Effektivitätsanalyse verschiedener Operationsverfahren zur Behandlung der Stressinkontinenz im Zeitraum von 1996 bis 2004

Zusammenfassung

Fragestellung: Ziel dieser Arbeit war es, die Operationsverfahren Kolposuspension, TVT™, Sparc™ und Monarc™ miteinander anhand verschiedener Parameter zu vergleichen. Die Ergebnisse sollen als Entscheidungshilfe dienen, um das verträglichste und effektivste Verfahren einsetzen zu können. Material und Methodik: Es wurden retrospektiv alle im untersuchten Krankenhaus durchgeführten Stressinkontinenzoperationsverfahren (1120 Operationen) zwischen 1996 und 2004 erfasst und miteinander anhand der Operationsdauer, der Komplikationsrate und der Liegedauer verglichen. Folgende statistische Tests kamen zur Anwendung: Arithmetisches Mittel, Standardabweichung, Median, t-Test, χ²- und der ANOVA-Test mit Bonferoni-Korrektur. Ergebnisse: Je neuer die eingesetzte Technik, umso kürzer die festgestellte Operationsdauer. Am längsten dauerte die Kolposuspension mit 45,08 min (± 18,18, n = 37) am schnellsten konnte die Monarc™-Technik mit 14,58 min (± 6,19, n = 113) durchgeführt werden. An Komplikationen traten bei den untersuchten Operationsverfahren Blasenperforationen, Blutungen, Harnwegsinfekte und postoperative Harnverhalte auf. Es bestand bei allen Operationsverfahren eine unterschiedliche Liegedauer, die sich bis auf TVT™ und Sparc™ signifikant voneinander unterschied. Kolposuspension 8,86 Tage (± 2,86, n = 37), Monarc™ 3,65 Tage (± 1,55, n = 113). Schlussfolgerung: Die Monarc™-Operation erscheint hinsichtlich aller beobachteter Parameter als die effektivste und auch kostengünstigste Technik zur operativen Behandlung der Stressinkontinenz.

Abstract

Purpose: This study compares different urinary incontinence surgeries like colposuspension, TVT™, Sparc™ and Monarc™ with each other on the basis of different parameters. The results serve as a decision factor for the choice of the most compatible procedure. Material and Methods: In retrospect, all urinary incontinence surgeries carried out in the examined hospital (1120 operations) between 1996 and 2004 were recorded statistically and compared with each other on the basis of operation duration, complication rate and days in hospital. The following statistic tests were used: arithmetic mean, standard deviation, median, t-test, χ² and the ANOVA test. Results: The more up to date the assigned technology, the shorter the recorded operation duration. The colposuspension needs longest with 45.08 min (± 18.18, n = 37) in comparison with Monarc™ 14.58 min (± 6.19, n = 113), which was faster. Complications like bladder perforations, bleedings, infections and post surgery urinary retentions were reported. Results show that the stay in hospital depends on the operation procedures, which differ significantly (p < 0.5) from each other (with the exception of TVT™ and Sparc™). Colposuspension required 8.86 days (± 2.86, n = 37), Monarc™ 3.65 days (± 1.55, n = 113). Conclusion: With respect to all observed parameters, Monarc™ surgery appears to be the most effective and also most economical technology in the treatment of stress urinary incontinence.

