsör kontraktilitesinin de eşlik ettiği göz önünde bulundurulmalıdır.

Anahtar Kelimeler:

prostat kanseri, prostatektomi sonrası inkontinans, ürodinami

KEEP IN MIND OTHER CAUSES THAN INTRINSIC SPHINCTER DYSFUNCTION IN POST-PROSTATECTOMY INCONTINENCE

Objective: This study aims to determine the causes of urinary incontinence and accompanying bladder pathologies in patients with persistent incontinence 12 months after radical prostatectomy. Methods: Thirty-four patients who underwent open radical retropubic prostatectomy (RRP) due to localized prostate cancer and incontinent after surgery between January 2015 and December 2020 and underwent urodynamic study (UDS) were retrospectively reviewed. All UDSs were performed according to the ICS protocol of good urodynamic practice and assessed by the same doctor. Patients were assessed by demographic and clinical parameters including age, body mass index (BMI), comorbidity, preoperative PSA level, prostate volume (PV), transrectal prostate biopsy Gleason score, clinical stage, pathological ISUP grade, pathological stage, lymph node positivity, international consultation on incontinence questionnaire-short form and subjective questionnaire for daily pad use. Results: Urodynamic studies showed that 29 patients (85.2%) had intrinsic sphincter deficiency (ISD). Nine (26.4%) of 29 patients with ISD had a secondary diagnosis of overactive bladder (OAB), impaired detrusor contractility (IDC) and OAB+IDC 9 (11.6%), 4 (11.6%), 1 (2.9%), respectively. Nineteen patients (55.8%) had a sole diagnosis of ISD, whereas 15 patients (44.1%) had another primary diagnosis or a secondary diagnosis other than ISD. Conclusion: Although ISD is the most common cause of persistent urinary incontinence in patients after radical prostatectomy, it should be taken into account that overactive bladder and impaired detrusor contractility are also accompanied by a significant proportion of patients.

Keywords:

prostate cancer, post-prostatectomy incontinence, urodynamics,

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