Üriner inkontinansın farklı tiplerinin tedavisinde manyetik sandalye tedavisi

Amaç: Üriner inkontinansın farklı tiplerinin tedavisinde vücut dışı manyetik innervasyon tedavisinin kullanılabilirliğini değerlendirmek Gereç ve Yöntemler: Ortalama yaşı 59.76±14.51 olan inkontinans nedeniyle vücut dışı manyetik innervasyon tedavisi alan 88 hasta (44 erkek, 44 kadın) çalışmaya dahil edildi. 53 (%60) hastada stress inkontinans, 24 (%27) hastada mix tip inkontinans, 9 (%10) hastada gerçek inkontinans, 2 (%3) hastada urge inkontinans saptandı. 31 (%35) hastada radikal prostatektomi (RP) sonrası, 13 (%15) hastada transüretral prostatektomi (TURP) sonrası, 8 (%9) hastada doğum sonrası, 35 (%40) hastada idiopatik üriner inkontinans saptandı. Hiçbir hastada inkontinans cerrahisi öyküsü yoktu. Tüm hastalar 16 seans terapiyi tamamladı. Her seans 20 dk olarak ve haftada 3 kez yapıldı. Bulgular: Yirmi iki (%25) hastada kür, 32 (%36) hastada iyileşme, 25 (%28) hastada kısmı fayda ve 9 (%10) hastada tedavide başarızlık izlendi. Her iki cinsiyet tedaviden fayda gördü. Tedavi öncesi ve sonrası semptom skoru erkeklerde 18.25±2.44 ve 11.80±5.32 (p=0.001), benzer şekilde kadınlarda 16.62±4.67 ve 7.91±5.32 (p=0.001) idi. RP ve TURP öyküsü olanlarda tedavi öncesi ortalama semptom skoru 18.00± 2.52 ve 18.15±2.41, tedavi sonrası 12.44±4.82 ve 11.54±5.68 idi (p=0.001, 0.001). Stres veya miks inkontinansta tedavi sonrası anlamlı iyileşme gözlendi; tedavi öncesi semptom skoru 17.38±3.7 ve 17.00±4.38, tedavi sonrası 9.75±5.18 ve 7.83±5.28 (p=0.001, p=0.001) idi. Gerçek inkontinans tedaviden en az yarar gördü; tedavi öncesi ve sonrası semptom skoru 19.33±2.17 ve 16.33±4.47 (p=0.08) idi Sonuç: Vücut dışı manyetik innervasyon tedavisi üriner inkontinans tedavisinde güvenli ve uygulanabilir bir tedavidir. Bu tedavi şekli onkolojik cerrahi dahil çeşitli etiyolojiler nedeniyle meydana gelen üriner inkontinansın farklı tiplerinde etkili bir yöntemdir. Bu yöntemde en az fayda gerçek inkontinansta gözlenmiştir. Daha fazla sayıda ve daha uzun takipli çalışmalarla bu sonuçlar konfirme edilmelidir

Extracorporeal magnetic chair in the treatment of various types of urinary incontinence

Objective: To evaluate the usefulness of extracorporeal magnetic innervations (ExMI) therapy in the treatment of various types of urinary incontinence(UI) Material and Methods: Total of 88 patients with mean age of 59.76±14.51 (44 male, 44 female) who underwent (ExMI) therapy due UI were included. The patients were diagnosed to have stress UI (53 patients, 60%), mixed UI (24 patients, 27%), true UI (9 patients, 10%) and urge UI (2 patients, 3%). Thirty one patients (35%) had UI after radical prostatectomy (RP), 13 patients(15%) had UI after transurethral prostatectomy (TURP), 8 patients (9%) had UI after delivery and 35 patients (40%) were idiopathic. All patients were primary cases without history of anti-incontinence surgery. All patients have completed 16 sessions of therapy. Each session is 20 minutes and done three times a week. The severity of UI was evaluated using 3rd,4th, and 5th question from ICIQ-SF. Results: Twenty two patients (25%) were cured, 32 (36%) were improved and 25(28%) partially benefited and 9 (10%) patients had failure of therapy. Both sexes benefited from the therapy; the male score before and after therapy were 18.25±2.44 and 11.80±5.32 respectively (p=0.001), similarly the female scores before and after therapy were 16.62±4.67 and 7.91±5.32 respectively (p=0.001). The mean values of symptoms score before therapy for patients with history of RP and TURP were 18.00± 2.52 and 18.15±2.41 respectively and the post therapeutic score were 12.44±4.82 and 11.54±5.68 respectively (p=0.001,0.001). Patients with stress or mixed types of UI showed significant improvements after therapy; the symptoms scores before therapy were 17.38±3.7 and 17.00±4.38 respectively and after therapy the score became 9.75±5.18 and 7.83±5.28 respectively (p=0.001, p=0.001). Patients with true incontinence had the least benefit of therapy, the symptoms score before and after therapy were 19.33±2.17 and 16.33±4.47 respectively (p=0.08). Conclusion: ExMI therapy offers a safe and feasible treatment modality for UI. This kind of therapy is effective for different types of UI which occurred due to various types etiologies including oncologic surgery. The least benefit of this modality was in patients with true UI. Further studies recruiting larger number of patients with longer follow up period should be carried out to confirm these results

Kaynakça

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2. Lasserre A, Pelat C, Guéroult V, Hanslik T, Chartier-Kastler E, Blanchon T et al. Urinary incontinence in French women: prevalence, risk factors, and impact on quality of life. Eur Urol 2009 ;561:177-83.

