بهبودی و عوارض ناشی از دو روش درمانی کم تهاجم Trans obturator tape و Supra pubic arc در درمان زنان مبتلا به بی‌اختیاری استرسی ادرار

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 استادیار، گروه اورولوژی، دانشکدهی پزشکی،دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 دانشیار، گروه زنان و مامایی، دانشکدهی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 دستیار، گروه زنان و مامایی، دانشکدهی پزشکی و کمیته‌ی تحقیقات دانشجویی،دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

4 دانشیار، گروه اورولوژی،دانشکدهی پزشکی،دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: یکی از مشکلات شایع زنان بی‌اختیاری ادراری استرسی (Stress urinary incontinence یا SUI) است. از میان درمان‌های بی‌اختیاری ادرار جراحی‌های کم آزار (Minimal invasive anti-incontinence surgery) در حال حاضر در بسیاری از نقاط جهان جایگزین روش‌های قبلی جراحی شده‌اند. در ایران استفاده از روش‌های نوین جراحی مانند استفاده از در برای بازگرداندن مجرای ادرار به محل آناتومیک مثل و TOT (Transobturaror tape) محدود به برخی از مراکز دانشگاهی است و اغلب از روش‌های جراحی کلاسیک پیشین مانند Burch ، Marshal marketti و Classic sling در درمان بی‌اختیاری ادراری استفاده می‌گردد. هدف از این مطالعه بررسی مقایسه‌ای بهبودی و عوارض دو روش درمانی TOT و SPARC (Suprapubic ARC) یا TVT (Transvaginal tape) در درمان SUI بود..روش‌ها: تعداد 146 بیمار مبتلا به بی‌اختیاری ادرار به طور تصادفی تحت عمل جراحی TOT یا SPARC قرار گرفتند.یافته‌ها: عمل ترمیم پرولاپس قدامی در 43 نفر (7/59 درصد) از گروه SPARC و 29 نفر (2/39 درصد) از گروه TOT انجام شد. میزان بهبودی در دو گروه به ترتیب 90 درصد و93 درصد بود. اختلال در ادرار کردن در 3/11 درصد از بیماران گروه SPARC و 6/17 درصد از بیماران گروه TOT مشاهده شد. درد لگنی و درد کشاله‌ی ران به ترتیب در 2/4درصد و 5/13 درصد از بیماران گروه‌های SPARC و TOT دیده شد ولی تفاوت آماری معنی‌داری نداشت. عوارض التهابی در گروه SPARC به طور معنی‌داری بیشتر بود.نتیجه‌گیری: به طور کلی میزان بهبودی در دو روش مشابه بود و از نظر عوارض نیز تنها عوارض میان مدت در SPARC به طور معنی‌دار بیشتر بود.

کلیدواژه‌ها

عنوان مقاله [English]

Transobturator Tape (TOT) and Suprapubic Arc (SPARC) in Women with Stress Urinary Incontinence: A Comparison between Two Minimally Invasive Treatments

نویسندگان [English]

  • Mahtab Zargham 1
  • Zahra Sadat Allameh 2
  • Sodabeh Dokhani 3
  • Farshid Alizadeh 1
  • Mohmad Hatef Khorami 4
  • Mohamad Hossein Izadpanahi 1
  • Farhad Tadayon 1
1 Assistant Professor, Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Associate Professor, Department of Gynecology, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 Resident, Department of Gynecology, School of Medicine And Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
4 Associate Professor, Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Stress urinary incontinence (SUI) is very prevalent in middle-aged women. Minimal invasive anti-incontinence surgery is the most common surgery for treating the problem. The purpose of this study was to compare the therapeutic results and complications of minimally invasive anti-incontinence operative procedures for middle-aged women with SUI.Methods: We prospectively evaluated 146 women with SUI, who underwent suprapubic arc (SPARC) or transobturator (TOT) sling by the same surgeon.Findings: Concurrent anterior prolepses repair was performed in 43 (59.7%) and 29 (39.2%) patients in the SPARC and TOT groups, respectively. Objective cure rate was 90% and 93% respectively in the SPARC and TOT groups. Voiding difficulties were observed in 8 (11.1%) cases of the SPARC group and 13 (17.6%) patients of the TOT group. Urethrolysis and complete mesh removal were necessitated in 2 cases of the SPARC group. Regional and pelvic pains were observed in 3 (4.2%) and 10 (13.5%) patients of the SPARC and TOT groups, respectively. Vaginal erosion occurred in 8 (11.1%) and zero individuals of the SPARC and TOT groups, respectively Conclusion: The short-term anti-incontinence effects of SPARC and TOT were much similar. However, chronic pelvic and groin pain (with movement) occurred in 13.5% of women in the TOT group which implies the need for further study to determine the best technique in active women.

کلیدواژه‌ها [English]

  • Stress Urinary Incontinence
  • Trans vaginal sling
  • Transobturator sling

مراجع

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مجله دانشکده پزشکی اصفهان
دوره 29، شماره 172 - شماره پیاپی 172
بهمن و اسفند 1390
صفحه 2855-2864

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سابقه مقاله

  • تاریخ دریافت: 20 شهریور 1390
  • تاریخ بازنگری: 19 اردیبهشت 1403
  • تاریخ پذیرش: 17 فروردین 1401

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