TOOMAS TAMM ITK UROLOOG EUS president
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1 TOOMAS TAMM ITK UROLOOG EUS president
2 Kirchen et al., Presented at 2002 EAU meeting, Birmingham
3 Intrinsic sphincter deficiency (Kennedy 1937) Changes in the posterior urethrovesical angle (Jeffcoate & Roberts 1952) Shortering of the proximal urethra and the change in funnel type (Lapides 1960) Pressure balancing theory (Enhörning 1961) Mid-urethra theory (Ulmsten 1990, 1993) Valpas, NEEM 1 Tampere 2007 Hammock theory (1994 DeLancey)
4 TVT Ulmsten U et al Int Urogyn J Pelvic Floor Dysf 1996;7:81-6 Transobturator sling E. Delorme Prog Urol 2001;11: De Leval J Eur Urol 2003;44: (TOT inside-out)
5 Enne operatsiooni Põhjalik haige füsikaalne uuring (anamnees, objektiivne staatus) Urineerimispäevik Jääkuriin, uroflow-meetria, urodünaamika Intraoperatiivselt Kesk-ureetra lingu paigaldamine Pingevaba Vaginaalne tampoon, et ära hoida hematoomi teket
6 Author TVT Burch Persson jt 89% 87% Valpas jt 86% 57% Paraiso jt 91% 81% Ward jt 63% 51% NEEM 1, Tampere 2007
7 80-92%
8 Objective 71-91% Subjective 48-91%
9 aranemine 79-92% bstruktsioon ja/või retensioon 2,3-36,4% e Novo urge 0-25,9% õie-ureetra vigastus 0-11,6% luline verekaotus 0-10% ingu erosioon 0-5,6%
10 Incision Mini-Slings Versus Standard Midurethral Slings ical Management of Female Stress Urinary Incontinence: -Analysis of Effectiveness and Complications ed Abdel-Fattah a,*, John A. Ford a, Chou Phay Lim b, Priya Madhuvrata c EUROPEAN UROLOGY 6 0 ( ) etropuubilise ja transobturatoorse ling 5-11 a 77-80% iniling 30,2 kuud 40% Cornu J-N, Eur Urol aastat 10 % North et al., BJOG 2010 iniling: lühem operatsiooni aeg, vähem valusid. Sagedasem reoperatsioonide vajadus
11 VT 10 years after op N = 206 Failure rate 19% Complications occurred mainly during month 1 after surgery Followup time 0-1 month 10% 1 month- 10 years 7% Complication rate
12 nternational registry on sub-mid al tapes (MUT) implanted by retro or trans-obturator route: preliminary s on 700 patients P. aremeau, Urology, Nimes, France ol Suppl 2007;6(2): pt- Soome.Prantsusmaa, Hispaania, Itaalia, UK, Lõuna Aafrika 89% esmane SUI operatsioon 3 kuud postop: 89,75% kuiv 15,85% oluliselt parem 3,4% sama, veidi parem, halvem
13 tioloogia ebaselge Intraoperatiivselt lingu asend ebaõige Ling valesti fikseerunud Uriinipidamatuse tekkemehhanismi põhjuseks kaasnev patoloogia
14 üüa aru saada ebaõnnestumise põhjusest egatüüpi UI puhul vajalik lisaks operatiivsele avi medikamentoosne ravi uringud (urodünaamika?, tsüstoskoopia? -tip) eoperatsiooni vajadus? Halvemad tulemused fikseerunud uretrovesikaalse segmendi puhul
15 alikud Mitte ravida Periuretraalsed süstid (kollageen jms) Teine ling, eelistatult retropuubiliselt Burch kolposuspensioon Kunstlik sfinkter FFU section, P.Kerrebroeck, E. Kocjancic, F. Haab rckardt FC and Costa P
16 Periuretraalsed süstid (kollageen jms) Transuretraalne kollageen Injektsioon Paranemine 65% kuni 1 aasta Langeb alla 30% jälgimisel üle 1 aasta
17 urch kolposuspensioon Peale esimest ebaõnnestunud operatsiooni paranemine 81% Peale 2. ebaõnnestunud operatsiooni paranemine 25% Peale kolmandat ebaõnnestunud operatsiooni paranemine 0%
18 ol. 2009; 55(6): (ISSN: ) on-free Vaginal Tape in the Management of Recurrent ynamic Stress Incontinence after Previous Failed rethral Tape los Liapis *, Panagiotis Bakas, Georgios Creatsas TVT kordusoperatsioonina paranemine 74%
19 ck JS, Ku JH, Shin JW, Park KJ, Kim SW, Oh S-J. Shortening ension-free vaginal tape for the treatment of urrent incontinence. J Urol 2004;171:1634. UI retsidiiv peale ebaõnnestunud TVT operatsiooni: Lõdvenenud lingu asendi korrigeerimine 4-0 polüpropüleen õmblusega või 2 meedium suuruse klipsiga Lühendab lingu
20 isauuringud vajadusel upe limaskest Lokaalne östrogeenravi 2-4 nädalat enne reoperatsiooni Uretrolüüs- uretrovesikaalse osa mobiilsuse saavutamiseks elnev ling Põletik, asend Normaalne asend, pinge, põletikuvaba
21 äielik lingu eemaldamine Infektsiooni puhul Vaginaalne erosioon üle 1 cm Tundmatu lingu materjal l B & F. Haab Current Opinion in Urol, Vol 16, No4 July 2006
22 pe eesseinas muhv Muhvi servade õmblus
23
24 rapuubiline TVT
25 test lingu pingutamine kuni leke kuni 2011a 18 muhvi operatiooni Kõik kordusoperatsioonid Eelnevalt 3 Burch ja 6 RP- TVT ja 9 TVT-O a, keskmine vanus 71 a. 1 a paranenud muutuseta 5 a paranenud 12 pt 100% Infektsioone 0%
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