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S94 FROZEN HIP AND TRANSOBTURATOR TAPE
S93
Depression in primary nocturnal enuresis
Arikan Dr. Cigli State Hospital, Dept. of Urology, Izmir, Turkey Introduction & Objectives: Dissatisfaction with life before the admission in children with primary nocturnal enuresis and the treatment and the response to the treatment were assessed. Material & Methods: 86 patients with primary nocturnal enuresis were assessed between June 2009 and June 2012. 21 girls and 65 boys attended. The mean age of the patients was 8.2 (6-17). Urine analysis, uroflowmetry, miction diary for two days, IBSS questioning form and the form of depression scale for children were given in the first meeting with children. Average IBBS of the children was found 12.09. Diurnal enuresis was also present in a total of 40 children. Results: A depression scale constituted by 27 questions was used. The answers to the questions were graded as 0-1-2. A questionnaire form organized for children by Kovascs and based on the Beck scale was used. The scale was filled up while it was read by the children under the surveillance of their parents or read by their parents. Scores higher than 19 were accepted as pathological result. While mean depression score of the children was found 11.5, mean scores were 12.8 and 11.1 in girls and boys successively. First an alarm treatment was recommended for the children, however due to the social reasons 7 patients were followed up under the alarm treatment. Oral Desmopressin lyophilisate was given to the rest of the children. After the treatment, at the 3th month follow up, while this score was 4.6 for all of the children, it was determined 4.6 in girls and 4.1 in boys. Conclusions: Even primary nocturnal enuresis is a condition that increases dissatisfaction with life, for a strong construction in the future of these children whose mental constructions newly begin, both family consciousness and treatment are necessary. Conclusions: The data obtained and summarized confirm already published opinion on the isolated uropathogens. The difference in resistance in same uropatogens and their polyresistance are due to prolonged catheterization of the patients in the surgical clinic. These data can be used as a guideline to define the antibiotic therapy, when a particular pathogen is registered.
S92
Transobturator tape fears
Arikan Dr. Cigli State Hospital, Dept. of Urology, Izmir, Turkey Introduction & Objectives: The complications that developed during and after the operation in patients who underwent a transobturator tape procedure in consequence of stress urinary incontinence, were examined. Material & Methods: Transobturator tape procedure was applied to a total of 384 patients between June 2009 and June 2012. The mean age of the patients was 58 (32-77). Concurrently, the reduction of Labia minora was performed in 51 patients, a cystocele operationwas performed in 13 patients and a rectocele operation was performed in 3 patients. TOT application was performed with a handle movement from outside to inside. Bladder was emptied before the procedure. During the operation, a cystoscopy was not performed unless it was required. Results: Hematuria was observed only in 4 patients after the mesh implantation and a following cystoscopy was performed in these cases. No bladder perforation was observed. An eroded area was determined. During the passage of the handle urine, leakage into the lodge was observed in 2 patients. All of the injuries developed during the right passage. Of the two perforation injuries, one injury developed 14 months ago and the other developed 10 days ago. Injury of the vaginal vault occurred in 34 patients, primary repair was applied only to 4 patients after the mesh implantation, the others were left to heal secondary. No cauterization or ligation because of a bleeding was applied to any patient. Regardless to the level of bleeding, the incision line was primarily sutured after the implantation of the mesh. No vaginal wall erosion developed due to the mesh. No postoperative bleeding was observed. Vaginal tampon was forgotten in 5 patients postoperatively. 3 of them fell spontaneously, 1 was pulled out by a gynecologist and one was pulled out by myself in the 1 week’s follow up examination. Postoperative application of Cefuroxime and hydration with 3 lt of fluid were made obligatory. The two of the last 120 patients, developed a postoperative urinary tract infection. Postoperative perianal cellulitis was observed in 1 patient and regressed with antibiotic administration. While the complaint of incontinence was not affected in 4patients, the application was performed again in two of them, however the result didn’t change. Conclusions: Transobturator tape application is a safe, effective procedure with a low complication rate in women with stress urinary incontinence.
