بررسی نتایج عمل تعلیق گردن مثانه با فاسیا در بیماران مبتلا به بی اختیاری استرسی ادرار

نوع مقاله: اصیل پژوهشی

نویسندگان

1 استادیار گروه زنان و مامائی، دانشکده پزشکی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

2 ارولوژیست، بیمارستان مهدیه، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

3 دستیار زنان و مامائی، دانشکده پزشکی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

4 پزشک عمومی دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

چکیده

مقدمه: بی اختیاری ادراری از علائم بسیار شایعی است که بر کیفیت زندگی میلیونها نفر در جهان تاثیری نامطلوب دارد. تعلیق
گردن مثانه با نواری ازفاسیا (PFS) به عنوان یک روش جراحی موثر در درمان بی اختیاری استرسی ادرار بکار می رود. هدف از
این مطالعه بررسی و تعیین میزان بهبودی کامل ، بهبود نسبی و شکست عمل جراحی تعلیق گردن مثانه با نواری از فاسیا در بیماران
طی 3 سال می باشد.
روش کار: در این مطالعه مقطعی- توصیفی تحلیلی پرونده 30 بیمار مبتلا به بی اختیاری استرسی ادراری که تحت عمل تعلیق
گردن مثانه با نواری از فاسیا قرار گرفتند، نتایج عمل جراحی بررسی و اطلاعات بدست آمده توسط نرم افزار SPSS نسخه 11
مورد تجزیه وتحلیل قرار گرفت.
نتایج : متوسط سن بیماران 43/9 ± 8/4 سال بود که 53/3% آنان مبتلا به بی اختیاری مختلط ادراری و 46/7% آنان مبتلا به بی
اختیاری استرسی خالص ادراری بودند. مدت زمان پیگیری22/3 ±9 /4 ماه بود. 73/3% بهبودی کامل یافته، 13/3% بهبودی نسبی
داشته و در 13/3% عمل با شکست مواجه شد. میزان بهبودی کامل در بی اختیاری استرسی خالص ادراری 100% بود در حالیکه در
نوع بی اختیاری مختلط ادراری 50% بود (P=0/008). همچنین میزان بهبودی کامل با مدت زمان وجود علائم، تعداد زایمان طبیعی،
ترکیب اعمال جراحی انجام شده و سن ارتباط معنی دار نداشت (P>0/05)، اما اختلالات لگنی همراه (سیستوسل و رکتوسل) با
میزان بهبودی کامل ارتباط معنی داری داشت (P=0/04).از بیماران 3ا/83% بارضایت کامل، 6/7% رضایت نسبی و 10% عدم رضایت
داشتند. عوارض کوتاه مدت در 33/3% و عوارض دراز مدت در 26/7% دیده شد. شایعترین عارضه زود هنگام، خونریزی واژینال و
شایعترین عارضه تاخیری عود علائم بود.
نتیجه گیری : تعلیق گردن مثانه با نواری از فاسیا روش موثر با حداقل عوارض و نتایج پایدار در بیماران مبتلا به بی اختیاری
استرسی ادراری به ویژه درنوع بی اختیاری استرسی خالص ادراری می باشد.

کلیدواژه‌ها


عنوان مقاله [English]

The evaluation of Pubovaginal Fascial Sling in Stress Urinary Incontinence in 30 Patients

نویسندگان [English]

  • Nahid Mostaghel 1
  • Soheyla Peyro 2
  • Shadi Mohammadi 3
  • Azar Zamani 4
1 Assistant Professor of Obstetrics and Gynecology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2 Urologist, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3 Resident of Obstetrics and Gynecology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
4 MD., Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
چکیده [English]

Introduction: Urinary incontinence is a very common symptom that adversely affects the quality of life of millions of people over worldwide. Pubovaginal fascial sling (P.F.S) is one of the effective surgical methods in treatment of urinary stress incontinence. The aim of this study was to determine the cure rate, improvement and failure rate in patients who underwent P.F.S. within 3 years.
 
Methods: In a descriptive-analytic study 30 patients with urinary stress incontinence who had P.F.S. surgery were studied. Results of all surgeries data were analyzed with SPSS Version 11.
 
Results: The Mean age was 43.9±8.4 years. Patients who sufferings from mixed urinary incontinence were 53.3% and the 46.7% had pure urinary stress incontinence. The mean follow up period was 22.3±9.4 months and 73.3 % were cured. Improvement was seen in 13.3% and in 13.3% surgery had failed. Cure rate in pure urinary stress incontinence was 100% and in mixed urinary incontinence was 50% (P=0.008). In addition, there was no significant difference between cure rate and duration of symptoms, vaginal delivery number, combination of operations, and age (P>0.05) but pelvic disorders (cystocele, rectocele) had significant correlation with cure rate (P=0.04). In our patients 83.3% were satisfied while 6.7% were partially satisfied and 10% were unsatisfied. Early complications were seen in 33.3% and late complications were seen in 26.7%. Vaginal bleeding was the most common early complication and the recurrence of urinary incontinence was the most common late complication.
 
Conclusion: Pubovaginal fascial slingis an effective and safe method with long standing results in urinary stress incontinence especially in pure stress urinary incontinence.

کلیدواژه‌ها [English]

  • Urinary Incontinence
  • Stress Urinary Incontinence
  • Pubovaginal Sling
  • Urge Incontinence
  • Mixed Urinary Incontinence
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