골반장기탈출증을 동반한 복압성 요실금에서 tension-free vaginal tape (TVT)과 transobturator tape (TOT)의 치료 성적 비교

Abstract

Objective: To compare tension-free vaginal tape (TVT) and transobturator tape (TOT) for surgical treatment of stress urinary incontinence (SUI) associated with pelvic organ prolapse (POP). Methods: Two hundred seventy eight consecutive patients affected by SUI associated with POP more than stage II were included in this retrospective study. Cure rate and postoperative complications such as hemoglobin difference between preoperative and postoperative period, vaginal hematoma, bladder and bowel injury, vaginal mesh erosion, urinary retention, de novo urgency, urinary tract infection were compared. Student`s t-test and chi square test were used for statistical analysis. A P-value below 0.05 was considered statistically significant. Results: The number of patients underwent TVT was 145 and TOT was 133. All patients were followed up for more than 12 months. The general characteristics of patients showed no significant difference between the two groups. There was no difference between two groups in cure rate. However, hemoglobin difference (TVT, 2.91±0.93 g/dL; TOT, 1.53±0.77 g/dL; P=0.04) was higher in TVT group than TOT group and urinary retention within 1 month (TVT, 35.17%; TOT, 21.05; P=0.02), and urinary tract infection (TVT, 11.72%; TOT, 3.75%; P=0.02) more frequently appeared in TVT group than TOT group. Other postoperative complications such as vaginal hematoma (TVT, 6.89%; TOT, 6.76%; P=0.86), bowel injury (TVT, 0%; TOT, 1.5%; P=0.64), vaginal mesh erosion (TVT, 7.58%; TOT, 4.51%; P=0.47), urinary retention after 1 month (TVT, 2.76%; TOT, 3.00%; P=0.35), de novo urgency (TVT 7.58%, TOT: 6.01%, P=0.48) were not different between two groups. Conclusion: Both procedures appear to be equally effective in the surgical treatment of SUI associated with POP. However, TOT seems to be a more safe procedure in postoperative complications