Eur Urol Suppl 2012;11(4):156
S94
Frozen hip and transobturator tape
Arikan Dr. Cigli State Hospital, Dept. of Urology, Izmir, Turkey Introduction & Objectives: On can experience cases whose hip range of motion in lithotomy position could not be adequately provided due to a hip prosthesis application or a different cause. The TOT procedure may be considered as a risky procedure that makes the applicability limits difficult, in such conditions. Material & Methods: 34 years old patient applied for the complaint of stress urinary incontinence. Her history revealed a bilateral congenital hip dislocation that had been diagnosed when she was 7, then an operation of bilateral hip acetabulum was performed. 10 years ago she also underwent an operation for bilateral hip replacement , during this period of time, she received physical therapy regularly and her social life continued without any problem. In her history, the patient who had 2 gravidities those ended with cesarian section, had the complaint of incontinence after her first pregnancy. The patient applied to our clinic for the complaint of incontinence that increases as days pass. Her gynecologic examination was positive for a urethral hypermobility, no cystocele nor rectocele was observed. Her examination revealed the narrowness of the hip joint and in order to understand if this narrowness would cause any problem during the operation , a pelvic AP graphy was performed. When the patient was lying in supine position, the hip was flexed and the angle was measured 87 degreesDuring the operation, the hip joint was not forced to open wider than its normal range of motion . After emptying the bladder through a urethral catheter, an injection of serum physiologic was applied to the anterior vaginal wall in order to facilitate the dissection. Handle entrance points were bilaterally determined from the inguinal line to 1 cm lateral to clitoris. A handle movement from outside to inside was preferred due to the surgical habitude. The handle could pass easily to the level of the obturator fascia however a restriction developed in the turn of ischiopubic ramus. In order to complete the movement, the handle was provided to exit from the vagina with little movements. Results: No complication was observed during the operation. Cystoscopy that was performed during the operation didn’t reveal any extraordinary image within the bladder or urethra. A vaginal tampon was inserted and the patient was transported to the clinic after the insertion of a urethral catheter. The vaginal tampon and urethral catheter were pulled out in the first day after the surgery and the patient was discharged from the hospital. In the follow up examination in the postoperative first month, hip pain was not observed and a complete continence was provided. No pathological finding was observed in the gynecologic examination. Conclusions: In cases whose adequate hip range of motion could not be provided in lithotomy position due to this kind of hip prosthesis or a frozen hip, TOT can appear as a procedure risky and difficult to apply. The application of the handle entrance from inside to outside seems to be more operable than the application from outside to inside. Besides, in these cases, the completion of the turn by the handle itself while the hand is in a fixed position seems as a movement easier than the completion of the turn of the handle by the wrist.
Depression in primary nocturnal enuresis
Arikan Dr. Cigli State Hospital, Dept. of Urology, Izmir, Turkey Introduction & Objectives: Dissatisfaction with life before the admission in children with primary nocturnal enuresis and the treatment and the response to the treatment were assessed. Material & Methods: 86 patients with primary nocturnal enuresis were assessed between June 2009 and June 2012. 21 girls and 65 boys attended. The mean age of the patients was 8.2 (6-17). Urine analysis, uroflowmetry, miction diary for two days, IBSS questioning form and the form of depression scale for children were given in the first meeting with children. Average IBBS of the children was found 12.09. Diurnal enuresis was also present in a total of 40 children. Results: A depression scale constituted by 27 questions was used. The answers to the questions were graded as 0-1-2. A questionnaire form organized for children by Kovascs and based on the Beck scale was used. The scale was filled up while it was read by the children under the surveillance of their parents or read by their parents. Scores higher than 19 were accepted as pathological result. While mean depression score of the children was found 11.5, mean scores were 12.8 and 11.1 in girls and boys successively. First an alarm treatment was recommended for the children, however due to the social reasons 7 patients were followed up under the alarm treatment. Oral Desmopressin lyophilisate was given to the rest of the children. After the treatment, at the 3th month follow up, while this score was 4.6 for all of the children, it was determined 4.6 in girls and 4.1 in boys. Conclusions: Even primary nocturnal enuresis is a condition that increases dissatisfaction with life, for a strong construction in the future of these children whose mental constructions newly begin, both family consciousness and treatment are necessary. Conclusions: The data obtained and summarized confirm already published opinion on the isolated uropathogens. The difference in resistance in same uropatogens and their polyresistance are due to prolonged catheterization of the patients in the surgical clinic. These data can be used as a guideline to define the antibiotic therapy, when a particular pathogen is registered.
