복압성요살금 환자에서 임상적 특성에 따른 요누출점압, 최대요도폐쇄압 과 기능적 길이에 관한 연구

Abstract

Objective : The aim of this study is to evaluate the relationship of leak point pressure, maximal urethral closure pressure and functional urethral length to clininal characteristics - age, weight, number of vaginal delivery, history of hysterectomy and existence of estrogen(for postmenopause, whether HRT is done or not) in stress urinary incontinence patients. Methods : The study is included 320 patients with stress urinary incontinence patients who were diagnosed by urodynamic study at the Department of Obstetrics and Gynecology, Yonsei University College of Medicine from Mar. 1999 to Feb. 2003. We compared leak point pressure, maximal urethral closure pressure and functional urethral length by investigating age, weight, number of vaginal delivery, history of hysterectomy and existence of estrogen(for postmenopause, whether HRT is done or not). The patients with medical or surgical treatment history for urinary incontinence or having treatment of urinary incontinence at the time diagnosed was excluded from the study. In statics, Two sample t-test, Chi-Square test and ANOVA analysis were used. Pearson correlation was used to compare the correlations between each variables. Pvalue was considered significant at less than 0.05. Results : The study was perfomed for 320 patients, 7 patients were excluded by the standard value. Mean age of 313 patients were 55.0yrs(30~76yrs), mean weight 58.5kg (32~79kg) and mean number of vaginal delivery were 3.1(0~7). 47 patients(15%) were hysterectomy status, 122(39.0%) were premenopause or having HRT. Mean value of leak point pressure wase 83.6( ± 15.8)cmH2O, mean vaue of maximal urethral closure pressure was 62.8( ±18.6)cmH2O and mean value of functional urethral length was 3.7( ±.5)cm. 22 patients(7.0%) were leak point pressure ＜60 cmH2O and diagnosed as Intrinsic sphincteric deficiency. No patient was maximal urethral closure pressure ＜20 cmH2O in this study. There was no significant correlation between leak point pressure and clinical characteristics. Maximal urethral closure pressure was related to number of vaginal delivery, only one in clinical characteristics. Number of vaginal delivery increases, maximal urethral closure pressure decreases(r=0.12, p=0.03). Functional urethral length was increased with the presence of estrogen in clinical characteristics (r=0.02, p=0.04). Conclusion : Only number of vaginal delivery and presence of estrogen were weakly related to maximal urethral closure pressure and functional urethral length, Others did not showed the relations about clinical characteristics. According to our study, to predict the prognosis of stress urinary incontinence through only using the patient's clinical characteristics would be not accurate.