Kvaliteta života bolesnica nakon "sling" operacija zbog statičke urinarne inkontinencije [Quality of life in patients after "sling" operations for stress urinary incontinence]

Hodžić, Damir (2014) Kvaliteta života bolesnica nakon "sling" operacija zbog statičke urinarne inkontinencije [Quality of life in patients after "sling" operations for stress urinary incontinence]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

The aim of this study was to determine the efficacy and surgical outcome of the sling procedures in stress incontinent women in comparison to conventional anterior colporrhaphy. Total of 56 patients with stress urinary incontinence (SUI) were treated with sling procedure between November 2011 and March 2013, 39/56 (69,6%) with suprapubic arc (SPARC) and 17/56 (30,4%) with MiniArc method. During the same period total of 49 patients with SUI were treated with traditional anterior colporrhaphy according to Bagović method as the control group. All patients were prospectively clinically assessed over a period of 3, 6 and 12 months after surgery. The objective cure rate after the follow-up was 92,9% (52/56) in observed group of patients and 79,6% (39/49) in control group and improvement was occurred in rest of 5,4% (3/56) and 18,4% (9/49), respectively (p<0,05). The overall complications rate was significantly lower in the observed group of patients than in the control group, 12,5% (7/56) vs. 28,6% (14/49), (p<0,05). In the sling group was postoperatively noticed slightly higher rate of urinary incontinence, but in the colporrhaphy group was emphasized rate of urinary retention. Only one from the each group of patients failed the surgical procedure and required additional correction for SUI. The mean operating time for SPARC and MiniArc procedure was 19±7 and 9±5 minutes, respectively (p<0,0001). Mean duration of hospitalization was significantly shorter in the sling group of patients (2,6±1,0, range 2-7) days than in the control group of (9,6±1,8, range 6-18), (p<0,001<0,0001). Comparing to conventional surgery, sling methods are safe and highly effective, with low incidence of perioperative complications, promising long-term results and high patient's satisfaction. Sling procedures are minimally invasive and body integrity preserving methods with favorable impact on patient's quality of life, including sex life improvement.

Abstract in Croatian

Cilj ovog istraživanja bilo je utvrditi učinkovitost i operacijski ishod sling postupaka u žena sa statičkom inkontinencijom urina (SIU) u poredbi s konvencionalnom prednjom kolporafijom. U razdoblju od studenog 2011. do ožujka 2013. sling postupcima liječeno je ukupno 56 bolesnica sa SIU, 39/56 (69,6%) metodom SPARC i 17/56 (30,4%) metodom MiniArc. Tijekom istog razdoblja ukupno je 49 bolesnica sa SIU operirano primjenom klasične prednje kolporafije metodom po Bagoviću kao poredbena skupina. Sve bolesnice prospektivno su klinički nadzirane u razdoblju od 3, 6 i 12 mjesec nakon operacije. Ukupna stopa izlječenja nakon razdoblja kliničkog nadzora iznosila je 92,9% (52/56) u promatranoj skupini bolesnica i 79,6% (39/49) u poredbenoj skupini, a do poboljšanja je došlo u ostalih 5,4% (3/56) bolesnica u promatranoj i 18,4% (9/49) bolesnica u poredbenoj skupini (p<0,05). Ukupna stopa komplikacija bila je značajno niža u promatranoj skupini bolesnica nego u poredbenoj skupini, 12,5% (7/56) naspram 28,6% (14/49), (p<0,05). U skupini bolesnica liječenih sling metodama postopreacijski je zabilježena nešto viša stopa inkontinencije, a u skupini klasično operiranih bolesnica nešto izraženija stopa urinarne retencije. Kirurško liječenje nije uspjelo u samo po jedne bolesnice iz svake skupine i bilo je potrebno učiniti dodatnu korekciju SIU. Prosječno trajanje operacije iznosilo je 19±7 minuta za SPARC, a 9±5 minuta za MiniArc, (p<0,0001). Prosječno trajanje bolničkog liječenja bilo je značajno kraće u skupini bolesnica liječenih sling postupkom (2,6±1,0, raspon 2-7) dana nego u poredbenoj skupinu (9,6±1,8, raspon 6-18), (p <0,001<0,0001). Slijedom prikazanih rezultata, sling metode su vrlo učinkovite u liječenja SIU sniskom pojavnošću perioperacijskih komplikacija i obećavajućim dugoročnim rezultatima te primjerenim zadovoljstvom bolesnica. Sling metode su minimalno invazivne i poštedne s obzirom na tjelesni integritet bolesnica uz povoljan utjecaj na kvalitetu života, uključujući unaprjeđenje seksualnog života.

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