Özge KIZILKALE, MUSTAFA EROĞLU, Gazi YILDIRIM, SÜLEYMAN MURAT BAKACAK, M. Sühha BOSTANCI, RUKSET ATTAR, Zeynep BAKACAK, Cem FIÇICIOĞLU

İleri̇ Yaşta Pelvi̇k Organ Prolapsusu (POP) Ve Stres Üri̇ner İnkonti̇nans(SUİ) Bi̇rli̇kteli̇ği̇nde Gerçekleşti̇rdi̇ği̇mi̇z 8 Adet Le Fort Kolpoklezi̇s ve Transobturatuar Tape (TOT) Operasyonlarımızın Retrospektif İncelenmesi

Amaç: İleri yaşta, fiziksel kondisyonları düşük, anestezinin riskli olduğu POP+SUİ tanılı hastalarda Le Fort Kolpokleizis + TOT operasyonlarının etkili, postoperatif mortalite ve morbiditesi düşük, gerekirse lokal anestezi ile bile yapılabilecek güvenilir bir prosedür olduğunun gösterilmesi. Materyal Ve Metodlar: Son 3 yıl içinde Yeditepe Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniğine başvuran ve POP+SUİ tanısıyla Le Fort Kolpoklezis + TOT operasyonu yapılan 8 hastamız retrospektif incelendi. Bulgular: Kliniğimize başvuran bu hastaların ortalama yaşı 82,8 idi. Hepsinin muayenesinde ileri derecede pelvik organ prolapsusu izlendi. Stres testte hepsinde idrar kaçağı mevcut idi. Hastalarımızın hiçbirinin aktif bir cinsel yaşamı ve cinsel yaşam beklentisi yoktu. Tüm hastalarımızda hipertansiyon, 3 hastamızda diyabet, 2 hastamızda geçirilmiş serebrovasküler hastalık hikayesi, 1 hastamızda KOAH ve 1 hastamızda da idiopatik akciğer ödemi mevcut idi. Tüm hastalar operasyon öncesi ilgili branşlar ve anesteziyoloji ile konsulte edildiler. Hastalarımızdan 3 tanesi sedasyon+lokal, 3 tanesi genel, 2 tanesi de regional anestezi altında opere edildiler. Bütün hastalarımızın vajen ön ve arka duvarlarından dikdörtgen şekilli mukozalar çıkarıldı. Her iki yanda oluk bırakacak şekilde vajen ön ve arka duvarları birbiri üzerine sütüre edildi (Le Fort Kolpoklezis). Buna ilaveten hastalara TOT operasyonu da yapıldı. Peroperatif hastalarda herhangi bir problem yaşanmadı. Post operatif birinci günlerinde sondalar çıkarılarak rezidü idrar ölçüldü. Tüm hastalarda miktar 100 ccden azdı. Post operatif herhangi bir komplikasyon oluşmayan hastalar ortalama ikinci günlerinde taburcu edildiler. Operasyon sonrası altıncı aylarındaki muayenelerinde hiçbirinde SUİ saptanmadı.

Retrospective Analysis of 8 Le Fort Colpocleisis and Transobturatory Tape (TOT) Application in Advanced Age Pelvic Organ Prolapsus (POP) and Stress Urinary Incontinence

AIM: To show that Le fort colpocleisis+TOT operations are effective, safe procedures with low mortality and morbidity which can be applied with local anesthesia in advanced aged patients with low physical conditions and high anesthesia risks.Patients And Methods: 8 patients visiting Yeditepe University Hospital Obstetrics and Gynecology Cllinic for POP and SUI and undergoing Le Fort Colpocleisis+TOT operation in the last 3 years were included in the study. Results: The mean age of our patients was 82,8 years. All patients had advance pelvic organ prolapsus on examination. They also had urinary incontinans on stress test. Neither of the patients had active sexual life or sexual life expectance. All our patients had hypertension, 3 of them had diabetes, 2 had cerebrovascular accident history, 1 had COPD, and 1 had idiopathic pulmonary edema. They were all consulted with anesthesiology and other related disciplines preoperatively. Three of our patients received sedation+local anesthesia, 3 had general anesthesia and 2 had regional anesthesia. Rectangular shaped mucosa was removed from anterior and posteror vaginal wall of all patients. The denude areas were sutured onto each other leaving grooves on lateral parts of vagina(Le Fort Colpoclesis). Also TOT operation was performed for each patient. No complication was encountered peri/postoperatively. Urinary catheters were removed on the first postoperative day and residual urine amounts were measured. Residual urine amount was less than 100 mls for each patient. Neither of our patients had postoprative complications and they were all discharged from the hospital on the second postoperative day. All our patients underwent repeat gynecologic examination and none of them had stress incontinance. Conclusion: Colpocleisis is a safe and efficient way of correcting POP in advanced age patients with no sexual life. The procedure has low postoperative mortality and morbidity. In the presence of SUI TOT is a safe,efficient and reliable procedure to be combined with Le Fort in a selected population of patients.

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