Haydarpasa Numune Med J. Ahead of Print: HNHJ-26937 | DOI: 10.14744/hnhj.2021.26937

The Evaluation of Long-term Outcomes of Ouside-In Transobturator Tape Procedure in the Treatment of Stress Urinary Incontinence

Alim Gökhan Kuþgöz¹, Ertugrul Can Tüfekçi², Fisun Vural², Ayþe Deniz Ertürk Coþkun^2
1Special Izmiryolu Sevgi Hospital
²Haydarpaþa Numune Training and Research Hospital, University of Health Science

INTRODUCTION: To investigate the objective-subjective success rates and complications of outside-in transobturator tape (TOT) surgery with UDI-6 questionnaire and subjective assessment after five years follow up.
METHODS: We analyzed 60 women with stress urinary incontinence who underwent outsite-in TOT procedure by the same surgeon and mesh,and were followed up after five years. All patients’ gynecological examination findings, stress test, Q-tip test, pad test, residual urinary volume, Urinary Distress Inventory (UDI-6) questionnaire, duration of operation and complications were recorded. Three years and five years after surgery, all patients were evaluated for anatomic-functional outcomes and subjective patient satisfaction.
RESULTS: The mean age of the population was 51,92±7,31 years, and 50% of the women were postmenopausal. Two patients (3.3%) had intraoperative bladder injury. Among long-term complications, one patient had (1.6%) de novo urge incontinence. There was no mesh erosion in the five years follow up. When we compared the preoperative and five-years postoperative Q-tip test angles a significant decrease was observed (63,92±14,17; 25,08±9,68 )( p =0.001). UDI-6 question3,4 survey scores were also significantly lower in the 5th year follow up (p=0.001) At the end of five years we observed an objective success in 82.9% of the patients. The patients also reported a subjective improvement of 82.9%.
DISCUSSION AND CONCLUSION: If proper surgical technique is used, outside-in TOT procedure is an efficient and safe method with high objective and subjective cure rates and low complication rates after a five year follow up.

Keywords: stress incontinence, mesh, urinary incontinence, TOT.

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Stres Ýnkontinans Tedavisinde Dýþtan Ýçe Transobturator Tape Prosedürünün Uzun Dönem Sonuçlarýnýn Ýncelenmesi

Alim Gökhan Kuþgöz¹, Ertugrul Can Tüfekçi², Fisun Vural², Ayþe Deniz Ertürk Coþkun^2
1Özel Ýzmiryolu Sevgi Hastanesi
²Saðlýk Bilimleri Üniversitesi, Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi

GÝRÝÞ ve AMAÇ: Transobturator tape (TOT) cerrahisi yapýlan hastalarýn 5 yýllýk objektif ve subjektif baþarý oranlarý ve uzun dönem komplikasyonlarýnýn araþtýrýlmasý.
YÖNTEM ve GEREÇLER: Stresle idrar kaçýrma þikayetiyle baþvuran 60 hastaya dýþtan içe TOT cerrahisi uygulanmýþ ve hastalar 5 yýl takip edilmiþtir. Her hastanýn preoperatif jinekolojik muayene bulgularý, stres test, Q-tip test, ped testi, residual idrar volümü, Urinary Distress Inventory (UDI-6) anketi, operasyon süresi ve komplikasyonlarý kaydedildi. Hastalar üç yýl ve beþ yýl sonra çaðrýlarak anatomik- fonksiyonel sonuçlar ve subjektif hasta memnuniyeti açýsýndan deðerlendirildi.
BULGULAR: Çalýþmaya katýlan hastalarýn yaþ ortalamasý 51,92±7,31 idi ve hastalarýn yarýsý postmenopozal dönemdeydi. Ýntraoperatif komplikasyon olarak 2 hastada (%3,3) intraoperatif mesane yaralanmasý yaþandý. 1 hastada postoperatif uzun hospitalizasyon gerekti (%1,6). Uzun dönem komplikasyon olarak 1 hastada (%1,6) de novo urge inkontinans izlendi. Beþ yýllýk takip sonucunda mesh erozyonu izlenmedi. Preoperatif bulgularla karþýlaþtýrdýðýmýzda, 5 yýlýn sonunda hastalarýn Q-tip test açýlarýnda anlamlý azalma izlendi (63,92±14,17; 25,08±9,68 )(p=0.001). UDI-6 soru 3,4 skorlarý kýyaslandýðýnda anlamlý düþük skorlar izlendi (p=0.001). 5 yýllýk takip sonucunda objektif baþarý oraný %82.9 iken hastalarýn belirttiði sübjektif iyileþme oraný da %82.9 bulunmuþtur.
TARTIÞMA ve SONUÇ: Stres inkontinans vakalarýnda cerrahi tekniklere uyulduðunda, dýþtan içe uygulanan TOT prosedürü 5 yýllýk objektif ve subjektik baþarý oranlarý yüksek ve komplikasyon yüzdesi düþük bir yöntemdir.

Anahtar Kelimeler: stres inkontinans, mesh, uriner inkontinans, TOT

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