Urge inkontinans hastalarında vajinal retroperitoneal uterosakral plikasyon

Aim: The primary aim of this study is to evaluate the effect of vaginal uterosacral plication on incontinence and quality of life in patients with uterosacral ligament insufficiency, stage I prolapse according to POP-Q score and urge incontinence symptoms.Materials and Methods: Patients presenting to the outpatient clinic of our hospital with complaints of overactive bladder were assessed.The Overactive Bladder Assessment Form (OAB-V8), Female Sexual Function Index (FSFI), Urinary Distress Index Short Form (UDI-6), Pelvic Floor Impact Questionnaire Short Form 7 (PFIQ-7), and Incontinence Impact Questionnaire Short Form (ICIQ-SF) were completed. Patients with a history of unsuccessful anticholinergic use and pelvic floor muscle therapy were selected. In patients with stage I prolapse according to the POP-Q classification and overactive bladder symptoms, the posterior fornix was supported with gauze to observe symptom improvement. Patients who experienced a reduction or complete resolution of symptoms like urinary incontinence, nocturia, and urge incontinence, and were diagnosed with uterosacral ligament insufficiency, were offered surgery. To achieve a permanent effect, vaginal retroperitoneal uterosacral plication was performed on patients who accepted surgery. A 3 cm horizontal incision was made behind the cervix, the uterosacral ligaments were located without opening the peritoneal cavity, clamped with Allis clamps, and then sutured together at two levels with 2-0 Ethibond sutures. The 6-month postoperative results of 7 patients are summarized in this report.Results: The average age of the patients was 41.1 years, and the average body mass index (BMI) was 35.5. The mean UDI-6 score decreased from 15.8 to 6.28, the mean OAB-V8 score decreased from 32.66 to 13.7, and the mean ICIQ-SF score decreased from 15.3 to 6.85. There was no change in the FSFI scores, but a slight decrease was observed in the PFIQ-7 scores. No surgical complications were observed in any patient.Conclusion: This report contributes to the clinical evidence that uterosacral ligament reinforcement can improve symptoms of overactive bladder syndrome in short-term, such as urge incontinence and nocturia (1-4). Patient-reported outcomes and apical tampon testing are important for proper patient selection. This surgical technique appears promising as a method with a short operation time, low complication risk, and can even be performed with regional anesthesia.