Efficacy of the trans‑obturator and retropubic mid‑urethral slings for stress urinary incontinence
Abstract
Izhodišče: Danes poznamo več vrst kirurških posegov za zdravljenje stresne urinske inkontinence (SUI) in več različnih kirurških tehnik za kirurške posege z vstavitvijo nenapetostnih trakov. V literaturi ni veliko objav o rezultatih kirurških posegov za zdravljenje SUI in primerjav kirurških posegov med seboj. Ocenjevali smo uspeh operacij z nenapetostnim trakom za zdravljenje SUI na Ginekološki kliniki UKC Ljubljana, kako in za koliko časa je poseg izboljšal kakovost življenja bolnic, ali so imele bolnice po posegu kakšne zaplete in katere, ter kako vrsta posega vpliva na rezultat zdravljenja.
Metode: V retrospektivno raziskavo, ki smo jo izvajali od januarja do avgusta 2017 na Ginekološki kliniki UKC Ljubljana, smo vključili vse bolnice s stresno ali mešano (a s prevladujočo stresno komponento) urinsko inkontinenco, povezano s hipermobilnostjo sečnice, pri katerih smo opravili transobturacijsko (TOT) ali retropubično (TVT) operacijo z nenapetostnim trakom. Iz raziskave smo izključili bolnice, pri katerih je od posega minilo več kot 10 let, bolnice, ki so bile v letu 2016 starejše od 80 let, bolnice s predhodno operacijo za zdravljenje urinske inkontinence in bolnice s prolapsom medeničnih organov, večjim od stopnje I po klasifikaciji POP–q v katerem koli vaginalnem kompartmentu. Po upoštevanju vključitvenih in izključitvenih meril, so ostale 1.104 preiskovanke, katerim smo po pošti poslali validirane vprašalnike (PGI-S, PGI-I, SANDVIK SEVERITY SCALE, UDI-6, IIQ-7, ICIQ-UI Short Form) in vprašanja o diagnozi, posegih, zapletih, ponovnih operacijah, pooperativnem rezultatu in zadovoljstvu s posegom. Do avgusta 2017 (6 mesecev po pošiljanju) smo prejeli 466 izpolnjenih vprašalnikov (odziv 42,2 %). Od tega je imelo 225 (48 %) vprašalnikov pomanjkljive podatke, zato smo jih izklučili iz nadaljnje analize. Za analizo je tako ostalo 241 preiskovank oz. njihovih vprašalnikov.
Rezultati: Od preiskovank, ki so do avgusta 2017 vrnile nepomanjkljivo izpolnjen vprašalnik (N = 241), je bil pri 189 (78 %) preiskovankah poseg opravljen s transobturacijskim pristopom (TOT), pri 52 (22 %) pa z retropubičnim (TVT). Skupini TOT in TVT se med seboj nista statistično značilno razlikovali niti v rezultatih posega, niti v deležu zapletov po posegu. Po TOT je ponovno operacijo potrebovalo 25/189 bolnic (13,2 %), po TVT pa 12/52 bolnic (23,1 %); p = 0,082. Po TOT je imelo težave z odtekanjem urina 18/189 bolnic (9,5 %), po TVT pa 7/52 bolnic (13,5 %); p = 0,411. Po TOT je imelo erozijo traku v nožnico / vnetje 12/189 bolnic (6,3 %), po TVT pa 2/52 bolnic (3,8 %); p = 0,495.
Zaključek: Zaključujemo, da sta učinkovitost in varnost kirurškega zdravljenju SUI pri ženskah z operacijo TOT in TVT medsebojno primerljivi. Pri izbiri kirurške tehnike pa je potrebno upoštevati relativne prednosti in slabosti ene in druge tehnike, zelo pomembne pa so tudi izkušnje zdravnika, ki izvaja poseg.
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