Stres Üriner İnkontinansta Cerrahi Tedaviler
Özet
Stres üriner inkontinans (SUİ), kadınlarda özellikle 60 yaş altında sıkça gözlenen ve yaşam kalitesini olumsuz etkileyen istemsiz idrar kaçağı durumudur. İlk aşamada konservatif ve cerrahi dışı yöntemler uygulansa da, bu yöntemlerin başarısız olduğu durumlarda cerrahi tedaviler en sık başvurulan seçeneklerdir. Cerrahi yaklaşımlar tarihsel süreçte anterior kolporafi ve Marshall Marchetti Krantz gibi retropubik yöntemlerle başlamış, ardından altın standart kabul edilen Burch kolposüspansiyonu ile devam etmiştir. Ancak günümüzde, uygulama kolaylığı ve yüksek başarı oranları nedeniyle minimal invaziv özellik taşıyan orta üretra askı operasyonları (Mid Üretral Sling) popülarite kazanmıştır. Bu kapsamda retropubik (TVT), transobturator (TOT) ve tek insizyonlu mini-sling yöntemleri sıklıkla kullanılmaktadır. Ayrıca daha az invaziv bir alternatif olarak ürethral direnci artırmayı hedefleyen dolgu (bulking) ajanları da tercih edilebilmektedir. Yapılan çalışmalar, TOT yönteminin komplikasyon oranlarının düşüklüğüyle, TVT'nin ise uzun vadeli kür başarılarıyla öne çıktığını göstermektedir. Günümüzde, cerrahın deneyimi ve hastanın beklentilerine göre en düşük komplikasyon ve en yüksek kür oranını sağlayacak optimal cerrahi yöntemin seçilmesi hedeflenmekte, ancak halen tek bir ideal cerrahi seçenek bulunmamaktadır.
Stress urinary incontinence (SUI) is an involuntary leakage of urine commonly observed in women, particularly under the age of 60, which negatively impacts the quality of life. Although conservative and non-surgical methods are implemented in the initial stage, surgical treatments are the most frequently applied options when these methods fail. Surgical approaches historically began with retropubic methods such as anterior colporrhaphy and Marshall Marchetti Krantz, followed by Burch colposuspension, which was accepted as the gold standard. However, today, minimally invasive mid-urethral sling operations have gained popularity due to their ease of application and high success rates. In this context, retropubic (TVT), transobturator (TOT), and single-incision mini-sling methods are frequently utilized. Additionally, bulking agents aiming to increase urethral resistance can also be preferred as a less invasive alternative. Studies demonstrate that while the TOT method stands out with lower complication rates, TVT is prominent with its long-term cure success. Nowadays, aiming for the lowest complication and highest cure rate based on the surgeon's experience and the patient's expectations is targeted; however, an optimal single surgical option has still not been determined.
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