ZusammenfassungFragestellung: Im Rahmen einer retrospektiven Studie untersuchten wir an 64 Patientinnen mittels Introitussonographie die Lage und Beweglichkeit des TVT-Bandes bei geheilten, gebesserten und bei als Therapieversager eingestuften Patientinnen. Material und Methodik: Präoperativ wurden bei allen Patientinnen zur Erfassung der Inkontinenzsymptomatik eine Anamnese, eine urodynamische Untersuchung, ein 1-Stunden-Pad-Test, ein Lebensqualitätsscore, eine gynäkologische Untersuchung mit Funktionstests und eine Introitussonographie in halbsitzender Position mit voller Blase durchgeführt. Dasselbe Untersuchungsprotokoll wurde auch postoperativ bis auf die Urodynamik eingehalten. Die TVT-Implantation wurde in der Standardtechnik in Lokalanästhesie mit Analgosedierung durchgeführt. Die Nachbeobachtungszeit betrug im Schnitt 16 Monate. Die meisten Patientinnen hatten die TVT-Implantation als alleinigen Eingriff. Lediglich 8 Patientinnen erhielten einen Kombinationseingriff. Ergebnisse: 55 (85,9%) Patientinnen waren geheilt, 6 (9,4 %) Patientinnen gebessert und 3 (4,7%) Patientinnen wurden als Therapieversager eingestuft. Bei den geheilten und teilweise auch gebesserten Patientinnen befand sich sonographisch im Mediansagittalschnitt das TVT-Band in Ruhe an der Grenze zwischen dem äuûeren zum mittleren Urethradrittel und verlief längs, d. h. parallel zur Urethra. Beim Valsalva-Manöver kam es durch die Senkung und Neigung der Harnröhre nach kaudal-dorsal zu einer ¹relativen Verschiebungª des TVT-Bandes im Bezug auf die Urethra, was zur dynamischen Stabilisierung des mittleren Abstract Purpose: We performed introital sonography on 64 patients before and after a Tension-free Vaginal Tape (TVT) operation and compared the position and mobility of the tape in cured, improved and failed patients. Methods: Before surgery all patients underwent urodynamic testing, a 1-hour pad test, quality-of-life assessment, gynecologic examination, and introital sonography in a semisitting position with a full bladder at rest and during Valsalva. The evaluation (without urodynamics) was repeated postoperatively. The TVT operation was performed with the standard technique using local anesthesia and intravenous sedation. Eight patients had concomitant procedures and 56 underwent TVT only. Results: After a mean follow-up of 16 months, 55 (86%) patients were cured, 6 (9.4 %) improved, and 3 (5%) unchanged (failed). In the cured and most of the improved patients sonography showed the tape between the outer and the middle thirds of the urethra in a longitudinal position, i.e., parallel to the urethra. During Valsalva, with descent and tilting of the urethra the tape shifted so as to support the middle third of the urethra. Simultaneously the tape assumed a more pronounced U-shape. These features were not seen in women after failed surgery. Conclusion: These results indicate that the optimal position of a TVT at rest is between the distal and middle third of the urethra and that a correctly placed tape assumes a U shape during Valsalva. The r...

Ö ÖZ ZE ET T Çocukluk çağı trombozları gün geçtikçe daha sık saptanan, morbidite ve mortalitesi yüksek bir durumdur. Venöz tromboembolizm (VTE) gelişmiş çocukların %90'ından fazlasında edinsel ve/veya kalıtsal protrombotik risk faktörü vardır. Multipl skleroz (MS), santral sinir sisteminin inflamatuar, demiyelinizan, aksonal hasar ile seyreden kronik hastalığıdır. MS hastalarında intravenöz kortikosteroidler atakların ağırlığını ve süresini kısaltmada etkili oldukları için sık kullanılmaktadır. Bu çalışmada, MS tanısı aldıktan sonra 6 ay içinde venöz tromboz ve pulmoner tromboemboli (PTE) gelişen olguya başarıyla uyguladığımız antikoagülan ve trombolitik tedavi ile profilaksi yaklaşımımız sunulmuştur.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Multipl skleroz; venöz tromboembolizm; pulmoner emboli; risk faktörü A AB BS S T TR RA AC CT T Thrombosis in children is increasingly recognized and its morbidity and mortality is high. In children, greater than 90% of venous thromboembolism (VTE) has an association with inherited or acquired prothrombotic risk factors. Multiple sclerosis (MS) is a chronic autoimmune, inflammatory neurological disease of the central nervous system, destroying the myelin and the axons to varying degrees. Intravenous corticosteroids are useful in reducing the severity and duration of relapses of multiple sclerosis. Here we present an adolescent boy with MS, VTE and pulmonary thromboembolism and we describe our successful anticoagulant and thrombolytic therapy with prophylaxis.K Ke ey yw wo or rd ds s: : Multiple sclerosis; venous thromboembolism; pulmonary embolism; risk factor