.: ORİJİNAL ARAŞTIRMA
Comparison of Transobturator Tape and Single Incision Mini-sling Procedures in the Surgical Treatment of Stress Urinary Incontinence in Obese Women: Retrospective Cohort Study
Obez Kadınlardaki Stress Üriner İnkontinansın Cerrahi Tedavisinde Transobturator Bant ve Tek İnsizyon Mini-Sling Prosedürlerinin Karşılaştırılması: Retrospektif Kohort Çalışması
J Reconstr Urol. 2021;11(2):61-7
doi: 10.5336/urology.2021-82933
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: To compare the effectiveness of Transobturator tape (TOT) and Single incision mini-sling (SIMS) procedures in obese women, which are the most preferred methods in the surgical treatment of stres urinary incontinence (SUI). Material and Methods: The data of 96 female patients who underwent surgical treatment for SUI with a body mass index ≥35 kg/m2 in our clinic were retrospectively analyzed. The patients were divided into two groups as TOT (n=54) and SIMS (n=42) according to the surgical procedure applied. The preoperative and postoperative 1-h pad test results, International Consultation on Incontinence Qestionnaire scoring form (ICIQ-SF) and the Incontinence Quality of Life (IQO-L) results of the groups were compared. Results: The total objective cure rate was 77.1% according to the 1-h pad test at a median 26 (12-114) month follow-up. While a median increase of 1.70 (1.27-11.92) g weight gain was detected in the TOT group in the postoperative 1-h pad test, it was 1.75 (1.5-66.25) g in the SIMS group (p=0.049). While there was no difference between the groups in terms of improvement in the postoperative ICIQ-SF score (p=0.073), the TOT group was significantly more advantageous than the SIMS group in terms of improvement in the IQO-L score (p=0.003). Median operating time was 40 (30-45) min in the TOT group and 25 (20-30) min in the SIMS group (p<0.001). Subjective and objective cure rates were significantly higher in the TOT group than SIMS group (81.5% vs 61.9% p=0.032 and 85.2% vs 66.7% p=0.032, respectively). Conclusion: Despite the longer operating time, the TOT procedure is more advantageous than the SIMS procedure in terms of subjective cure, objective cure and increase in quality of life score in the surgical treatment of SUI in obese women.
Keywords: Urinary incontinence; suburethral slings; complications; quality of life
Objective: To compare the effectiveness of Transobturator tape (TOT) and Single incision mini-sling (SIMS) procedures in obese women, which are the most preferred methods in the surgical treatment of stres urinary incontinence (SUI). Material and Methods: The data of 96 female patients who underwent surgical treatment for SUI with a body mass index ≥35 kg/m2 in our clinic were retrospectively analyzed. The patients were divided into two groups as TOT (n=54) and SIMS (n=42) according to the surgical procedure applied. The preoperative and postoperative 1-h pad test results, International Consultation on Incontinence Qestionnaire scoring form (ICIQ-SF) and the Incontinence Quality of Life (IQO-L) results of the groups were compared. Results: The total objective cure rate was 77.1% according to the 1-h pad test at a median 26 (12-114) month follow-up. While a median increase of 1.70 (1.27-11.92) g weight gain was detected in the TOT group in the postoperative 1-h pad test, it was 1.75 (1.5-66.25) g in the SIMS group (p=0.049). While there was no difference between the groups in terms of improvement in the postoperative ICIQ-SF score (p=0.073), the TOT group was significantly more advantageous than the SIMS group in terms of improvement in the IQO-L score (p=0.003). Median operating time was 40 (30-45) min in the TOT group and 25 (20-30) min in the SIMS group (p<0.001). Subjective and objective cure rates were significantly higher in the TOT group than SIMS group (81.5% vs 61.9% p=0.032 and 85.2% vs 66.7% p=0.032, respectively). Conclusion: Despite the longer operating time, the TOT procedure is more advantageous than the SIMS procedure in terms of subjective cure, objective cure and increase in quality of life score in the surgical treatment of SUI in obese women.
