Yonguc Tarik, Aydogdu Ozgu, Bozkurt Ibrahim Halil, Degirmenci Tansu, Gunlusoy Bulent, Sen Volkan, Yarimoglu Serkan
Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey.
Can Urol Assoc J. 2015 Jul-Aug;9(7-8):E546-50. doi: 10.5489/cuaj.2770. Epub 2015 Aug 10.
We evaluate the impact of severe obesity on surgical outcomes of the transobturator tape (TOT) procedure in patients with stress urinary incontinence (SUI).
In total, 32 women with severe obesity (body mass index [BMI] >35 kg/m(2)) were included in the study. All patients were preoperatively evaluated with history, pelvic examination, ultrasonography, and cough stress test. All patients completed the International Consultation on Incontinence Questionnaire-Short form (ICIQ-SF) preoperatively and at the postoperative follow-up. Cure of incontinence was defined as being completely dry after surgery. Cure was assessed subjectively and objectively. Subjective improvement defined as an International Consultation on Incontinence Questionnaire-Short form (ICIQ-SF) score ≤12 and satisfaction with surgery. Failure was defined as having no change or worsening of urinary incontinence after surgery. Postoperative patient satisfaction was assessed using a visual analog scale.
The mean follow-up time and mean BMI were 40.9 ± 20.9 months and 38 ± 3 kg/m(2), respectively. According to preoperative ICIQ-SF questionnaire scores, 20 patients (62.5%) had severe and 12 patients (37.5 %) had very severe urinary incontinence symptoms. No patient had slight or moderate symptoms. None of the patients experienced worsening symptoms after surgery. Objective cure, subjective cure, subjective improvement and patient satisfaction rates were 81.2%, 46.8%, 37.5%, and 84.3% respectively. Our overall complication rate was 9.3%. None of the patients experienced intraoperative complications.
In experienced hands, TOT is an effective and safe procedure to treat SUI, with minimal complications in severe obese women.
我们评估了重度肥胖对压力性尿失禁（SUI）患者经闭孔尿道中段吊带术（TOT）手术效果的影响。
本研究共纳入32例重度肥胖女性（体重指数[BMI]>35 kg/m²）。所有患者术前均进行了病史、盆腔检查、超声检查及咳嗽压力试验评估。所有患者在术前及术后随访时均完成了国际尿失禁咨询委员会简表（ICIQ-SF）。尿失禁的治愈定义为术后完全无尿失禁。通过主观和客观评估来判断治愈情况。主观改善定义为国际尿失禁咨询委员会简表（ICIQ-SF）评分≤12分且对手术满意。失败定义为术后尿失禁无变化或加重。采用视觉模拟量表评估患者术后满意度。
平均随访时间和平均BMI分别为40.9±20.9个月和38±3 kg/m²。根据术前ICIQ-SF问卷评分，20例患者（62.5%）有严重尿失禁症状，12例患者（37.5%）有非常严重的尿失禁症状。无患者有轻度或中度症状。术后无患者症状加重。客观治愈率、主观治愈率、主观改善率和患者满意率分别为81.2%、46.8%、37.5%和84.3%。我们的总体并发症发生率为9.3%。无患者发生术中并发症。
在经验丰富的医生手中，TOT是治疗SUI的一种有效且安全的手术方法，在重度肥胖女性中并发症极少。
