Can TUYGUN, Muzaffer EROĞLU, Abdurrahim İMAMOĞLU, Ahmet KİPER, Ufuk ÖZTÜRK

Stres üriner inkontinans olgularında makroplast implantasyon cihazı ile üretral "bulking" tedavisinin sonuçları

Amaç: Bu çalışma stres inkontinans olgularında enjektabl materyallerin endoskopik girişim ge-rektirmeden uygulanabilmesi amacıyla geliştirilmiş olan makroplast implantasyon cihazının kul-lanım kolaylığını ve hastalar üzerindeki etkisini incelemek için planlandı. Gereç ve yöntem: Ocak 1999- Haziran 2003 tarihleri arasında stres inkontinans tanısı konulan ve çalışma grubuna alınan 52 hastaya ortalama 6.8 ml makroplast enjekte edildi, işlem 14 hastada lokal, 38 hastada genel anestezi altında makroplast implantasyon cihazı kullanılarak gerçekleşti-rildi.; Bulgular: ilk uygulama sonunda 52 hastanın 20'sinde tam kür, 19'unda anlamlı iyileşme (bir ped ve altı) tesbit edildi. Onüç hastada inkontinans (bir ped üzeri) devam etti. İnkontinansı devam - eden hastalara ikinci uygulama yapıldı. İkinci uygulama sonunda 10 hastada tam kür, 4 hastada anlamlı düzelme görülürken 4 hasta inkontinan kaldı, ilk uygulamadan sonra 32.5 olan ortalama yaşam kalitesi skoru 13.75 olarak bulundu (p

Results of endourethral bulking treatment with macroplastique implantation device in patients with stress urinary incontinence

Aim: Patients with, in cases of stress urinary incontinence (SUI) were evaluated according to the ease of use and the efficacy of macroplastique implantation device which makes it possible to use injectable material without the need for endoscopic procedures. Materials and methods: Fifty-two female patients who were diagnosed with primary stress in-continence from January 1999 to June 2003 were injected with a mean volume of 6.8 cc of mac-roplastique, 14 locally, and 38 under general anesthesia through macroplastique implantation device. Results: Following the first application, 20 patients were dry (no pad), 19 patients were socially continent (one pad or less), 13 patients were incontinent (more than one pad). For patients who remained incontinent, second application was made. Following the second session, 10 patients were dry, 4 patients were socially continent and 4 patients remained incontinent. For the first session, mean quality of life score was 32.5 in the preoperative period and became 13.75 postoperatively (p

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1. Wolen LH. Incontinence in youg healthy nulliparous women. J Urol 1969;101:545-549. 2. Concensus Panel. Urinary incontinence in adults. JAMA 1989; 261:2685-2690. 3. Stanton SL. Stress incontinence. Why and how operation work. Urol Clin North Am 1985;2:279-284. 4. Burch JL. Cooper’s ligament urethrovesical suspension for stress incontinence. Am J Obstet Gynecol 1968; 100:764-774. 5. Alcalay M, Monga QA, Stanton SL. Burch colposuspension. A 10-20 year follow up. Br J Obstet Gynaecol 1995; 102:740-745. 6. Duckett JRA. Theuseofperiurethralinjectablesinthetreatmentof genuine stress incontinenece. Br J Obstet Gynaecol 1998;105: 390-396. 7. Khullar V,Cordozo LD, Abbott D ve ark.. Gax collagen in the treatment of urinary incontinence in elderly women. A 2 year follow up. Br j Obstet Gynaecol 1997;104:96-99. 8. Raz S, Ericsa DR: SEAPI QMM incontinence classıficationsystem.Neurology and Urodynamics 1992;11:192. 9. Malizia AA Jr, Reiman HM, Myers RP, et al. Migration and granulomatous reaction after periurethral injection of polytef (Teflon).JAMA1984;24:3277-3281. 10. Leth PM. Spread of teflonparticlesfromperiurethrallyinjectedteflonpastetopulmonarytissue.UgeskrLaeger1994;156:981-982(abstract). 11. Stothers L, Goldenberg SL. Delayed hypersensitivity and systemic arthralgia following transurethral collagen injection for stress urinary incontinance. J Urol 1998;159:1507-1509. 12. Pannek J, Brands FH, Senge T. Particle migration after transurethral injection of carbon coated beads for stress urinary incontinance. J Urol 2001;166:1350-1353. 13. Ritts RE. Re: Particle migration after transurethral injection of carbon coated beads for stress urinary incontinance. J Urol 2002; 167:1804-1805. 14. Aaranson IA, Tames RA, Greene WB, ve ark. Endoscopic treatment for reflux.EurUrol1993;23:394-399. 15. SheriffMK,FoleyS,McFarlaneJ,etal.Endosscopiccorrectionofintractable stress incontinence with silicone micro-implants. Eur Urol 1997; 32:284-288. 16. Usman F, Hanella S. A single transurethral Macroplastique injection as primary treatment for stress urinary incontinence. J Obstet Gynecol 1998;18:56-60. 17. Koelbl K, Saz V, DorflerD,etal.Transurethralinjectionofsiliconemicroimplants for intrinsic urethral sphincter deficiency.ObstetGynecool 1998;92:332-336. 18. Monga AK, Robinson D, Stanton SL. Periurethral collagen injections for genuine stress urinary incontinence: a 2 year follow up. Br J Urol 1995;76:156-160. 19. Hanella SM, Hall V, Duckett JRA et al. A multicentre evaluation of a new surgical technique for urethral bulking in the treatment ofv genuine stress incontinence. Br j Obstet Gynaecol 2000; 107:1035-1039. 20. Herschorn S, Radomski SB. Collagen injections for GSI: patient selection and durability. Int Urogynecol J 1997;8:18-24. 21. Shah PJR. Injectables and GSI. Urology news 1997;2:7-11.