한국 농촌 지역 여성에 있어서 복압성요실금과 방광 자극 증상에 관한 역학 조사

주명수,정태규,이재원,김홍식,정상욱,박종연,박태한 大韓泌尿器科學會 1999 Korean Journal of Urology Vol.40 No.9

Changes in Sexual Function after Mid-Urethral Tape Sling Operations for Stress Urinary Incontinence in Korean Women

이병희,김성대,조용현,김세웅,손동완 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.9

Purpose: We assessed sexual function by using a questionnaire in women who were diagnosed with stress urinary incontinence and underwent mid-urethral tape sling surgery. Materials and Methods: A retrospective survey was conducted of 151 women without evidence of detrusor overactivity or concomitant prolapse who underwent surgery (tension-free vaginal tape or tension-free vaginal tape-obturator) for stress urinary incontinence. The participants filled out a questionnaire regarding their preoperative and 6-month postoperative sexual function. Paired t-tests were used to compare changes over time. The generalized McNemar test was used to compare individual preoperative and postoperative findings. We considered a p-value less than 0.05 as significant. Results: Of the 303 women who fulfilled the inclusion criteria, 204 (67.3%) returned the questionnaire. Of those 204 women, 151 were sexually active before and after surgery. No significant differences were observed after surgery in the frequency or appreciation of intercourse or the extent of sexuality. A significant reduction in leakage symptoms was observed after surgery (p<0.01). Of the 151 women, 29 (19.2%) reported an improvement in satisfaction with intercourse and 23 (15.2%) reported a deterioration after the anti-incontinence procedure. Partner discomfort remained unchanged. Of the 151 patients, 26 (17.2%) patients were unsatisfied with the surgical outcome because of persistence or recurrence of stress urinary incontinence and deterioration in satisfaction with intercourse after surgery. Conclusions: These results suggest that mid-urethral tape sling operations for stress urinary incontinence improved the continence rate, but had little effect on preexisting sexual disturbances. Additional and larger retrospective studies are warranted to support these preliminary findings. Purpose: We assessed sexual function by using a questionnaire in women who were diagnosed with stress urinary incontinence and underwent mid-urethral tape sling surgery. Materials and Methods: A retrospective survey was conducted of 151 women without evidence of detrusor overactivity or concomitant prolapse who underwent surgery (tension-free vaginal tape or tension-free vaginal tape-obturator) for stress urinary incontinence. The participants filled out a questionnaire regarding their preoperative and 6-month postoperative sexual function. Paired t-tests were used to compare changes over time. The generalized McNemar test was used to compare individual preoperative and postoperative findings. We considered a p-value less than 0.05 as significant. Results: Of the 303 women who fulfilled the inclusion criteria, 204 (67.3%) returned the questionnaire. Of those 204 women, 151 were sexually active before and after surgery. No significant differences were observed after surgery in the frequency or appreciation of intercourse or the extent of sexuality. A significant reduction in leakage symptoms was observed after surgery (p<0.01). Of the 151 women, 29 (19.2%) reported an improvement in satisfaction with intercourse and 23 (15.2%) reported a deterioration after the anti-incontinence procedure. Partner discomfort remained unchanged. Of the 151 patients, 26 (17.2%) patients were unsatisfied with the surgical outcome because of persistence or recurrence of stress urinary incontinence and deterioration in satisfaction with intercourse after surgery. Conclusions: These results suggest that mid-urethral tape sling operations for stress urinary incontinence improved the continence rate, but had little effect on preexisting sexual disturbances. Additional and larger retrospective studies are warranted to support these preliminary findings.

