Cabir ALAN, Ahmet Reşit ERSAY, HANDAN ALAN, MURAT ZOR, Mete KİLCİLER

Kadınlarda idrar kaçırma tedavisinde uygulanan vaginal cerrahi girişimin cinsel fonksiyon üzerine olan etkisi

Amaç: Vajenin ön kısmının zengin sinir ağı nedeniyle kadın seksüel fonksiyonunda önemli bir yere sahip olduğu yapılan çalışmalarla gösterilmiştir. Kadınlarda idrar kaçırma prevalansı oldukça yüksek bir sağlık sorunudur. İdrar kaçırmanın birden fazla tipi vardır ve her biri içinde ayrı tedavi seçenekleri sunulmaktadır. Bu çalışmada idrar inkontinansının tedavisi için yapılan transvajinal girişimlerin seksüel fonksiyonları etkileyip etkilemediği araştırıldı. Gereç ve yöntem: Ekim 2005-Ağustos 2008 yılları arasında stres üriner inkontinans (SUI) nedeniyle transobturator vaginal tape (TOT) operasyonu uygulanan 54 kadın hastanın seksüel yönden aktif ve partneri olan 48’ine (%88) kliniğimizce oluşturulan 10 soruluk bir sorgulama formu doldurtuldu. Sorgulama formundaki 3 soru kontinans durumu ile, 7 soru ise cinsel fonksiyon durumu ile ilgiliydi. Kuruluk ile cinsel doyum arasındaki ilişki ki-kare ve fisher exact test kullanılarak karşılaştırıldı. Bulgular: TOT uygulanan hastaların ortalama yaşı 51.9 (38-68) ve ortalama takip süresi 14.7 ay (7.5-26.9) olarak saptandı. Cinsel fonksiyon değerlendirmesinde hastaların 5’i (%10), cinsel ilişki sırasında ağrı tarifledi ve bu olguların preoperatif dönemde de disparoni yakınması mevcuttu. Operasyon öncesi ve sonrası ilişki sırasındaki cinsel doyum farkı sorgulandığında hastaların 11’i (%23) olumsuz yönde etkilendiğini belirtti. Bu olguların menapozal durumu incelendiğinde tamamının menapozal dönemde olduğu ve 5’inde preoperatif dönemde de cinsel fonksiyon bozukluğu belirtileri olduğu belirlendi. Kuruluk (idrar kaçırmanın ortadan kalkması) ile cinsel doyuruculuk arasındaki ilişki incelendiğinde; kuru olan 47 hastanın 34’ü (%73) değişiklik olmadığını belirtti. Sonuç: Vaginal yoldan uygulanan bir girişim olan TOT operasyonu minimal invaziv bir cerrahi girişimdir ve ciddi seksüel disfonksiyona neden olmamaktadır. Postoperatif dönemde ortaya çıkan cinsel işlev bozukluğu ile ilgili şikayetler, postmenapozal hormonal durumun değişmesine bağlı olabilir.

The effects of transvaginal surgical procedures performed to treat urinary incontinence on female sexual function

Objective: It is shown in several studies that anterior vaginal wall has a great effect on sexual function due to rich nerve plexus supplies. On the other side, incontinence is a common female health problem. There are different kinds of urinary incontinence and all has different treatment options. In this study we evaluated the sexual functions after transvaginal surgical procedures performed for urinary incontinence. Materials and methods: Between October 2005-August 2008, 48 of 54 sexual active TOT (transobturatuar vaginal tapering) performed female patients, who had sexual partners, were included to study and these 48 (%88) accessible patients asked to answer a questionnaire, which was including 10 questions. In the questionnaire 3 questions were identifying the continence status and 7 were sexual function. The association between the sexual satisfaction and dryness were compared with qui-square and fisher exact tests. Results: The mean age and the mean follow-up time were 51.9 (38-68 years) and 14.7 months (7.5-26.9 months), respectively. Five patients (%10) reported dispareunia, which was also present in the preoperative period. Eleven patients (%23) reported a decreased sexual satisfaction after the procedure when compared to the preoperative period. All these patients were postmenopausal women and 5 of them also had sexual dysfunction preoperatively. When the association between dryness and sexual satisfaction is reviewed, it is seen that 34 of 47 dry women (no incontinence episodes) reported no change in their sexual satisfaction after the procedure. Conclusion: Despite being an anti-incontinence procedure performed with vaginal approach, transobturatuar vaginal tapering is a minimally invasive procedure and does not cause severe sexual dysfunction. Sexual dysfunction seen in the postoperative period can be due to postmenopausal hormonal changes.