S92
Transobturator tape fears
Arikan Dr. Cigli State Hospital, Dept. of Urology, Izmir, Turkey Introduction & Objectives: The complications that developed during and after the operation in patients who underwent a transobturator tape procedure in consequence of stress urinary incontinence, were examined. Material & Methods: Transobturator tape procedure was applied to a total of 384 patients between June 2009 and June 2012. The mean age of the patients was 58 (32-77). Concurrently, the reduction of Labia minora was performed in 51 patients, a cystocele operationwas performed in 13 patients and a rectocele operation was performed in 3 patients. TOT application was performed with a handle movement from outside to inside. Bladder was emptied before the procedure. During the operation, a cystoscopy was not performed unless it was required. Results: Hematuria was observed only in 4 patients after the mesh implantation and a following cystoscopy was performed in these cases. No bladder perforation was observed. An eroded area was determined. During the passage of the handle urine, leakage into the lodge was observed in 2 patients. All of the injuries developed during the right passage. Of the two perforation injuries, one injury developed 14 months ago and the other developed 10 days ago. Injury of the vaginal vault occurred in 34 patients, primary repair was applied only to 4 patients after the mesh implantation, the others were left to heal secondary. No cauterization or ligation because of a bleeding was applied to any patient. Regardless to the level of bleeding, the incision line was primarily sutured after the implantation of the mesh. No vaginal wall erosion developed due to the mesh. No postoperative bleeding was observed. Vaginal tampon was forgotten in 5 patients postoperatively. 3 of them fell spontaneously, 1 was pulled out by a gynecologist and one was pulled out by myself in the 1 week’s follow up examination. Postoperative application of Cefuroxime and hydration with 3 lt of fluid were made obligatory. The two of the last 120 patients, developed a postoperative urinary tract infection. Postoperative perianal cellulitis was observed in 1 patient and regressed with antibiotic administration. While the complaint of incontinence was not affected in 4patients, the application was performed again in two of them, however the result didn’t change. Conclusions: Transobturator tape application is a safe, effective procedure with a low complication rate in women with stress urinary incontinence.
Eur Urol Suppl 2012;11(4):156
S94
Frozen hip and transobturator tape
Arikan Dr. Cigli State Hospital, Dept. of Urology, Izmir, Turkey Introduction & Objectives: On can experience cases whose hip range of motion in lithotomy position could not be adequately provided due to a hip prosthesis application or a different cause. The TOT procedure may be considered as a risky procedure that makes the applicability limits difficult, in such conditions. Material & Methods: 34 years old patient applied for the complaint of stress urinary incontinence. Her history revealed a bilateral congenital hip dislocation that had been diagnosed when she was 7, then an operation of bilateral hip acetabulum was performed. 10 years ago she also underwent an operation for bilateral hip replacement , during this period of time, she received physical therapy regularly and her social life continued without any problem. In her history, the patient who had 2 gravidities those ended with cesarian section, had the complaint of incontinence after her first pregnancy. The patient applied to our clinic for the complaint of incontinence that increases as days pass. Her gynecologic examination was positive for a urethral hypermobility, no cystocele nor rectocele was observed. Her examination revealed the narrowness of the hip joint and in order to understand if this narrowness would cause any problem during the operation , a pelvic AP graphy was performed. When the patient was lying in supine position, the hip was flexed and the angle was measured 87 degreesDuring the operation, the hip joint was not forced to open wider than its normal range of motion . After emptying the bladder through a urethral catheter, an injection of serum physiologic was applied to the anterior vaginal wall in order to facilitate the dissection. Handle entrance points were bilaterally determined from the inguinal line to 1 cm lateral to clitoris. A handle movement from outside to inside was preferred due to the surgical habitude. The handle could pass easily to the level of the obturator fascia however a restriction developed in the turn of ischiopubic ramus. In order to complete the movement, the handle was provided to exit from the vagina with little movements. Results: No complication was observed during the operation. Cystoscopy that was performed during the operation didn’t reveal any extraordinary image within the bladder or urethra. A vaginal tampon was inserted and the patient was transported to the clinic after the insertion of a urethral catheter. The vaginal tampon and urethral catheter were pulled out in the first day after the surgery and the patient was discharged from the hospital. In the follow up examination in the postoperative first month, hip pain was not observed and a complete continence was provided. No pathological finding was observed in the gynecologic examination. Conclusions: In cases whose adequate hip range of motion could not be provided in lithotomy position due to this kind of hip prosthesis or a frozen hip, TOT can appear as a procedure risky and difficult to apply. The application of the handle entrance from inside to outside seems to be more operable than the application from outside to inside. Besides, in these cases, the completion of the turn by the handle itself while the hand is in a fixed position seems as a movement easier than the completion of the turn of the handle by the wrist.