여성의 복압성요실금 치료를 위한 변형된 수술법인 Canal Transobturator Tape에 대한 예비보고

이성훈,김태범,김계환,정한,이민성,윤상진 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.12

Purpose: Canal transobturator tape(TOT) was developed to reduce the complications of TOT by modifying the sling procedure of TOT with using a distal urethral polypropylene sling(DUPS). The aim of this present study was to describe a modified surgical technique for the treatment of female urodynamic stress urinary incontinence and to assess the objective and subjective efficacy of Canal TOT. Materials and Methods: Between October 2006 and November 2007, 87 female patients with stress urinary incontinence were enrolled in this retrospective study. All the patients underwent the Canal TOT procedure. The Incontinence Impact Questionnaire-7(IIQ-7) and the Urogenital Distress Inventory-6 (UDI-6) were used to evaluate the surgical outcomes. Results: The mean operative time for Canal TOT was 22.4 minutes(range: 15-39). During the surgery, there were 10% intraoperative and postopreative complications, including De novo urgency(n=3), weak stream(n=4) and difficult emptying(n=2). Yet all these complications occurred in the short-term and they were transient. Concomitant procedures were performed, including cystocele repair(n=7), rectocele repair(n=5), rectocele and cystocele repair(n=14), laparoscopically-assisted vaginal hysterectomy (n=5) and total vaginal hysterectomy(n=1). The average follow-up was 4.5 months(range: 3-12). Both the mean IIQ-7 and UDI-6 scores significantly decreased after Canal TOT and all the patients showed significant improvement of their subjective symptoms of stress incontinence. Conclusions: Our results demonstrate that Canal TOT may be a safe and effective surgical method for treating urodynamic stress incontinence in Korean women and this procedure provides a high cure rate. Purpose: Canal transobturator tape(TOT) was developed to reduce the complications of TOT by modifying the sling procedure of TOT with using a distal urethral polypropylene sling(DUPS). The aim of this present study was to describe a modified surgical technique for the treatment of female urodynamic stress urinary incontinence and to assess the objective and subjective efficacy of Canal TOT. Materials and Methods: Between October 2006 and November 2007, 87 female patients with stress urinary incontinence were enrolled in this retrospective study. All the patients underwent the Canal TOT procedure. The Incontinence Impact Questionnaire-7(IIQ-7) and the Urogenital Distress Inventory-6 (UDI-6) were used to evaluate the surgical outcomes. Results: The mean operative time for Canal TOT was 22.4 minutes(range: 15-39). During the surgery, there were 10% intraoperative and postopreative complications, including De novo urgency(n=3), weak stream(n=4) and difficult emptying(n=2). Yet all these complications occurred in the short-term and they were transient. Concomitant procedures were performed, including cystocele repair(n=7), rectocele repair(n=5), rectocele and cystocele repair(n=14), laparoscopically-assisted vaginal hysterectomy (n=5) and total vaginal hysterectomy(n=1). The average follow-up was 4.5 months(range: 3-12). Both the mean IIQ-7 and UDI-6 scores significantly decreased after Canal TOT and all the patients showed significant improvement of their subjective symptoms of stress incontinence. Conclusions: Our results demonstrate that Canal TOT may be a safe and effective surgical method for treating urodynamic stress incontinence in Korean women and this procedure provides a high cure rate.

Does the Incidence of Urgency Symptoms Increase Along with the Severity of Stress Urinary Incontinence?

