Kadınlarda stres veya mikst üriner inkontinans için laparoskopik ve açık Burch kolposüspansiyon tekniklerinin karşılaştırılması: üçüncü basamak bir merkezde on yıllık bir deneyim

Absrakt Amaç: İstanbul, Türkiye'de son on yıldır tek bir eğitim ve araştırma hastanesinde stres veya mikst tip üriner inkontinansta açık Burch Kolposüspansiyon ve laparoskopik Burch kolposüspansiyon tekniklerinin postoperatif seyrini, etkinliklerini ve komplikasyon oranlarını değerlendirmek. Gereç ve yöntemler: Kanuni Sultan Süleyman Eğitim ve Araştırma Merkezi'nde Ocak 2011 ile Mayıs 2022 tarihleri arasında gerçekleştirilen tüm Burch kolposüspansiyon vakalarında retrospektif bir kohort çalışması yapıldı. Tüm hastaların verileri hastaların elektronik tıbbi kayıtları incelerek elde edildi ve açık veya laparoskopik Burch kolposüspansiyon ameliyatı geçiren tüm hastalar analiz edildi. Birincil sonuç cerrahi başarı iken, ikincil sonuçlar cerrahi tip, ameliyat süresi, hastanede kalış süresi, tahmini kan kaybı, komplikasyonlar, sübjektif iyileşme ve ek girişimsel prosedür türleri dahil olmak üzere perioperatif ve postoperatif verilerdi. Bulgular: Gruplar arasında demografik ve klinik özellikler açısından anlamlı fark yoktu (p >0,05) (Tablo 1). Ameliyat sonrası majör komplikasyon oranı OK grubunda oldukça yüksekti (p<0,004) (Tablo 4). Postoperatif 6. ve 48. saatlerde ağrı skoru (VAS) değerleri açısından LK lehine istatistiksel olarak anlamlı fark vardı (6. saat, p=0.036, 48. saat, p<0.0001) (Tablo 3). Objektif başarı açısından çalışma grupları arasında istatistiksel olarak anlamlı fark yoktu (%15,5 ve %16,9, sırasıyla) (Tablo 4). Postoperatif subjektif kür oranları (UDI-6 ve IIQ-7) açısından gruplar arasında istatistiksel olarak anlamlı bir fark yoktu (Tablo 3). Sonuç: Midüretral Askı prosedürleri SÜİ hastalarında birinci basamak tedavidir. Ancak uzun dönem etkinlikleri diğer SÜİ tedavilerine benzer ve komplikasyon oranları daha düşüktür, bu nedenle cerrahlar LC'yi tercih edebilir.

Anahtar Kelimeler:

burch kolposüspansiyon, laparoskopi, üriner inkontinans

Comparison of laparoscopic versus open Burch colposuspension techniques for female stress or mixed urinary incontinence: a ten-year experience in a tertiary center

Aims: To evaluate postoperative course, efficacy, and complication rates of Open Burch Colposuspension and Laparoscopic Burch Colposuspension techniques in stress or mixed urinary incontinence at a single training and research hospital for the last ten years in İstanbul, Turkey. Methods: A retrospective cohort study was conducted in all Burch Colposuspension cases performed between January 2011 and May 2022 in the Department of Gynecology and Obstetrics of İstanbul Kanuni Sultan Süleyman Training and Resaerch Hospital. All patients’ data were reviewed from the electronic medical records and analyzed who underwent Burch colposuspension surgery either with an open or laparoscopic approach. The primary outcome was a surgical success, whereas secondary outcomes were perioperative and postoperative data, including surgical type, operating time, duration of hospital stay, estimated blood loss, complications, subjective cure, and additional interventional procedure types. Results: The demographic and clinical characteristics among the groups have no significant difference (p >0.05). The major complication rate postoperatively was considerably higher in the OC group (p<0.004). There is a statistically significant difference in favor of LC in terms of pain score values (VAS) postoperatively at the 6th and 48th hours (6th hour, p=0.036, 48th hour, p<0.0001). There was no statistically significant difference between study groups regarding objective success (%15,5 and %16,9, respectively). Postoperatively, there was no statistically significant difference between groups regarding subjective cure rates (UDI-6 and IIQ-7). Conclusions: Midurethral Sling procedures are the first-line treatment in SUI patients. However, their long-term effectiveness is similar to other SUI treatments and lower complication rates, so surgeons can prefer LC.

Keywords:

Burch colposuspension, laparoscopy, urinary incontinence,

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