Abdominal ve vajinal cerrahi sonrası üriner disfonksiyonların değerlendirilmesi
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Dosyalar
Tarih
2011
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Yapılan histerektomi operasyonlarının %90'ından fazlası benign hastalıklara bağlıdır ve bunların da 2/3'ü sadece menstrüel bozukluklardan dolayıdır. Radikal histerektominin uzun dönem üriner ve seksüel disfonksiyona yol açabilen pelvik otonomik sinir hasarına neden olduğu yayınlanırken; benign sebeplerle yapılan basit histerektominin üriner fonksiyonlar üzerindeki etkileriyle ilgili çalışmalar ise çelişkilidir. Bu prospektif çalışmada farklı endikasyonlarla yapılan çeşitli histerektomi tiplerinin üriner fonksiyonlar üzerine olan etkilerini değerlendirmek amaçlanmıştır. Çalışmamıza, Ocak 2010-Temmuz 2011 tarihleri arasında Trakya Üniversitesi Tıp Fakültesi Hastanesi Kadın Hastalıkları ve Doğum Kliniğine başvuran ve çalışmaya katılmayı kabul eden, benign nedenlerle basit abdominal histerektomi uygulanan 20 hasta, uterin prolapsus nedeniyle vajinal histerektomi uygulanan 15 hasta, jinekolojik bir kanser (over ve endometrium kanseri) nedeniyle pelvik lenf nodu disseksiyonunun da dâhil olduğu basit abdominal histerektomi uygulanan 15 hasta ve serviks kanseri nedeniyle pelvik lenf disseksiyonunun da dahil olduğu radikal histerektomi uygulanan 13 hasta olmak üzere toplam 63 hasta alındı. Tüm olgular operasyon öncesi ve postoperatif dönemin 3-6. ayları arasında Trakya Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı bünyesinde bulunan Ürojinekoloji ünitesinde ürojinekolojik testler ve anketler kullanılarak değerlendirildi. Çalışmamızda semptom anketlerine göre hastalar değerlendirildiğinde, vajinal histerektomi uygulanan hastalarda operasyon sonrasında stres semptomlarında ve radikal histerektomi sonrasında ise irritatif semptomlarda artış saptanmıştır. Hastaların yaşam kaliteleri değerlendirildiğinde sadece radikal histerektomi uygulananlarda operasyon sonrası hayat kalitesi azalmış, diğer hastalarda ise iyileşme saptanmıştır. Fizik muayene bulguları ve objektif testlerle tespit edilen stres inkontinans sıklığının operasyon sonrası basit abdominal histerektomi uygulanan hastalarda azalmış olduğu, vajinal histerektomi uygulananlarda ise artış gösterdiği tespit edilmiştir. Üroflovmetrik inceleme sonuçlarında görülmüştür ki hangi tip histerektomi yapılırsa yapılsın ve buna pelvik lenf nodu disseksiyonu ilave edilsin veya edilmesin işeme akım hızları, sürelerinde operasyon sonrası operasyon öncesine göre bir değişim göstermemektedir. Radikal histerektomi uygulanan hastalarda işeme paterninde obstrüktif işemenin tüm hastalarda ortaya çıktığı görülmüştür. İşeme sonrası kalan rezidü idrar miktarı ise radikal histerektomi grubunda artmış olduğu, özellikle vajinal histerektomi grubunda istatistiksel anlamlı olmak üzere diğer gruplarda azalmış olduğu görülmüştür. Sonuç olarak histerektomi sonrası üriner inkontinans şikâyetlerinin operasyon sonrası objektif olarak yorumlanabilmesi için histerektomi planlanan tüm hastaların üriner semptomlar açısından detaylı anamnezleri alınmalı ve gerekirse ürodinamik değerlendirme yapılmalıdır. Anahtar kelimeler: Basit abdominal histerektomi, vajinal histerektomi, radikal histerektomi, üriner disfonksiyon, üroflovmetri.
