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여성 복압성 요실금 환자에서 TVT 술식 후 발생한 배뇨곤란의 Hegar 확장기를 이용한 치료경험
문형윤,노준,김철성,장대수,조원진,임동훈,백승 대한배뇨장애요실금학회 2005 International Neurourology Journal Vol.9 No.1
The tension-free vaginal tape procedure (TVT) has become a state of the art operation for female stress urinary incontinence. The most common problems after the TVT seen are voiding difficulties. Although the incidence of urinary retention appears to be low after the TVT procedure, it is recommended that patients be counseled about the risk and carefully monitored for voiding symptoms during the first 3 weeks postoperatively. When obstruction after the TVT is clinically evident, immediate tape adjustment in the operating room by open vaginal incision, may be indicated. We report of voiding difficulty 8 weeks after the TVT who was successfully managed with urethral dilation. (J. Korean Continence Society 2005;9:46-48)
여성 복압성 요실금 환자에서 IRIS 술식의 효용성 : TVT 및 SPARC 술식과의 비교
김지윤,정희창 대한배뇨장애요실금학회 2006 International Neurourology Journal Vol.10 No.2
Purpose: To compare IRIS procedure with TVT and SPARC in the treatment of female stress urinary incontinence (SUI). Materials and Methods: Among 96 patients with SUI who underwent sling procedure, we retrospectively compared IRIS procedure (n=34) to TVT (n=32) and SPARC (n=30). All patients were evaluated preoperatively with a detailed history, pelvic examination, voiding cystourethrography, urodynamic study and incontinence staging with SEAPI classification. Parameters of comparison included presence of stress incontinence, length of hospital stay, duration of catheterization, operation time, complication, success rate and satisfaction rate. Results: The success rates were 97%, 96.9% and 96.7% in the IRIS, TVT and SPARC group, respectively. The satisfaction rates were 94.1%, 96.9% and 96.6% in the IRIS, TVT and SPARC group. The complication rates were 23.5%, 21.8% and 23.3% in the IRIS, TVT and SPARC group. There was no statistically significant difference among the 3 groups in terms of success rates, satisfaction rates, complication rates, and postoperative subjective SEAPI scores. Conclusion: IRIS procedure was equally effective compared to conventional mid urethral sling procedure such as TVT and SPARC in the management of female SUI with high cure rates and acceptably low complication rates. (J. Korean Continence Society 2006;10:126-131)
과민성 방광모델로서 자연발생 고혈압 쥐에서 비마취하 요역동학 검사로 관찰한 항콜린성 제제인 tolterodine의 배뇨 압력 및 용적에 대한 경구 및 주사 효과
이소영,권용현,윤상민,진롱후,장진혁,강용진,이택 대한배뇨장애요실금학회 2009 International Neurourology Journal Vol.13 No.2
Purpose: We investigated the effect of oral or intravenous tolterodine on cystometric parameters in awake spontaneously hypertensive rats (SHRs) as a model of overactive bladder (OAB). The aim of our study was to observe the experimental conditions required to reproduce the clinical pharmacological effects of tolterodine, as seen in humans, to decrease bladder pressure or increase bladder capacity. Materials and methods: We studied the effects of the most widely used antimuscarinic drug, tolterodine, on cystometric parameters via two different administrations (oral and intravenous) in awake SHRs. Results: Oral administration of tolterodine 10 mg/kg-1 body weight in awake rats did not change any cystometric parameters significantly. Intravenous administration of tolterodine 0.3 mg/kg-1 body weight significantly decreased basal pressure (BP) and micturition pressure (MP), but showed no effect on micturition interval (MI) or bladder capacity (BC). Conclusion: Despite a high dose of tolterodine via an oral or an intravenous route, a decrease in BP or MP was the only effect on cystometrographic parameters in awake rats, whereas MI and BC were not significantly affected. Therefore, it is difficult to reproduce in awake rats as an acute response the cystometric increase in the MI that is observed in humans after chronic administration of antimuscarinic agents.