Kolposuspension - TVT™ - Monarc™ - Inkontinenz - Sparc™

Colposuspension - TVT™ - Monarc™ - stress urinary incontinence - Sparc™

Literatur

• 1 Brocklehurst J C. Urinary incontinence in the community: analysis of a MORI poll.  Br Med J. 1993;  306 832-834
• 2 Diokno A C, Brock M B, Brown M B, Herzog A R. Prevalence of urinary incontinence and other urological symptoms in the noninstitutionalized elderly.  J Urol. 1986;  136 1022-1025
• 3 Diokno A C, Brown M B, Goldstein N G, Herzog A R. Epidemiology of bladder emptying symptoms in elderly men.  J Urol. 1992;  148 1817-1821
• 4 Hunskaar S, Arnold E P, Burgio K, Diokno A C, Herzog A R, Mallett V T. Epidemiology and natural history of urinary incontinence. Abrams P, Khoury S, Wein A Incontinence. Plymouth; Plymbridge Distributors Ltd 1999: 197-226
• 5 Koyano W, Shibata H, Haga H, Soyama V. Prevalence and outcome of low ADL and incontinence among the elderly: five years follow-up in a Japanese urban community.  Arch Gerontol Geriatr. 1986;  5 197-206
• 6 Campbell A J, Reinken J, McCosh L. Incontinence in the elderly: prevalence and progress.  Age Ageing. 1985;  14 65-70
• 7 Goepel M, Hoffmann J, Piro M, Rübben H, Michel M C. Prevalence and physician awareness of urinary bladder dysfunction.  Eur Urol. 2002;  41 234-239
• 8 Milsom I, Abrams P, Cardozo L, Roberts R G, Thüroff J W, Wein A J. How widespread are the symptoms of overactive bladder and how are they managed? A population-based prevalence study.  BJU Int. 2001;  87 760-766
• 9 Melchior H. Harninkontinenz im Alter.  Urologe B. 1996;  36 435-440
• 10 Hu T W, Wagner T H, Bentkover J D, LeBlanc K, Piancentini A, Stewart W F, Corey R, Zhou S Z, Hunt T L. Estimated economic costs of overactive bladder in the United States.  Urology. 2003;  61 1123-1128
• 11 Lahodny J. Vaginale Inkontinenz- und Deszensuschirurgie. Stuttgart; Enke 1991
• 12 Baden W FT, Walker. Surgical Repair of Vaginal Defects. Philadelphia; Lippincott 1992: 97-104
• 13 Hoang-Böhm J, Jünemann K-P, Krautschick A, Braun P-M, Marx C, Alken P. Vergleich Burch vs. Stamey: Langzeitergebnisse von zwei konkurrierenden Operationsverfahren.  Urologe [A]. 1997;  36 400-404
• 14 El-Toukhy S, Mahadevan Angharad E, Davies T. Burch colposuspension: a 10 to 12 years follow-up.  J Obstet Gynaecol. 2000;  20 178-179
• 15 Allahdin S, McKinley C A, Mahmood T A. Tension free vaginal tape: a procedure for all ages.  Acta Obstet Gynecol Scand. 2004;  83 937-940
• 16 Nilsson C G, Falconer C, Rezapour M. Seven-year follow-up of the tension-free vaginal tape procedure for treatment of urinary incontinence.  Obstet Gynecol. 2004;  104 1259-1262
• 17 Enzelsberger H, Schalupny J, Heider R, Mayer G. TVT versus TOT - Eine prospektiv randomisierte Studie zur operativen Behandlung der weiblichen Stressinkontinenz.  Geburtsh Frauenheilk. 2005;  65 506-511
• 18 Dietz H P, Foote A J, Mak H L, Wilson P D. TVT and Sparc suburethral slings: a case-control series.  Int Urogynecol J Pelvic Floor Dysfunct. 2004;  15 129-131 131-(discussion)
• 19 Tseng L H, Wang A C, Lin Y H, Li S J, Ko Y J. Randomized comparison of the suprapubic arc sling procedure vs tension-free vaginal taping for stress incontinent women.  Int Urogynecol J Pelvic Floor Dysfunct. 2004;  (Epub ahead of print October 27, 2004)
• 20 Cindolo L, Salzano L, Rota G, Bellini S, D'Afiero A. Tension-free transobturator approach for female stress urinary incontinence Minerva.  Urol Nefrol. 2004;  56 89-98
• 21 Delorme E, Droupy S, de Tayrac R, Delmas V. Transobturator tape (Uratape). A new minimally invasive method in the treatment of urinary incontinence in women.  Prog Urol. 2003;  13 656-659
• 22 Delorme E, Droupy S, de Tayrac R, Delmas V. Transobturator tape (Uratape): a new minimally-invasive procedure to treat female urinary incontinence.  Eur Urol. 2004;  45 203-207