Abstract
Over 90 % of hysterectomy operations are performed for benign diseases and 2/3 of these hysterectomies are due to menstrual problems. It is published that long-term urinary and sexual dysfunction could be emerged cause of pelvic autonomic damage as a result of radical hysterectomy; whereas studies about effects of the simple hysterectomy for benign conditions on urinary functions are conflicting. The aim of this study is to evaluate the effects of different types of hysterectomy on urinary functions that are performed for various indications. Our study included a total of 63 patients admitted to Trakya University, Faculty of Medicine, Clinics of Gynecology and Obstetrics between January 2010-July 2011 and whose accepted to join to study; simple abdominal hysterectomy performed for benign conditions in 20 patients, vaginal hysterectomy performed for uterine prolapse in 15 patients, simple abdominal hysterectomy with pelvic lymph node dissection for a gynecologic cancers (ovarian and endometrial carcinoma) in 15 patients, and radical hysterectomy with pelvic lymph node dissection for cervical cancer in 13 patients. All cases were evaluated preoperatively and between 3-6 months of postoperative period by using urogynecological tests and questionnaires in Trakya University, Faculty of Medicine, Urogynecology unit. When patients were evaluated by symptom questionnaires, stress symptoms were increased in patients whose had hysterectomy vaginally and irritative symptoms were increased after radical hysterectomized patients. Quality of life was decreased only in patients with radical hysterectomy, as rest of patients was provided an improvement in respect to evaluation of quality of life in patients. Frequency of stress incontinence that determined by physical examination findings and objective tests were decreased after surgery in simple abdominal hysterectomy and were increased after vaginal hysterectomy. In results of uroflowmetric examination, it is noticed that urine flow rate and duration of voiding were not changed postoperatively compared to preoperative period regardless of which type of hysterectomy were performed and whether or not with pelvic lymph node dissection. It is observed that obstructive voiding was developed in all patients underwent a radical hysterectomy in terms of voiding patterns. Postvoid residual urine volume was increased in radical hysterectomy group and decreased in other groups; decreasing of post-voiding residue was statistically significant in vaginal hysterectomy group. In conclusion, in order to interpret objectively postoperative complaints of urinary incontinence after hysterectomy detailed medical history should be taken with regard to urinary symptoms and urodynamic evaluation should be performed if necessary in all of patients scheduled for hysterectomy. Key words: Simple abdominal hysterectomy, vaginal hysterectomy, radical hysterectomy, urinary dysfunction, uroflowmetry.
Abstract
Over 90 % of hysterectomy operations are performed for benign diseases and 2/3 of these hysterectomies are due to menstrual problems. It is published that long-term urinary and sexual dysfunction could be emerged cause of pelvic autonomic damage as a result of radical hysterectomy; whereas studies about effects of the simple hysterectomy for benign conditions on urinary functions are conflicting. The aim of this study is to evaluate the effects of different types of hysterectomy on urinary functions that are performed for various indications. Our study included a total of 63 patients admitted to Trakya University, Faculty of Medicine, Clinics of Gynecology and Obstetrics between January 2010-July 2011 and whose accepted to join to study; simple abdominal hysterectomy performed for benign conditions in 20 patients, vaginal hysterectomy performed for uterine prolapse in 15 patients, simple abdominal hysterectomy with pelvic lymph node dissection for a gynecologic cancers (ovarian and endometrial carcinoma) in 15 patients, and radical hysterectomy with pelvic lymph node dissection for cervical cancer in 13 patients. All cases were evaluated preoperatively and between 3-6 months of postoperative period by using urogynecological tests and questionnaires in Trakya University, Faculty of Medicine, Urogynecology unit. When patients were evaluated by symptom questionnaires, stress symptoms were increased in patients whose had hysterectomy vaginally and irritative symptoms were increased after radical hysterectomized patients. Quality of life was decreased only in patients with radical hysterectomy, as rest of patients was provided an improvement in respect to evaluation of quality of life in patients. Frequency of stress incontinence that determined by physical examination findings and objective tests were decreased after surgery in simple abdominal hysterectomy and were increased after vaginal hysterectomy. In results of uroflowmetric examination, it is noticed that urine flow rate and duration of voiding were not changed postoperatively compared to preoperative period regardless of which type of hysterectomy were performed and whether or not with pelvic lymph node dissection. It is observed that obstructive voiding was developed in all patients underwent a radical hysterectomy in terms of voiding patterns. Postvoid residual urine volume was increased in radical hysterectomy group and decreased in other groups; decreasing of post-voiding residue was statistically significant in vaginal hysterectomy group. In conclusion, in order to interpret objectively postoperative complaints of urinary incontinence after hysterectomy detailed medical history should be taken with regard to urinary symptoms and urodynamic evaluation should be performed if necessary in all of patients scheduled for hysterectomy. Key words: Simple abdominal hysterectomy, vaginal hysterectomy, radical hysterectomy, urinary dysfunction, uroflowmetry.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Basit Abdominal Histerektomi, Vajinal Histerektomi, Radikal Histerektomi, Üriner Disfonksiyon, Üroflovmetri, Simple Abdominal Hysterectomy, Vaginal Hysterectomy, Radical Hysterectomy, Urinary Dysfunction, Uroflowmetry
