복압성 요실금 수술시 tension-free vaginal tape의 치료 성적 : 요도 괄약근 부전증 환자와 비요도 괄약근 부전증 환자의 비교

Abstract

Objective: The object of this study is to compare treatment outcomes of tension free vaginal tape (TVT) for intrinsic sphincter deficiency (ISD) and non-intrinsic sphincter deficiency (NISD) patients in stress urinary incontinence (SUI), and to evaluate whether TVT can be effectively used in both groups of SUI patients. Methods: 111 women with SUI treated by TVT at the Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, the Yonsei Medical Center from Jun. 2003 to Jun. 2005 were included in this study. The patients were divided into two groups; 31 patients with ISD, and 80 patients with NISD. SUI was diagnosed according to the result of urodynamic tests. Urodynamic studies (UDS) include uroflowmetry, multi-channel cystometry and urethral pressure profilometry. The Patients were followed up at 1, 3, 6, and 12 months postoperatively, and those with any follow-up loss were excluded from this study. Results: There were no significant differences found in demographics between ISD and NISD groups; mean age, parity, BMI, menopausal status and HRT (P>0.05). Maximum urethral closure pressure (MUCP)(46.8124.29 vs.75.7±32.61 cmH2O; P<.0001) and Vasalva leak-point pressure (VLPP)(53.48±10.12 vs 107.23±42.95 cmH2O; P<0.0001) showed significant difference between the two groups. However, other parameters of UDS except MUCP and VLPP showed no statistical difference. The cure rates of the two groups at 1 month follow up (87.0% vs 100%; p=0.0053) showed significant difference. No significant differences were found at 3, 6 and 12 months. There were no differences in postoperative complication rate (voiding difficulty, de novo urgency, urinary tract infection) between two groups irrespective of follow-up months. Conclusion: Tension-free vaginal tape is effective for stress urinary incontinence in both ISD and NISD patients.