Keywords: Urinary incontinence; suburethral slings; complications; quality of life
ÖZET
Amaç: Stres üriner inkontinansın [stres urinary incontinence (SUI)] cerrahi tedavisinde en sık tercih edilen yöntemlerden olan transobturator bant [transobturator tape (TOT)] ve tek insizyon mini-sling [Single incision mini-sling (SIMS)] prosedürlerinin obez kadınlardaki etkinliğini inceleyerek, bu 2 yöntemin sonuçlarını karşılaştırmak. Gereç ve Yöntemler: Kliniğimizde SUI nedeniyle cerrahi tedavi yaptığımız beden kitle indeksi≥35 kg/m2 olan toplam 96 kadın hastanın verileri retrospektif olarak incelenmiştir. Hastalar uygulanan cerrahi prosedüre göre TOT (n=54) ve SIMS (n=42) olarak 2 gruba ayrılmıştır. Hastaların preoperatif ve postoperatif 1 saatlik ped testi sonuçları, Uluslar arası İnkontinans Konsültasyon Sorgulama Anketi-Kısa Form [International Consultation on Incontinence Qestionnaire scoring form (ICIQ-SF)] ve İnkontinans Yaşam Kalitesi Ölçeği [Incontinence Quality of Life (IQOL)] skorları belirlenerek gruplar karşılaştırılmıştır. Bulgular: Medyan 26 (12-114) aylık takipte 1 saatlik ped testine göre toplam objektif kür oranı %77,1 bulunmuştur. Postoperatif 1 saatlik ped testinde TOT grubunda medyan 1,70 (1,27-11,92) g ağılık artışı olurken SIMS grubunda medyan 1,75 (1,5-66,25) g ağırlık artışı olduğu saptanmıştır (p=0,049). Postoperatif ICIQ-SF skorundaki düzelme bakımından gruplar arasında fark bulunmazken (p=0,073) IQO-L skorundaki düzelme bakımından TOT grubunun SIMS grubundan anlamlı olarak avantajlı olduğu görülmüştür (p=0,003). Medyan operasyon süresinin TOT grubunda 40 (30-45) dk ve SIMS grubunda 25 (20-30) dk olduğu görülmüştür (p<0,001). Subjektif kür ve objektif kür oranları ise TOT grubunda SIMS grubundan anlamlı olarak yüksek bulunmuştur (sırasıyla %81,5 vs %61,9 p=0,032 ve %85,2 vs %66,7 p=0,032). Sonuç: Daha uzun operasyon süresine rağmen obez kadınlarda TOT prosedürü SIMS prosedürüne göre subjektif kür, objektif kür ve IQO-L skorundaki iyileşme bakımından daha avantajlıdır.
Anahtar Kelimeler: Üriner inkontinans; subüretral slingler; komplikasyonlar; yaşam kalitesi
Amaç: Stres üriner inkontinansın [stres urinary incontinence (SUI)] cerrahi tedavisinde en sık tercih edilen yöntemlerden olan transobturator bant [transobturator tape (TOT)] ve tek insizyon mini-sling [Single incision mini-sling (SIMS)] prosedürlerinin obez kadınlardaki etkinliğini inceleyerek, bu 2 yöntemin sonuçlarını karşılaştırmak. Gereç ve Yöntemler: Kliniğimizde SUI nedeniyle cerrahi tedavi yaptığımız beden kitle indeksi≥35 kg/m2 olan toplam 96 kadın hastanın verileri retrospektif olarak incelenmiştir. Hastalar uygulanan cerrahi prosedüre göre TOT (n=54) ve SIMS (n=42) olarak 2 gruba ayrılmıştır. Hastaların preoperatif ve postoperatif 1 saatlik ped testi sonuçları, Uluslar arası İnkontinans Konsültasyon Sorgulama Anketi-Kısa Form [International Consultation on Incontinence Qestionnaire scoring form (ICIQ-SF)] ve İnkontinans Yaşam Kalitesi Ölçeği [Incontinence Quality of Life (IQOL)] skorları belirlenerek gruplar karşılaştırılmıştır. Bulgular: Medyan 26 (12-114) aylık takipte 1 saatlik ped testine göre toplam objektif kür oranı %77,1 bulunmuştur. Postoperatif 1 saatlik ped testinde TOT grubunda medyan 1,70 (1,27-11,92) g ağılık artışı olurken SIMS grubunda medyan 1,75 (1,5-66,25) g ağırlık artışı olduğu saptanmıştır (p=0,049). Postoperatif ICIQ-SF skorundaki düzelme bakımından gruplar arasında fark bulunmazken (p=0,073) IQO-L skorundaki düzelme bakımından TOT grubunun SIMS grubundan anlamlı olarak avantajlı olduğu görülmüştür (p=0,003). Medyan operasyon süresinin TOT grubunda 40 (30-45) dk ve SIMS grubunda 25 (20-30) dk olduğu görülmüştür (p<0,001). Subjektif kür ve objektif kür oranları ise TOT grubunda SIMS grubundan anlamlı olarak yüksek bulunmuştur (sırasıyla %81,5 vs %61,9 p=0,032 ve %85,2 vs %66,7 p=0,032). Sonuç: Daha uzun operasyon süresine rağmen obez kadınlarda TOT prosedürü SIMS prosedürüne göre subjektif kür, objektif kür ve IQO-L skorundaki iyileşme bakımından daha avantajlıdır.
Anahtar Kelimeler: Üriner inkontinans; subüretral slingler; komplikasyonlar; yaşam kalitesi
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