김현민,오미미,이정구 대한비뇨의학회 2010 Investigative and Clinical Urology Vol.51 No.11

Purpose: This study aimed to determine whether symptoms of urinary urgency increase according to the severity of stress urinary incontinence (SUI). For this purpose, we recruited women with symptoms of mixed as well as pure SUI and compared the clinical characteristics of each subgroup. Materials and Methods: A total of 241 female patients who were diagnosed with SUI and mixed urinary incontinence (MUI) were analyzed retrospectively. Patients with only SUI were categorized as group 1. Patients with MUI were categorized as group 2. Clinical and urodynamic differences between the 2 groups were compared. Results: The proportion of Stamey grade was significantly different between the 2 groups: grade 1 SUI was higher in group 1, but grades 2 and 3 SUI were higher in group 2. The incidence of urgency was proportional to the degree of Stamey grade (23.5% in grade 1, 36.9% in grade II, and 60.0% in grade III). In the urodynamic study, the presence of detrusor overactivity was significantly higher in group 2 than in group 1 (25.9% vs. 49.4%). Other clinical parameters were also significantly different between the 2 clinical groups: Q-tip angle (group 1: 42.1o, group 2: 28.6o, p<0.05), maximal urethral closure pressure (group 1: 54.7 cmH2O, group 2: 44.1 cmH2O, p<0.05), maximal bladder capacity (group 1: 356.3 ml, group 2: 282.0 ml, p<0.05), and bladder volume at first desire (group 1: 144.6 ml, group 2: 123.2 ml, p<0.05). Conclusions: According to this analysis, the more serious the symptoms of SUI, the higher the incidence of urinary urgency. Purpose: This study aimed to determine whether symptoms of urinary urgency increase according to the severity of stress urinary incontinence (SUI). For this purpose, we recruited women with symptoms of mixed as well as pure SUI and compared the clinical characteristics of each subgroup. Materials and Methods: A total of 241 female patients who were diagnosed with SUI and mixed urinary incontinence (MUI) were analyzed retrospectively. Patients with only SUI were categorized as group 1. Patients with MUI were categorized as group 2. Clinical and urodynamic differences between the 2 groups were compared. Results: The proportion of Stamey grade was significantly different between the 2 groups: grade 1 SUI was higher in group 1, but grades 2 and 3 SUI were higher in group 2. The incidence of urgency was proportional to the degree of Stamey grade (23.5% in grade 1, 36.9% in grade II, and 60.0% in grade III). In the urodynamic study, the presence of detrusor overactivity was significantly higher in group 2 than in group 1 (25.9% vs. 49.4%). Other clinical parameters were also significantly different between the 2 clinical groups: Q-tip angle (group 1: 42.1o, group 2: 28.6o, p<0.05), maximal urethral closure pressure (group 1: 54.7 cmH2O, group 2: 44.1 cmH2O, p<0.05), maximal bladder capacity (group 1: 356.3 ml, group 2: 282.0 ml, p<0.05), and bladder volume at first desire (group 1: 144.6 ml, group 2: 123.2 ml, p<0.05). Conclusions: According to this analysis, the more serious the symptoms of SUI, the higher the incidence of urinary urgency.

수술 후 재발한 여성 복압성요실금 환자의 수술적 치료방법

윤하나,홍재엽,박영오 大韓泌尿器科學會 1999 Korean Journal of Urology Vol.40 No.3

중부 요도 슬링 수술의 실패 위험인자(단기 추적관찰): 순수 복압성요실금과 복합성요실금이 다른가?

정성진,황인식,김성수,민경은,한병규,홍성규,변석수,이상은,이승태 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.6