• 23 Gunnemann A, Heleis W, Pohl J, Paliakoudis I, Thiel R. The transobturator tape (TOT). A minimally-invasive procedure for the treatment of female urinary stress incontinence.  Urologe [A]. 2004;  43 1106-1110
• 24 Sergent F, Marpeau L. Prosthetic restoration of the pelvic diaphragm in genital urinary prolapse surgery: transobturator and infracoccygeal hammock technique.  J Gynecol Obstet Biol Reprod (Paris). 2003;  32 120-126
• 25 Sergent F, Sebban A, Verspyck E, Sentilhes L, Lemoine J P, Marpeau L. Per- and postoperative complications of TVT™ (tension-free vaginal tape).  Prog Urol. 2003;  13 648-655
• 26 Bulent Tiras M, Sendag F, Dilek U, Guner H. Laparoscopic Burch colposuspension: comparison of effectiveness of extraperitoneal and transperitoneal techniques.  Eur J Obstet Gynecol Reprod Biol. 2004;  116 79-84
• 27 Fatthy H, El Hao M, Samaha I, Abdallah K. Modified Burch colposuspension: laparoscopy versus laparotomy.  J Am Assoc Gynecol Laparosc. 2001;  8 99-106
• 28 Goel M C, Roberts J G. Dynamic rectus abdominis tendon colposuspension for female stress urinary incontinence: a new procedure and its follow-up.  Urol Int. 2003;  71 45-50
• 29 Cetinel B, Demirkesen O, Onal B, Akkus E, Alan C, Can G. Are there any factors predicting the cure and complication rates of tension-free vaginal tape?.  Int Urogynecol J Pelvic Floor Dysfunct. 2004;  15 188-193 (Epub 2004 Feb 13)
• 30 deTayrac R, Deffieux X, Droupy S, Chauveaud-Lambling A, Calvanese-Benamour L, Fernandez H. A prospective randomized trial comparing tension-free vaginal tape and transobturator suburethral tape for surgical treatment of stress urinary incontinence.  Am J Obstet Gynecol. 2004;  190 602-608
• 31 Soulie M, Cuvillier X, Benaissa A, Mouly P, Larroque J M, Bernstein J, Soulie R, Tollon C, Brucher P, Vazzoler N, Seguin P, Pontonnier F, Plante P. The tension-free transvaginal tape procedure in the treatment of female urinary stress incontinence: a French prospective multicentre study.  Eur Urol. 2001;  39 709-714 715-(discussion)
• 32 Tong Y C. An alternative method of tension-free vaginal tape implantation for the treatment of female urinary incontinence.  Urol Int. 2003;  71 51-54
• 33 Deval B, Levardon M, Samain E, Rafii A, Cortesse A, Amarenco G, Ciofu C, Haab F. A French multicenter clinical trial of SPARC for stress urinary incontinence.  Eur Urol. 2003;  44 254-258 258-259 (discussion)
• 34 Mellier G. A Meta-Analysis of the Intra-Operative Safety and Effectiveness of the Transobturator Hammock. Paris, France; ICS/IUG 2004
• 35 Meltomaa S, Backman T, Haarala M. Concomitant vaginal surgery did not affect outcome of the tension-free vaginal tape operation during a prospective 3-year follow-up study.  J Urol. 2004;  172 222-226
• 36 Bombier L, Freeman R M, Perkins E P, Williams M P, Shaw S R. Why do women have voiding dysfunction and de novo detrusor instability after colposuspension?.  BJOG. 2002;  109 402-412
• 37 FitzGerald M P, Brubaker L. The etiology of urinary retention after surgery for genuine stress incontinence.  Neurourol Urodyn. 2001;  20 13-21
• 38 Schussler B. Postoperative disorder of bladder emptying in gynecology: pathophysiology and possibilities for treatment.  Geburtsh Frauenheilk. 1988;  48 551-558
• 39 Bodden-Heidrich R. Psychosomatic aspects of urogynaecology: model considerations on the pathogenesis, diagnosis and therapy.  Zentralbl Gynakol. 2004;  126 237-243
• 40 Zubke W, Becker S, Kramer B, Wallwiener D. Persistent urinary retention after tension-free vaginal tape: a new surgical solution.  Eur J Obstet Gynecol Reprod Biol. 2004;  115 95-98
• 41 Manikandan R, Kujawa M, Pearson E, O'Reilly P H, Brown S C. Results of the tension-free vaginal tape procedure for stress incontinence: patient's perspective.  Int J Urol. 2004;  11 206-212