Kadnda idrar boaltma sorunu Do Dr Evrim Erdemoglu

Kadında idrar boşaltma sorunu Doç. Dr. Evrim Erdemoglu, Süleyman Demirel Üniversitesi, Isparta Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Sunum 1. Etyopatogenez, 2. Ürodinaminin yeri, 3. Ne zaman uretrolizis? Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Etioloji • Doğum • Obesite • Fonksiyonel Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Risk Faktörleri • • • Yaş DM Stroke – Vasküler hastalıklar Depresyon Fekal inkontinens Epizyotomi Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Risk Faktörleri • • • Pelvik cerrahi Radyoterapi B 12 eksikliği Kalp yetmezliği KOAH Delirium-Demans-Parkinson Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

PATOGENEZ Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

OAB Sık idrara gitme Nocturia İnkontinens Urgency İdiopatik Nöröjenik Lokal Faktörler Yaşlanma Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

SI 1. Uretral Hipermobilite 2. Intrensek Spinkter Yetmezliği (ISD) • Valsalva Leak Point Pressure (VLPP) Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

SI Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Geçici İnkontinens - DIAPPERS D I A Delirium Infection Atrophy Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Geçici İnkontinens - DIAPPERS P P E Pharmacologic Physcological Excess Urine Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Geçici İnkontinens - DIAPPERS R S Restricted Mobility Stool Impaction DIAPPERS Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Sinir Sistemi ve Urolojik Sorunlar Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Cerrahi ve Urolojik Sorunlar Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Urodinami • • • İnkontinansın objektif gösterilmesi İlk işeme hissi Intravesical, urethral, abdominal basınçlar İdrar akım hızı Residual volume Leak point pressure Akım basınç çalışması EMG Videourodynamics Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Urodinaminin Yeri • • • • The impact of multichannel urodynamics upon treatment recommendations for female urinary incontinence. Ward RM, Hampton BS, Blume JD, Sung VW, Rardin CR, Myers DL Int Urogynecol J Pelvic Floor Dysfunct. 2008; 19(9): 1235. The aim of this study was to evaluate whether multichannel urodynamic testing changes a physician's treatment recommendations when managing women with urinary incontinence. In this prospective reader study, four fellowship-trained urogynecologists reviewed 39 abstracted cases of urinary incontinence on two occasions: first without and subsequently with urodynamic data. Treatment recommendations were made for each case after each review. The probability of urodynamic data modifying treatment recommendations was estimated for each reader and for the population of readers using a random effects logistic regression to account for reader variability. The overall probability that urodynamic data would change treatment was 26. 9% (95% confidence interval (CI), 18. 6%, 37. 2%) for medical treatments and 45. 5% (95% CI, 37. 8%, 53. 4%) for surgical treatments. Reader-to-reader differences accounted for 3% and<1% of the total variance for medical and surgical treatments, respectively. Multichannel urodynamic evaluations are significantly associated with changes in medical and surgical treatment recommendations in a referral population. Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Urodinaminin Yeri • Urodynamic investigations for management of urinary incontinence in adults. • Glazener CM, Lapitan MC • Cochrane Database Syst Rev. 2002; • BACKGROUND: Urodynamic tests are used to investigate people who have urinary incontinence or other urinary symptoms in order to make a definitive objective diagnosis. The aim is to help to select the treatment most likely to be successful. The investigations are invasive and time consuming. OBJECTIVES: The objective of this review was to discover if treatment according to a urodynamic-based diagnosis led to clinical improvements in urinary incontinence, compared to treatment based on history and examination. SEARCH STRATEGY: We searched the Cochrane Incontinence Group trials register. Date of the most recent search: April 2002. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing clinical outcomes in groups of people who were and were not investigated using urodynamics, or comparing one type of urodynamics against another. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Authors of one study were contacted for more information, including adverse effects. MAIN RESULTS: Two small trials involving 128 women were included. In one small trial, women who were investigated with urodynamics were more likely to receive active treatment with drugs or surgery. However, the numbers in both trials were too small to determine if this affected clinical outcomes such as a reduction in incontinence. REVIEWER'S CONCLUSIONS: A larger definitive trial is needed, in which people are randomly allocated to management according to urodynamic findings or to standard management based on history and clinical examination. Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Urodinami Sorunları • • • Teknik standart değil Artifisyel işlem non fizyolojik Transuretral katetere bağlı SI gizlenebilir Aynı hastada reproducibil değil Asemptomatik kişlerde normal değerlerin range’i geniş Tespit edilen her anomali klinik olarak önemli değil Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Urodinami Dezavantajları • Pahalı • Konforsuz • Zaman alıcı Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Urodinami • Unkomplike SI’de urodinami yapılması tedavi sonuçlarını değiştirmiyor. Gereli değil. Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Urodinami • Pelvik organ prolapsusu • Mix tip Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Urodinami İstenmesi Gerekli Durumlar • • Komplike SI’de yararlı olabilir; Geçirilmiş urojinekolojik operasyon Radyoterapi Nörolojik durumlar Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Urodinami İstenmesi Gerekli Durumlar • • Ayakta valsalvasız kaçak Nokturi PVR >50 ml Stress testte geç kaçak Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Uygulamamız • • • Öykü Fizik muayene TIT, İdrar kültürü PVR Q tip veya ilgili testler Gerekirse günlük / üroflow Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Uretrolisiz • Sling sonrası işeme disfonksiyonu %5 -15 • MMK’da %5 -20 • Burch’de %4 -20 Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Tanı • Operasyon sonrası başlayan yada kötüleşen semptomlar • Q tip • Sistoskopi • Urodinami Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Zamanlama • 4 hafta içinde müdale Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Teknik • Vaginal • Retropubik Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013

Kliniğimizde 2013’deki Uretrolisiz • Laparoskopik Burch (Tanagho modifikasyonu) 13, uretrolisiz 1 • Dış merkezde yapılan TOT sonrası uretrolisiz 1 Suleyman Demirel University, Dept. Of Gynecology and Gynecologic Oncology, Erdemoglu E, Isparta, 2013