Purpose: Although application of the mid-urethral sling (MUS) operation has expanded to more complicated cases such as patients with mixed urinary incontinence (MUI), the success rates in patients with MUI have been reported to be lower than those in patients with pure stress urinary incontinence (SUI). We evaluated and compared the risk factors for failure after MUS surgery in patients with pure SUI and in those with MUI. Materials and Methods: Two hundred twenty-eight women were categorized as having pure SUI (Group A, 163 patients) or MUI (Group B, 65 patients). Preoperative evaluations including a symptom questionnaire, physical examination, and urodynamic study were performed. Patients underwent retropubic (17.5%) or trans-obturator (82.5%) MUS surgery. Results: The demographic characteristics that differed between the 2 groups were body mass index, presence of cystocele, and severity of incontinence. The success rate in Group A (95.7%) was higher than that in Group B (84.6%) (p=0.015, chi-square test). In Group A, VLPP, PdetQmax, and weight of the 1-hour pad test were identified as risk factors for failure of the operation in the univariate analysis, but only weight of the 1-hour pad test was an independent risk factor in the multivariate analysis (adjusted odds ratio [OR]=3.5; 95% confidence interval [CI]=1.204-8.895, p=0.045). In Group B, menopause without hormone replacement, AUA Symptom Index-QoL score, maximal cystometric capacity (MCC), and involuntary detrusor contraction (IDC) were the risk factors in the univariate analysis, but only MCC (adjusted OR=0.9; 95% CI=0.645-0.984, p=0.032) and IDC (adjusted OR=2.3; 95% CI=1.014-3.309, p=0.044) were independent risk factors in the multivariate analysis. Conclusions: Unlike in pure SUI, weight of the 1-hour pad test was not a significant predictor of failure of surgery in MUI. Meanwhile, MCC and IDC, which indicate the pathophysiologic status of the detrusor muscle itself, were important predictors of failure of surgery in MUI. Purpose: Although application of the mid-urethral sling (MUS) operation has expanded to more complicated cases such as patients with mixed urinary incontinence (MUI), the success rates in patients with MUI have been reported to be lower than those in patients with pure stress urinary incontinence (SUI). We evaluated and compared the risk factors for failure after MUS surgery in patients with pure SUI and in those with MUI. Materials and Methods: Two hundred twenty-eight women were categorized as having pure SUI (Group A, 163 patients) or MUI (Group B, 65 patients). Preoperative evaluations including a symptom questionnaire, physical examination, and urodynamic study were performed. Patients underwent retropubic (17.5%) or trans-obturator (82.5%) MUS surgery. Results: The demographic characteristics that differed between the 2 groups were body mass index, presence of cystocele, and severity of incontinence. The success rate in Group A (95.7%) was higher than that in Group B (84.6%) (p=0.015, chi-square test). In Group A, VLPP, PdetQmax, and weight of the 1-hour pad test were identified as risk factors for failure of the operation in the univariate analysis, but only weight of the 1-hour pad test was an independent risk factor in the multivariate analysis (adjusted odds ratio [OR]=3.5; 95% confidence interval [CI]=1.204-8.895, p=0.045). In Group B, menopause without hormone replacement, AUA Symptom Index-QoL score, maximal cystometric capacity (MCC), and involuntary detrusor contraction (IDC) were the risk factors in the univariate analysis, but only MCC (adjusted OR=0.9; 95% CI=0.645-0.984, p=0.032) and IDC (adjusted OR=2.3; 95% CI=1.014-3.309, p=0.044) were independent risk factors in the multivariate analysis. Conclusions: Unlike in pure SUI, weight of the 1-hour pad test was not a significant predictor of failure of surgery in MUI. Meanwhile, MCC and IDC, which indicate the pathophysiologic status of the detrusor muscle itself, were important predictors of failure of surgery in MUI.

여성복압성요실금환자에서 Valsalva Leak Point Pressure와 증상정도의 상관관계

김천일,박철희,최봉기 啓明大學校 醫科大學 1999 계명의대학술지 Vol.18 No.3

Purpose: The Valsalva leak point pressure testing is a valuable tool in the diagnosis of female stress urinary incontinence, especially intrinsic sphincter deficiency. The purpose of this study is to correlate clinical parameters of stress urinary incontinence with Valsalva leak point pressure which represents intrinsic sphincter activity. Materials and Methods: We examined sixty consecutive women with stress urinary incontinence including symptom grade(SEAPI-QMN classification), Q-tip test, 1 hour pad test and Valsalva leak point pressure. The clinical parameters of stress urinary incontinence were compared each other and the correlation coefficients were analyzed between them. Results: The mean patient age was 50 years(range 27 to 75 years). Their symptom grade was grade 1 in 17 patients (28.3%), 2 in 30 (50%) and 3 in 13 (22.7%). According to Blaivas and Olsson classification, they were type Ⅰ in 10 patients (16.7%), Ⅱ in 43 (71.7%) and Ⅲ in 7 (12.6%). The patients who have Valsalva leak point pressure of greater than 60cm. water and the urethral hypermobility were grade 1 in 17 patients (100%) and 14 patients (82.4%), 2 in 28 (93.3%) and 26 (86.7%), 3 in 4 (30.8%) and 7(53.8%). There was a statistically significant difference between the number of patients with Valsalva leak point pressure of greater than 60cm. water and 60cm. water or less among the 3 symptom grades (p<0.01). The Valsalva leak point pressure in patients with urethral hypermobility was significantly higher than in those without urethral hypermobility (p<0.05). The Valsalva leak point pressure was highly correlated with the symptom grades among clinical parameters of stress urinary incontinence. Conclusion: Women with higher symptom grades of stress urinary incontinence were significantly more likely to have a low Valsalva leak point pressure which indicate intrinsic sphincter deficiency.

