Yaşar BOZKURT, Oğuz MERTOĞLU, Ferruh ZORLU

Üriner stres inkontinansda sling cerrahisi öncesi ürodinamik değişkenlerin preoperatif ve postoperatif klinik yansımaları

Bu çalışmada, üriner stres inkontinansda (saf veya karışık tip) otolog rektus fasyal sling cerrahisi öncesi ürodinamik değişkenlerin preoperatif ve postoperatif kliniğe yansımasını değerlendirmeyi amaçladık. Tepecik Eğitim ve Araştırma Hastanesi Üroloji Kliniğinde Mart 1999- Ocak 2005 tarihleri arasında üriner stres inkontinans nedeniyle otolog rektus fasyal sling cerrahi operasyonu yapılan hasta dosyaları retrospektif olarak incelendi. Çalışmaya 10 saf, 31 karışık tipte inkontinansı bulunan toplam 41 hasta alındı. Yaş ortalaması 50.4 (33-70) yıl idi. Onbeş hastada intrensek sfinkter yetmezliği (İSY) mevcuttu. Karışık tip inkontinansda ürodinamik incelemede; ilk duyu hissi düşük hacimde olmuş ve detrusor aşırı aktivitesi fazla görülmüştü. İSY başarı sonucunu değiştirmemekteydi. Ürodinamideki detrusor basıncı (Pdet) ile postoperatif rezidü idrar arasında anlamlı bir ilişki bulunmadı (P>0.05). Üriner stres inkontinansda; rektus fasyal sling cerrahisi öncesi yapılan ürodinamik inceleme, preoperatif ve postoperatif hasta kliniği ile uyumlu bulunmadı. Cerrahi başarıyı öngörmede ürodinamideki parametrelerden sadece ilk duyu hacmi anlamlı bulundu.

The relationships between preoperative urodynamic parameters and clinical outcomes in urinary stress incontinence

The aim of present study was to evaluate the influence of urodynamic parameters on preoperative and postoperative clinical pictures in stress incontinence. Charts of patients, who were operated for stress incontinence using autologous rectus fascia sling between March 1999 and January 2005 in Tepecik Training and Research Hospital Urology Clinic, were evaluated retrospectively. A total of 41 patients were divided into two subgroups as, pure (10 patients) and mixed stress incontinence (31 patients) groups. Mean age of patients was 50.4 (33-70) years. Fifteen patients had intrinsic sphincter insufficiency (ISI). Mixed incontinence group had lower volume for first sensation and more detrusor overactivity than pure group. ISI did not alter the success of operation. Urodynamically no relationship was found between detrusor pressure and postoperative postvoiding residual urine (P>0.05). In conclusion, urodynamic evaluation before surgery was not related to preoperative and postoperative clinical picture of patients, but first sensation of bladder is only predictive for the success in fascial sling surgery.

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