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1.Abrams P, Cardozo L, Fall M et al. The standardization of terminology of lower urinary tract function: report from the Standardization Subcommittee of the International Continence Society. Neurourol Urodyn 2002; 21: 167-78.
2.Demirci F, Özden S, Yücel N ve ark. Postme-nopozal Türk kadınlarında üriner inkontinans prevalansı. J Obstet Gynecol 1999; 3: 138-42.
3.Oskay UY, Beji NK, Yalcin O. A study on urogenital complaints of postmenopausal women aged 50 and over. Acta Obstet Gynecol Scand 2005; 84: 72-8.
4.Ürojinekoloji; Temel kadın hastalıkları ve doğum bilgisi.. Kişnişçi H, Gökşin E, Ustay K ve ark. (ed.) Güneş Kitap Evi. Ankara. 1996: s: 730- 747.
5.Delorme E. Transobturator urethal suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol 2001; 11: 1306-13.
6.Hilliges M., Falsoner C. And Ekman-Ordeberg G. et al.: Innervation of the vaginal mucosa as revealed by PGP 9,5 immunohistochemstery. Acta Anatomica 1995, 153: 119-126
7.O’Connell HE., Hutson JM., Anderson CR. And Plenter RJ.: Anatomical relationship between urethra and clitoris. J Urol 159: 1892-1897, 1998
8.Elzevier HW, Venema PL, sexual function after tension-free vaginal tape for stress incontinence: results of a mailed question. Int Urogynecol J Pelvic Flor Dysfunction. 2004; 15: 313-8
9.Torre Zambrano G, Lujan Galan M, Martin Garcia C, Garcia Tello A, Rodriguez Garcia N. TVT and TOT for surgical correction of female stress urinary incontinence. Comparison between techniques. Arch Esp Urol 2008 Oct; 61 (8): 861-5.
10.Orhan S. Aksakal, Tayfun Güngör, Abdullah Karaer, E. Nil U⁄Urlu, Aral M. Atalay, Ümit Bilge. Stres Üriner ‹nkontinansta Transobturator Tape Tedavisi. J Turkish-German Gynecol Assoc, Vol. 7 (3); 2006 Turkish-German Gynecol Assoc, Vol. 7 (3); 2006
11.Kuuva N, Nilsson CG. A nationwide analysis of complications associated with tension-free vajinal tape (TVT) procedure. Acta Obstet Gynecol Scand 2002; 81: 72-7.
12.Muir TW, Tulikangas PK, Fidela PM, Walters MD. The relationship of tension-free vajinal tape insertion and vascular anatomy. Obstet Gynecol 2003; 101: 933-6.
13.Whiteside JL, Walters MD. Anatomy of the obturator region: relation to a transobturator sling. Int Urogynecol J Pelvic Dysfunct 2004; 15: 223-6.
14.Delorme E. Transobturator uretral suspension: mini-invasive procedure in the treatment of stress incontinence in women. Prog Urol 2001; 11: 1306-13.
15.Mellier G, Benayed B, Bretones S, Pasquier JC. Suburetral tape via the obturator route: is the TOT a simplification of the TVT? Int Urogynecol J Pelvic Floor Dysfunct 2004; 15: 227
16.Rosen RC, Taylor JF. And Leiblum SR. Et al.: Prevalance of sexual dysfunction in women: results of survey study of 329 women in an outpatient gynecological clinic. J Sex Marital Ther 1993, 19: 171-188
17.Read S., King M. And Watson J.: Sexual dysfunction in primary medical care: Prevalance, characteristics and detection by general practitioner. J Pub Health Med 1997, 19: 387
18.Barlow DH., Cardozo LD. And Francis RM. Et al.: Urogenital ageing and its effect on sexual health in older British women. Br J Obstet Gynaecol 1997, 104:87-91
19.Sarrel PM.: Sexuality and menopause. Obstet Gynecol 1990, 75:26-30
20.Thirlaway K., Fallowfield L. And Cuzick J.: The sexual activity questionnare: a measure of women’s sexual functioning. Qual life Res 1996, 5: 81-90
21.Iosif CS.: sexual function after colpourethropexy in middle ages women. Urol ınt 1988, 43: 231
22.Paraiso MF, Ballard LA and Walters MD et al.: Pelvic support defects and visceral and sexual function in women treated with sacrosipnous ligament suspension and pelvic reconstruction. Am J Obstet Gynecol 1996, 175: 1423-1431
23.Haase P. And Skibsted L.: İnfluence of operations for stress incontinence and/or genital genital descencus on sexual life: Acta Obstet Gynecol Scand 1988, 57: 559-561
24.Holley RL, Varner RE., Gleason BP., Apffel LA., Scott S.: Sexual function after sacrospinous ligament fixation for vaginal vault prolapse 25. Berglund AL, Eisemann M. And Lalos A. Et al. Social adjustment and spouse relations among women with stress incontinence befrore and after surgical treatment. Soc Sci Med 1996, 42: 1537-1544
26.Lenck LC, Vanneuville G., Monnet JP., Harmand Y.: Urethral Sphicter (G Point). Anatomo-clinical correlations. Rev Fr Gynecol Obstet. 1992 Feb; 87 (2): 65-9.
27.Lemack GE, Zimmern PE. Sexual function after vaginal surgery for stress incontinence: results of mailed quastionnaire. Urology 2000 Aug 1; 56 (2): 223-7
28.Berglund AL. And Fugi Meyer KS.: Some sexological characteristics of stress incontinent women. Scand J Urol Nephrol 1996, 30:207-212
29.Maatia M., Bhaumik J and Davies AE.: Sexual function after using tension-free vaginal tape for the surgical treatment of genuine stress incontinence. BJU Int 90 (6): 540-3, 2002