Selim AFŞAR, Adnan DİLLİ, MUSTAFA EROĞLU, SADIK ŞAHİN

LeFort ve Transobturator Tape (TOT) Operasyonlarının Etkinliği ve Komplikasyonları : 14 Olgunun Analizi

Amaç: Bu retrospektif kohort çalışmasının amacı; total prolapsus olgularında, LeFort operasyonu ile birlikte uygulanan transobturator tap TOT prosedürünün cerrahi sonuçlarının ve komplikasyonlarının değerlendirilmesidir. Gereç ve Yöntemler: Bu retrospektif çalışmaya; 2011-2013 yılları arasında Baden-Walker evre III-IV pelvik organ prolapsusu olan ve stres üriner inkontinans (SÜİ), mikst üriner inkontinans (MÜİ) veya gizli SÜİ tanısı alan, 70 yaş üstü ve cinsel yaşam beklentisi olmayan 14 hasta dahil edildi. Tüm hastalara LeFort ve TOT operasyonu ile birlikte yüksek perineorafi operasyonu rutin olarak uygulanmıştır. Postoperatif tüm olgular 2. hafta, 6. hafta ve 3. ayda kontrollere çağrılarak ürojinekolojik muayeneleri yapıldı, operasyon ba- şarısı, üriner disfonksiyon ve perioperatif komplikasyonlar kayıt edilerek değerlendirildi. Bulgular: Hastaların ortalama yaşı 77,3±4,5 (72-87) ve paritesi 7,1±2,4 (4-10) olarak bulunmuştur. Çalışma grubunda; 8 hastada (%57) MÜİ ve 2 hastada (%14) SÜİ bulguları mevcuttu. Dört (%29) hasta ise inkontinans şikayeti olmamasına rağmen prolapsusları redükte edildiğinde öksürük-stres testinde inkontinan (gizli SÜİ) olarak bulunmuştur. Hastalarda tekrar cerrahi girişim gerektiren veya uzun süreli aralıklı kateterizasyon gerektiren üriner retansiyon izlenmemiştir. Hastaların postoperatif dönem takiplerinde sadece 1 (%7) hastada de novo urge inkontinans izlenmiştir ve antikolinerjiklerle tedavi edilmiştir. Hastaların takiplerinde prolapsus tekrarı veya de novo SÜİ izlenmemiştir. Sonuçlar: Pelvik organ prolapsusu olan ve cinsel yaşam beklentisi olmayan yaşlı kadınlarda; LeFort ve TOT operasyonun yüksek perineorafi ile birlikte uygulanması oldukça etkin, güvenilir ve minimal invazif bir seçenektir. Gizli SÜİ olguların tespiti ve cerrahi yönetimi ile profilaktik TOT operasyonun bu olgulardaki yeri hakkında prospektif çalışmalara ihtiyaç vardır.

Aim: The aim of this retrospective cohort study is to evaluate the surgical outcomes and complications of LeFort operation with concomitant transobturator tape TOT procedure in totally prolapsed cases. Material and Methods: In this retrospective study; which is conducted between the dates 2011 and 2013, sexually-inactive fourteen patients, over the age of 70, who had Baden-Walker grade III-IV pelvic organ prolapse (POP) and diagnosed as stress urinary incontinence (SUI), mixt urinary incontinence (MUI) or occult SUI were enrolled. All patients had undergone LeFort and TOT procedure with high perineoraphy. In follow-up period; all cases were evaluated at the 2nd week, 6th week and 3rd month by urogynecological examination and surgical outcomes; urinary dysfunction and perioperative complications were recorded. Results: The median age was 77,3±4,5 years (range 72The median age was 77,3±4,5 years (range 72-87) and parity was 7,1±2,4 (range 4-10). In study group; 8 patients (57%) had complaint of MUI and 2 patients (14%) had complaint of SUI. Four patients (29%) without a complaint of stress incontinence, demonstrated leakage (occult SUI) with cough-stress examination during prolapse reduction. There was no urinary retention requiring chronic catheterization or surgical management. . There was only 1 (7%) postoperative de novo urgency in follow-up period and it was managed by anticholinergics. There was no postoperative de novo SUI or recurrence of prolapse. Conclusion: In older women who had pelvic organ prolapse and sexually-inactive; LeFort and concurrent TOT procedure with high perineoraphy, is highly effective, safety and minimally-invasive option. There is need for prospective studies in the detection and surgical management of occult SUI cases and the role of prophylactic TOT operation in these cases.

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