여성의 복압성 요실금의 수술적 치료에서 Tension-free vaginal tape (TVT)과 Burch colposuspension의 비교

김조영 ( Kim Jo Yeong ),정희성 ( Jeong Hui Seong ),이영태 ( Lee Yeong Tae ),차선희 ( Cha Seon Hui ),김현철 ( Kim Hyeon Cheol ),강석호 ( Kang Seog Ho ),조진호 ( Jo Jin Ho ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.2

목적 : 여성의 순수 복압성 요심금의 수술적 치료로서 tension-free vaginal tape과 Burch colposuspension의 치료효과, 시술용이성, 합병증을 비교하고자 한다. 연구 방법 : 2000년 1월부터 2002년 12월까지 본원에서 2도 이상의 순수 복압성 요실금을 진단 받은 환자 77명 중 37명은 TVT를 시행하고, 40명은 Burch colposuspension을 시행한 후 6개월 이상 추적 관찰된 환자를 대상으로 치료효과와 합병증을 비교하였다. 결과 : Tension-free vaginal tape군에서의 치료율은 91.4%, Burch colposuspension군의 치료율은 90%로 나타났다. 평균 수술시간은 TVT군에서 23.4분, Burch colposuspension군에서 47.2분이었고, 평균 입원일수는 TVT군에서 1.8일, Burch colposuspension군에서 5.2일 이었으며, 술 후 발생한 합병증의 빈도와 중증도에는 두 군에서 차이가 없었다. 결론 : Tension-free vaginal tape은 순수 복압성 요실금의 수술적 치료로서 그 치료율은 Burch colposuspension과 비슷하고 술 후 합병증의 빈도와 중증도에서도 큰 차이를 보이지 않았으며, Burch colposuspension에 비해 더 간단한 수술법으로 생각된다. Objective : The purpose of this study was to compare the effectiveness, easiness, postoperative complications between tension-free vaginal tape (TVT) and Burch colposuspension (BC) in the surgical management of female genuine stress urinary incontinence. Methods : A retrospective study of 77 cases with stress urinary incontinence at Department of Obstetrics and Gynecology and Urology, Pochon CHA University Medical College from January 2000 to December 2002, followed up more than 6 months. All of 77 cases were above grade 2 genuine stress urinary incontinence, 37 cases were performed tension-free vaginal tape, 40 cases were performed Burch coloposuspension. Results : Cure rate was 91.4% in the tension-free vaginal tape (TVT) group, 90% in the Burch colposuspension group. The mean operative time for TVT was 23.4 minutes and for Burch colposuspension was 47.2 minutes. The mean hospital stay in TVT was 1.8 days and in Burch colposupension was 5.2 days. The incidence and severity of postoperative complication is similar in both groups. Conclusion : The cure rates of TVT were comparable with Burch colposuspension in the surgical management of female genuine stress urinary incontinence. And the incidence and severity of postoperative complication is similar in both groups. Moreover TVT is simple procedure more than Burch colposuspension.

동시에 시행된 질식자궁적출이 Tension-free Vaginal Tape 수술결과에 미치는 영향

조진국,송하정,최경우,조성태,김기경 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.9

Purpose: Hysterectomy, regardless of the surgical technique, increases the risk of having to undergo stress urinary incontinence surgery later in life. Furthermore, transvaginal hysterectomy may cause some changes in the normal architecture and tension of the tissues surrounding the pelvic floor, and this may also cause some changes in the continence mechanisms of the bladder and urethra. We investigated if there are any adverse effects of concomitant vaginal hysterectomy on the outcomes of a tension-free vaginal tape procedure. Materials and Methods: The outcomes of the tension-free vaginal tape (TVT)/transvaginal total hysterectomy(VTH) group were compared with that of the TVT group in terms of cure and improvement of incontinence, satisfaction with the procedure and the complications. The preoperative evaluation included history taking, physical examination and stress tests and determining the stress-related leakage, the emptying ability, the anatomy, the protection and the inhibition(SEAPI) scores. The outcomes were evaluated at over one year after operation. Results: The cure and improvement rates were 77.5% and 15% in the TVT group, and 88.9% and 7.4% in the TVT/VTH group, respectively, without any statistical difference between the two groups. The rates of patient- satisfaction with the procedure were similar in two groups. There were no serious or long term complications related to the procedure except for a case of local hematoma in the hysterectomy site, which was controlled conservatively. Conclusions: Our findings suggest that a TVT operation can be done simultaneously with vaginal hysterectomy with similar results as those of TVT operation only. In addition, it is thought that the simultaneous TVT operation in a patient who is undergoing hysterectomy and has urinary stress incontinence deserves to be recommended in a positive light. Purpose: Hysterectomy, regardless of the surgical technique, increases the risk of having to undergo stress urinary incontinence surgery later in life. Furthermore, transvaginal hysterectomy may cause some changes in the normal architecture and tension of the tissues surrounding the pelvic floor, and this may also cause some changes in the continence mechanisms of the bladder and urethra. We investigated if there are any adverse effects of concomitant vaginal hysterectomy on the outcomes of a tension-free vaginal tape procedure. Materials and Methods: The outcomes of the tension-free vaginal tape (TVT)/transvaginal total hysterectomy(VTH) group were compared with that of the TVT group in terms of cure and improvement of incontinence, satisfaction with the procedure and the complications. The preoperative evaluation included history taking, physical examination and stress tests and determining the stress-related leakage, the emptying ability, the anatomy, the protection and the inhibition(SEAPI) scores. The outcomes were evaluated at over one year after operation. Results: The cure and improvement rates were 77.5% and 15% in the TVT group, and 88.9% and 7.4% in the TVT/VTH group, respectively, without any statistical difference between the two groups. The rates of patient- satisfaction with the procedure were similar in two groups. There were no serious or long term complications related to the procedure except for a case of local hematoma in the hysterectomy site, which was controlled conservatively. Conclusions: Our findings suggest that a TVT operation can be done simultaneously with vaginal hysterectomy with similar results as those of TVT operation only. In addition, it is thought that the simultaneous TVT operation in a patient who is undergoing hysterectomy and has urinary stress incontinence deserves to be recommended in a positive light.

