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.

Schlüsselwörter

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

Key words

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

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