Transobturator Tape Operation Is More Effective in Premenopausal Women than in Postmenopausal Women with Stress Incontinence

Polat Dursun,Tevfik Berk Bildaci,Hulusi Bulent Zeyneloglu,Esra Kuscu,Ali Ayhan 대한비뇨의학회 2011 Investigative and Clinical Urology Vol.52 No.9

Purpose: Midurethral synthetic slings for female stress urinary incontinence are minimally invasive polypropylene mesh tapes that are inserted under the midurethra with trocars. In the past decade, this new technology has become the most commonly performed procedure for female stress urinary incontinence, replacing the traditional open procedures. However, its effectiveness in pre- and postmenopausal women has not previously been compared. Materials and Methods: We assessed the clinical outcome of the transobturator tape (TOT) procedure in premenopausal (n=45) and postmenopausal (n=49) women by means of self-report and the Urinary Distress Inventory 6 (UDI-6) questionnaire. Results: The mean age of the pre- and postmenopausal women was 44 and 60 years, respectively. Mean parity was 2.4 and 3, respectively. There were no significant differences with respect to mean operation time, duration of hospitalization, or intraoperative and postoperative complications. However, premenopausal women were more satisfied with the operation than were postmenopausal women (p=0.014). Also, UDI-6 scores were significantly better in premenopausal women (p=0.027). Conclusions: The TOT operation appeared to be more effective in premenopausal women with stress urinary incontinence. However, further studies with larger sample sizes are needed to confirm our results. Purpose: Midurethral synthetic slings for female stress urinary incontinence are minimally invasive polypropylene mesh tapes that are inserted under the midurethra with trocars. In the past decade, this new technology has become the most commonly performed procedure for female stress urinary incontinence, replacing the traditional open procedures. However, its effectiveness in pre- and postmenopausal women has not previously been compared. Materials and Methods: We assessed the clinical outcome of the transobturator tape (TOT) procedure in premenopausal (n=45) and postmenopausal (n=49) women by means of self-report and the Urinary Distress Inventory 6 (UDI-6) questionnaire. Results: The mean age of the pre- and postmenopausal women was 44 and 60 years, respectively. Mean parity was 2.4 and 3, respectively. There were no significant differences with respect to mean operation time, duration of hospitalization, or intraoperative and postoperative complications. However, premenopausal women were more satisfied with the operation than were postmenopausal women (p=0.014). Also, UDI-6 scores were significantly better in premenopausal women (p=0.027). Conclusions: The TOT operation appeared to be more effective in premenopausal women with stress urinary incontinence. However, further studies with larger sample sizes are needed to confirm our results.

추나수기요법과 자침으로 호전된 복압성요실금 환자 치험 2례

윤문식 ( Moon Sik Yoon ),박종민 ( Jong Min Park ),이진호 ( Jin Ho Lee ),김경옥 ( Kyung Ok Kim ),윤유석 ( You Suk Youn ),정성엽 ( Sung Yub Jung ),김성용 ( Sung Yoong Kim ) 한방재활의학과학회 2006 한방재활의학과학회지 Vol.16 No.1

Objectives : This study was performed to evaluate the effect of Chuna manipulation and acupuncture treatment on stress urinary incontinence clinically. Methods : The patients wewe hospitalized Dept. of Oriental Rehabilitation Medicine, Jaseng Oriental Hospital, diagnosed as Stress Urinary Incontinence and treated with Chuna Manipulation, Acupuncture. After measured the Symptom, we analyzed effect of chuna manipulation and acupuncture treatment on stress urinary incontinence. Results and Conclusions : Symptom of patient such as stress urinary incontinence was improved after above treatment. So it is suggested that oriental medical treatment are effective in the stress urinary incontinence.

복압성 요실금 여성에서 요역동학검사가 필요한가?

윤현철,이정구 大韓泌尿器科學會 2002 Korean Journal of Urology Vol.43 No.8