골반장기 탈출증 환자의 복식 천골질고정술 수술 후 발생하는 배뇨장애 예측인자

Abstract

OBJECTIVE: Although there were many studies about postoperative voiding dysfunction after anti-incontinence operation, little studies after pelvic organ prolapse operation were published. We sought to determine risk factors for voiding dysfunction (VD) after abdominal sacrocolpopexy (ASC). METHODS: ASC was performed on 89 women at Yonsei University Health System from January 2007 to December 2009. VD was defined as post void residual (PVR)>150 mL. Foley catheter was removed after the third or forth postoperative day (POD). Risk factors for VD were examined using logistic regression models. RESULTS: Seventeen patients (19.1%) had VD. Total abdominal hysterectomy (TAH) was performed on 70.8%, transobturator tape (TOT) on 55.1% concomitantly. There was no significant difference in age (mean+/-standard deviation [SD], 59.9+/-12.8 vs. 62.7+/-8.1 yr), parity (mean [range], 3 [1-5] vs. 3 [1-8]), body mass index (mean+/-SD, 24.0+/-2.7 vs. 24.4+/-3.6), TAH (70.6% vs. 70.8%), TOT (52.9% vs. 55.6%) and pelvic organ prolapse quantification stage 4 (94.1% vs. 68.1%, P-value 0.057). There was significant difference in diabetes mellitus (29.4% vs. 9.7%, odds rations [OR]: 3.87 [95% confidence intervals, CI: 1.05-14.23]) and the day of foley removal (POD 4: 47.1% vs. 13.9%, OR: 5.51 [95% CI: 1.72-17.64]). There was no significant difference in urodynamic parameters including maximal capacity, urethral closure pressure, maximal flow rate, mean flow rate, post void residual except detrusor pressure at maximal flow rate (Pdet at Qmax), (13+/-8 vs. 23+/-15, per 10 cm H20, OR 0.54 [95% CI: 0.31-0.95]). In the multiple logistic regression model, only Pdet at Qmax OR 0.94 (95% CI: 0.89-0.99) remained statistically significant. CONCLUSION: Women with lower Pdet at Qmax are more likely to have VD after ASC.