비신경인성 여성 배뇨장애환자에서 4주간의 Doxazosin GITS의 효용성과 안정성: 단기 추적 결과
이규성,서주태,주명수,김준철,한덕현,김지영,정진우,추설호 대한배뇨장애요실금학회 2008 International Neurourology Journal Vol.12 No.1
Purpose: We administered doxazosin gastrointestinal therapeutic system (GITS) to women with non-neurogenic voiding dysfunction to evaluate its therapeutic effects. Materials and Methods: Women who had voiding dysfunctions for at least 3 mo were included. Inclusion criteria were age ≥18yr, an International Prostate Symptom Score (IPSS) ≥15, and a maximum flow rate (Qmax) <15mL/sec and/or postvoid residual (PVR) ≥150mL. Patients with neurogenic voiding dysfunction or anatomical bladder outlet obstruction were excluded. All patients were classified according to the Blaivas-Groutz nomogram. After 4 weeks, treatment outcomes were evaluated. Results: Sixty-two patients were evaluated of mean age 53.8 (32-78)yr. According to the Blaivas-Groutz nomogram, 24 patients had no or mild obstruction (group A) and 38 had moderate or severe obstruction (group B). After treatment, mean IPSS decreased significantly and by more than 5 points in 42 (67.7%). Mean bother scores, Qmax, and PVR also changed significantly. Thirty-seven (59.7%) showed Qmax increases of more than 50%. No significant difference were observed between the groups in terms of IPSS, bother score, Qmax, PVR, micturition frequencies, or functional bladder capacity changes. Adverse effects related to medication were de novo stress urinary incontinence (SUI) (1 case) and underlying SUI aggravation (1 case). By satisfaction assessments, 16 patients (25.8%) were 'mainly satisfied', 31 (50%) were 'slightly satisfied', and 15 (24.2%) were 'dissatisfied'. Conclusion: Doxazosin GITS was found to be effective in female patients with voiding dysfunction regardless of obstruction grade. The α-adrenoceptor antagonists should be viewed as initial treatment option for women with a non-neurogenic voiding dysfunction. (J Korean Continence Soc 2008;12:19-26)
Tension-free Vaginal Tape (TVT)수술 후 발생한 배뇨곤란에서 시행한 테이프 절단에 대한 연구
이동환,김준철,이지열,서홍진 대한배뇨장애요실금학회 2005 International Neurourology Journal Vol.9 No.1
Purpose: Tension-free vaginal tape (TVT) procedure is widely used as an initial operative method in stress urinary incontinence because of high success rate and low morbidity. However, some patients have complained of voiding difficulties after TVT. We evaluated 14 patients who underwent mesh cutting because of obstructive symptoms after TVT. Materials and Methods: 14 patients who underwent mesh cutting because of prolonged obstructive symptoms after TVT were included for the study. Their voiding symptoms were evaluated by Qmax, voiding time and postvoid residual urine. These parameters which were done before TVT, post-TVT and post-mesh cutting were compared. Results: 4 out of 14 patients were intrinsic sphincter deficiency (valsalva leak point pressure <60 cmH2O) and no patient had detrusor overactivity before TVT. After TVT, Qmax was decreased from 25.4±3.5 ml/sec to 9.4±2.4 ml/sec, and voiding time was prolonged from 26.7±6.6 sec to 65.5±24.8 sec. However, the volume of postvoid residual urine was unchanged. After mesh cutting, Qmax was increased to 21.7±7.7 ml/sec and voiding time was decreased to 27.2±7.6 sec. Subjective voiding symptoms were improved immediately in 13 out of 14 patients (92.9%), although 1 patient showed small amount of urine leakage when coughing. And also, in 1 out of 2 patients, detrusor overactivity which was shown after TVT was disappeared. Conclusion: We believe that we do not need to hesitate to cut the mesh in patients who are suffering from severe obstructive symptoms after TVT. (J. Korean Continence Society 2005;9:13-16)
여성 복압성요실금 환자에서 수술적 치료 후 발생한 배뇨장애의 치료
한동석,나용길,김홍식,설종구,길건,신주현,소성민,육승모,김용웅,임재성 대한배뇨장애요실금학회 2005 International Neurourology Journal Vol.9 No.1
Purpose: We studied the voiding dysfunction after surgical treatment of female stress urinary incontinence and diagnosis and treatment. Materials and Methods: Three hundred women with stress urinary incontinence underwent surgical procedure between January 1998 and December 2004. Ninety two patients (30.6%) experienced the postoperative voiding dysfunction. As the primary procedure for the management of postoperative voiding dysfunction alpha-blockers medication and clean intermittent catheterization (CIC) were performed. Then, hegar dilation and urethral pull-down procedure were performed as a secondary measure. For the patients who showed persistent obstructed symptoms, cutting of mesh or sling materials were performed. Results: In 57 patients, symptoms improved by alpha-blockers medication and CIC. The others were received hegar dilation and urethral pull-down procedure, and 29 patients were improved. 6 patients were not controlled by conservative treatment, of which 3 patients underwent cutting of mesh or sling. De novo urgency was developed in 12 patients. Anticholinergics were taken, symptoms were diminished in 10 patients after 5 months of medication. Conclusion: Most voiding dysfunction after surgery may be effectively managed by conservative treatment. In cases of failure, hegar dilation and urethral pull-down procedure may be useful within postoperative first weak. Finally, cutting of mesh or sling must be considered in patient whose the secondary measure is failed. (J. Korean Continence Society 2005;9:40-45)
배뇨근과활동 및 수축력장애를 동반한 전립선비대증 환자에서 경요도전립선절제술의 치료 효과
조희주,강정윤,정정윤,유탁근,우제형 대한배뇨장애요실금학회 2005 International Neurourology Journal Vol.9 No.2
Purpose: Detrusor hyperactivity with impaired contractility (DHIC) can be found in many elderly patients with benign prostatic hyperplasia (BPH). It is hard to expect the efficacy of transurethral resection of prostate (TURP) on such patients. Therefore, we retrospectively estimated the effect of TURP on BPH patients with DHIC. Materials and Methods: Eighteen male patients with BPH and DHIC were underwent TURP. Through urodynamic studies, DHIC was identified. Findings of bladder outlet obstruction were evaluated with TRUS and/or diagnostic cystoscopy in all patients. They were requested to go through uroflowmetry and international prostate symptom score (IPSS), before and after TURP. The subjective satisfaction scale was measured after TURP. Results: Total IPSS (from 20.6 to 12.5), obstructive symptom score (from 11.5 to 6.0), and maximal flow rate (from 6.0 ml/sec to 14.6 ml/sec) of the patients were improved significantly (p<0.05) after TURP. Storage symptom score (from 9.0 to 6.3) got better, but the improvement was not statistically significant (p>0.05). Only 2 (12%) of the patients were unsatisfied with the outcomes of TURP. Conclusion: We suggest that TURP can be used as a good therapeutic option for selected patients with BPH accompanied with DHIC. (J. Korean Continence Society 2005;9:135-138)