Comparison of the Kelly’s plication and TOT simultaneously with vaginal hysterectomy, on the incontinence, and sexual functions

Vol. 44 (4): 779-784, July – August, 2018

doi: 10.1590/S1677-5538.IBJU.2018.0019


ORIGINAL ARTICLE

Neslihan Bayramoglu Tepe 1, Omer Bayrak 2, Huseyin Caglayan Ozcan 1, Mete Gurol Ugur 1, Ilker Seckiner 2
1 Department of Obstetrics and Gynecology, University of Gaziantep, Gaziantep, Turkey; 2 Department of Urology, University of Gaziantep, Gaziantep, Turkey

ABSTRACT

Purpose: To compare the effect of vaginal hysterectomy-anterior/posterior colporrhaphy with Kelly’s plication(VH-KP), versus vaginal hysterectomy-anterior/posterior colporrhaphy-transobturator tape(VH-TOT) surgeries on incontinence, quality of life, and sexual functions in patients with pelvic organ prolapse(POP), and concurrent obvious stress urinary incontinence(SUI).

Materials and Methods: Between 2013 and 2017, fifty patients treated with VH-KP(n = 25), and VH-TOT(n = 25) due to POP and SUI, were evaluated prospective consecutively. Age, parity, duration of urinary incontinence,and the daily pad use were recorded.

Patients were filled “rinary Distress Inventory-6(UDI-6)”, “Incontinence Impact Questionnaire 7(IIQ-7)” and “Index of Female Sexual Function(IFSI)” questionnaire forms at preoperatively,and postoperative 6th month. No usage of pads was accepted as subjective cure rate.Intraoperative,and postoperative complications were noted.

Results: There was no statistically significant difference between two groups, for the mean age of the patients, parity, duration of SUI, and the daily pad use, preoperatively (p > 0.05). Decreased UDI-6 scores, IIQ-7 scores and daily pad usage, and increased IFSF scores were found statistical significantly in each group, at the postoperative 6 th month (p < 0.05). However, VH-TOT group had higher improvement rates, on UDI-6 scores (69.5% vs 63.0%, p = 0.04). In addition, it was notable that the the rates of the patients had IFSF scores ≥ 25 was higher in VH-KP group (p = 0.05). Four (16%) patients had recurrent SUI in the VH-KP group (p = 0.039) and vaginal extrusion occurred in 2 (8%) patients in the VH-TOT group (p = 0.153), postoperatively.

Conclusions: Although the effects of VH-TOT surgery are superior to conventional methods for incontinence and quality of life; negative effects on sexual functions are notable. In addition, although recurrence rates of TOT are low, complications such as vaginal extrusion are accompanied by drawbacks of mesh usage.

Keywords: Pelvic Organ Prolapse; Urinary Incontinence; Quality of Life

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