intermittent self-dilatation for urethral stricture disease in males
TRANSCRIPT
![Page 1: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/1.jpg)
![Page 2: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/2.jpg)
Tanım Uretral darlık; anterior üretra etrafındaki spongioz
dokunun skar formasyonu sonrası oluşan kontraktürüdür.
Uretrayı zedeleyen herhangi bir proçes üretral darlığa sebep olabilir
Gelişmiş ülkelerde 1/3 oranda idiopatik iken bilinen nedenler arasında kateterizasyon/endoskopik cerrahi
Gelişmekte olan ülkelerde ise CYBH ile beraber pelvik travma major etyolojik faktördür.
![Page 3: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/3.jpg)
Louritzen ve ark. 2009 yılında yaptığı bir çalışmaya göre ilk endoskopik üretrotomi sonrası striktürgelişme insidansı %25-89 arasında değişmektedir.
Darlık lokalizasyonu ve uzunluğuna bağlı olarak
![Page 4: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/4.jpg)
İntermittant self dilatasyon (ISD) çubuk şeklindeki bir kateterin belli aralıklarla hastanın kendisinin üretrayıgeçerek uyguladığı bir yöntem
Sterilizasyon ve atravmatizasyon sağlamak amacıyla lubrikasyonun yeterli olması önemli
Bu zorluklarından dolayı bir eğitmen (dr/hemş) eşliğinde öğretilmesi gereken bir olgu
![Page 5: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/5.jpg)
Derlemenin amacı; üretra darlıklarında ISD’nunfaydasını açık operasyon veya endoskopik yöntemler karşısındaki yerini belirlemek
![Page 6: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/6.jpg)
Metodoloji En az bir kolunda ISD içeren RKÇ’lar derlenip bir
meta-analiz yapılmış.
Mesane boşaltılması amacıyla kullanılan kateterizasyon çalışmalara dahil edilmemiş
Hasta grubu
Erkek ( Geniş yaş aralığı)
Darlıklar etyoloji, uzunluk veya lokalizasyon bağımsız
![Page 7: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/7.jpg)
3 veri karşılaştırılmış ISD vs takip
Kateterizasyon/Program süresi
Araç (PVC Nelaton polyvinyl kateter / Hidrofilik kateterlerLoFric)
Primer sonuçlar Darlık rekürens riski
AÜSS (PROM* skorlaması)
QoL***Patient-reportedoutcome**Quality of life
![Page 8: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/8.jpg)
Sekonder sonuçlar ÜSE, travma, hospitalizasyon
Uyum
Kost-effektivite
![Page 9: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/9.jpg)
![Page 10: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/10.jpg)
6 çalışmada üretrotomi intern sonrası ISD vs takip karşılaştırılması yapılmış
Afridi 2010, Bodker 1992, Husmann 2006, Khan 2011, Kjaergend1994, Metankelie 1995
2 çalışmada dilatasyon programları arasında karşılaştırma yapılmış
Harriss 1994, Tommela 1993
2 çalışmada kateter tipleri karşılaştırılmış Husseini 2008, Sellami 2011
![Page 11: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/11.jpg)
Kaisary 1985 Şu an kullanılmayan ISD aracı kullanımı nedeniyle
Tunc 2002 Hastalara dilatasyonu bizzat cerrah yaptığı nedeniyle
Meta analize dahil edilmemiş
![Page 12: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/12.jpg)
2/11 2 çalışmada yeterli randomizasyon
0/11 Hiçbir çalışmada hasta dağılımı homojen değil
1/11 Sadece bir çalışma çift kör
![Page 13: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/13.jpg)
![Page 14: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/14.jpg)
![Page 15: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/15.jpg)
![Page 16: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/16.jpg)
![Page 17: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/17.jpg)
![Page 18: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/18.jpg)
![Page 19: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/19.jpg)
![Page 20: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/20.jpg)
![Page 21: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/21.jpg)
![Page 22: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/22.jpg)
![Page 23: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/23.jpg)
![Page 24: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/24.jpg)
![Page 25: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/25.jpg)
![Page 26: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/26.jpg)
![Page 27: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/27.jpg)
![Page 28: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/28.jpg)
![Page 29: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/29.jpg)
![Page 30: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/30.jpg)
![Page 31: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/31.jpg)
![Page 32: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/32.jpg)
![Page 33: Intermittent self-dilatation for urethral stricture disease in males](https://reader030.vdocuments.mx/reader030/viewer/2022032616/55a5e7511a28abb6128b4586/html5/thumbnails/33.jpg)