Journal of Reconstructive Urology

.: REVIEW
Prostatektomi Cerrahisi Sonrası İnkontinansta Güncel Yaklaşımlar: Literatür Değerlendirmesi
Current Approaches in Incontinence After Prostatectomy Surgery: A Review of the Literature
Yavuz Onur DANACIOĞLUa, Abdulmuttalip ŞİMŞEKa
aÜroloji Kliniği, Sağlık Bilimleri Üniversitesi Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi, İstanbul, TÜRKİYE
J Reconstr Urol. 2019;9(1):25-33
doi: 10.5336/urology.2019-66618
Article Language: TR
Full Text
ÖZET
 Prostata yönelik her türlü invaziv girişimden sonra idrar inkontinansı görülebilmesine rağmen, prostatektomi sonrası inkontinans tanımının üroloji pratiğine girmesi radikal prostatektomi hastalarındaki artışla olmuştur. Prostatektomi sonrası gelişen üriner inkontinans, hastaların hayat kalitesini önemli oranda etkilemektedir. Radikal prostatektomi operasyonlarının sayısı son yıllarda gittikçe artmaktadır ve bu hastaların çoğu sfinkterik yetmezlik, detrusor hipokontraktilitesi sonucunda oluşan öksürme, hapşırma veya eforla gelişen istemsiz stres üriner inkontinansa sahiptirler. Prostatektomi sonrası inkontinansın oranı çalışmaların metodolojisine, operasyon öncesi kontinans durumuna, operasyon öncesi sfinkterin durumuna, cerrahi tekniğe ve cerrahın tecrübesine bağlıdır. Prostatektomi sonrası inkontinansın tedavisinde konservatif yaklaşım, farmakoterapi ve cerrahi tedavi olarak üç farklı yaklaşım bulunmaktadır. Hastaların çoğunda aşırı aktif mesaneyi tedavi edebilmek amacıyla, pelvik taban egzersizi veya biofeedbackin de dâhil edildiği konservatif yaklaşım ile tedaviye başlanmaktadır. Seçilmiş hastalarda medikal tedavi ve transüretral dolgu madde enjeksiyonu stres inkontinans tedavisinde fayda sağlamaktadır, ancak artifisyel üriner sfinkter ve erkek slingleri yüksek başarı oranları ile en etkin tedavi seçenekler arasında yer almaktadır. Artifisyel üriner sfinkter implantasyonu, prostatektomi cerrahisi sonrası oluşan stres inkontinansın tedavisinde altın standarttır, fakat son yıllarda yeni cihazlar da geliştirilmiştir. Bugüne kadar tek bir spesifik cerrahi tekniğin sonuçlarını araştıran veya farklı cerrahi tekniklerin sonuçlarını karşılaştıran randomize kontrollü bir çalışma bulunmamaktadır. Bu çalışmada, çeşitli mevcut ve yeni tedavi modalitelerinin etkinlik ve güvenirlilik açısından değerlendirip sunulması amaçlanmıştır.

Anahtar Kelimeler: Prostatektomi; üriner inkontinans; rekonstrüktif cerrahi prosedürleri
ABSTRACT
 Although the urinary incontinence may be seen after any kind of prostatic operation, postprostatectomy incontinence has entered to urological armamentarium only after the rise at the radical prostatectomy patients. Urinary incontinence has a significant impact on the quality of life of the patients who undergo prostatectomy. With the increasing number of radical prostatectomies performed in the last decade and most patients have stress urinary incontinence with sphincteric incompetence and detrusor hypocontractility implicating their development, which occured involuntary urinary leakage on effort or exertion, or on sneezing or coughing. Post-prostatectomy incontinence rates seem to depend on several factors including the methodology of the trials, preoperative continence status, preoperative sphincter status, surgical technique and the experience of the surgeon. The treatment of post-prostatectomy incontinence consists of three different approaches: conservative management, pharmacotherapy, and surgical treatment. In many cases, treatment begins with conservative approaches, including pelvic floor muscle training or biofeedback can be used to treat overactive bladder. For stress incontinence, pharmacotherapy and transurethral bulking agents are utilized in select patients; however, artificial urinary sphincter and male slings are the most efficacious options with good success rates. The implantation of artificial urinary sphincter is the gold standard to treat post-prostatectomy stress incontinence, but new devices have recently been developed. To date, there is no randomized controlled trial investigating the outcome of one specific surgical treatment or comparing the outcome of different surgical treatment options. In this review, the various current and new treatment modalities are critically discussed with special emphasis on safety and efficacy.

Keywords: Prostatectomy; urinary incontinence; reconstructive surgical procedures
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5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com