3. Elving, LB, Elving LB, Foldspang A, Lam GW, Mommsen S. Descriptive epidemiology of urinary incontinence in 3,100 women age 30-59. Scand J Urol Nephrol Suppl 1989;125:37-43.

4. Diokno AC, Brock BM, Brown MB, Herzog AR et al., Prevalence of urinary incontinence and other urological symptoms in the noninstitutionalized elderly. J Urol 1986;136:1022-5.

5. Hu TW, Hu TW, Wagner TH, Bentkover JD, Leblanc K, Zhou SZ, Hunt T. Costs of urinary incontinence and overactive bladder in the United States: a comparative study. Urology 2004;63:461-5.

6. Yamanishi T, Yasuda K, Suda S, Ishikawa N, Sakakibara R, Hattori T, Ito H et al.Comparative study of the magnetic versus electrical stimulation on inhibition of detrusor over activity .J Urol 2000; 56:777-81.

7. Fujishoro T.Enomoto H, Ugawa Y, Takabashi S, Ueono S, Kitamura T. Magnetic stimulation of the sacral roots for the treatement of stress incontinence:an investigational study and placebo controlled trial. J Urol 2000; 164:1277-9.

8. Voorham-van der Zalm PJ, Pelger RC, Stiggelbout AM, Elzevier HW, Lycklama Nijeholt GA .Effects of magnetic stimulation in the treatment of pelvic floor dysfunction. BJU Int 2006 ;97:1035-8.

9. Yokoyama T, Fujita O, Nishiguchi J, Nozaki K, Nose H, Inoue M, Ozawa H, Kumon.Extracorporeal magnetic innervation treatment for urinary incontinence. Int J Urol 2004;11:602-6.

10. Unsal A, Saglam R, Cimentepe E. Extracorporeal magnetic stimulation for the treatment of stress and urge incontinence in women--results of 1-year follow-up. Scand J Urol Nephrol 2003;37:424-8.

11. Nial TMG, Rizk ESE, Peter KS, Rodney AP, Howard WR, Stepheen JC. Extracorporeal maganetic innervation therapy for stres urinary incontinence. Urology 53; 6: 1108- 1111.

12. Choe JH, Choo MS, Lee KS. Symptom change in women with overactive bladder after extracorporeal magnetic stimulation: a prospective trial. Int Urogynecol J Pelvic Floor Dysfunct 2007 ;18:875-80.

13. Galloway NT, El-Galley RE, Sand PK, Appell RA, Russell HW, Carlin SJ. Update on extracorporeal magnetic innervations (EXMI) therapy for stress urinary incontinence.. Urology 2000 4;56:82-6.

14. Kim JW, Kim MJ, Noh JY, Lee HY, Han SW. Extracorporeal pelvic floor magnetic stimulation in children with voiding dysfunction. BJU Int 2005;95:1310-3.

15. Bölükbaş N, Vural M, Karan A, Yalçin O, Eskiyurt N. Effectiveness of functional magnetic versus electrical stimulation in women with urinary incontinence. Eura Medicophys 2005;41:297-301.

16. Barker AT, Freeston IL, Jalinous R, Jarratt JA. Magnetic stimulation of the human brain and peripheral nervous system: an introduction and the results of an initial clinical evaluation.Neurosurgery 1987;20:100-9.

17. Yokoyama T, Nishiguchi J, Watanabe T, Nose H, Nozaki K, Fujita O, Inoue M, Kumon H. Comparative study of effects of extracorporeal magnetic innervations versus electrical stimulation for urinary incontinence after radical prostatectomy. Urology 2004 ;63:264-7.

18. Galloway NT, El-Galley RE, Sand PK, Appell RA, Russell HW, Carlan SJ. Extracorporeal magnetic innervation therapy for stress urinary incontinence.. Urology 1999;53:1108-11.

19. Yokoyama T, Inoue M, Fujita O, Nozaki K, Nose H, Kumon H. . Preliminary results of the effect of extracorporeal magnetic stimulation on urinary incontinence after RP: a pilot study. Urol Int 2005;74:224-8.

Kaynak Göster

Yeni Üroloji Dergisi
  • ISSN: 1305-2489
  • Yayın Aralığı: Yılda 3 Sayı
  • Başlangıç: 2005

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