골반장기탈출증을 동반한 복압성 요실금에서 tension-free vaginal tape (TVT)과 transobturator tape (TOT)의 치료 성적 비교

양효인 ( Hyo In Yang ),정현주 ( Hyun Joo Jung ),전명재 ( Myung Jae Jeon ),남가현 ( Ka Hyun Nam ),최지훈 ( Ji Hoon Choi ),김세광 ( Sei Kwang Kim ),배상욱 ( Sang Wook Bai ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.1

목적: 골반장기탈출증과 병합된 복압성 요실금 환자에 있어서 tension-free vaginal tape (TVT)과 transobturator tape (TOT)의 수술 후 합병증과 요실금의 치료 성적을 비교하기 위함이다. 연구 방법: POP-Q (Pelvic Organ Prolapse-Quantification)에 따른 2기 이상의 골반장기탈출증이 병합된 복압성 요실금 환자 중 TVT 혹은 TOT를 시행하여 1년 이상 추적 관찰이 가능했던 환자 278명을 대상으로 후향적으로 연구를 시행하였다. 수술 후 합병증 (방광손상, 수술 후 혈색소 감소, 요저류, 새로 발생한 요절박, 요로감염, 질미란, 질혈종)과 복압성 요실금의 치료 성적을 비교하였다. 통계 방법은 SPSS (version 12.0)을 이용하여 Student t-test, chi square test를 시행하였으며 P-value 0.05미만을 유의한 것으로 정의하였다. 결과: 두 환자군의 일반적 특성은 차이를 보이지 않았다. 수술 후 합병증은 혈색소 감소, 요저류, 요로감염에서 TVT를 시행한 환자군에서 TOT를 시행한 환자군보다 통계학적으로 유의하게 높은 발생률을 보였다 [혈색소 감소: TVT (25.51%), TOT (15.03%), P=0.04; 요저류: TVT (37.93%), TOT (21.05%), P=0.02; 요로감염: TVT (11.72%), TOT (3.75%), P=0.02]. 두 그룹간의 치료 성적은 유의한 차이를 보이지 않았다. 결론: 골반장기탈출증이 병합된 복압성 요실금 환자의 수술적 치료로서 TVT와 TOT는 비슷한 치료 성적을 보이지만 TOT를 시행한 경우 수술 후 혈색소 감소, 요저류 및 요로감염의 수술 후 합병증이 적은 것으로 나타났다. Objective: To compare tension-free vaginal tape (TVT) and transobturator tape (TOT) for surgical treatment of stress urinary incontinence (SUI) associated with pelvic organ prolapse (POP). Methods: Two hundred seventy eight consecutive patients affected by SUI associated with POP more than stage II were included in this retrospective study. Cure rate and postoperative complications such as hemoglobin difference between preoperative and postoperative period, vaginal hematoma, bladder and bowel injury, vaginal mesh erosion, urinary retention, de novo urgency, urinary tract infection were compared. Student`s t-test and chi square test were used for statistical analysis. A P-value below 0.05 was considered statistically significant. Results: The number of patients underwent TVT was 145 and TOT was 133. All patients were followed up for more than 12 months. The general characteristics of patients showed no significant difference between the two groups. There was no difference between two groups in cure rate. However, hemoglobin difference (TVT, 2.91±0.93 g/dL; TOT, 1.53±0.77 g/dL; P=0.04) was higher in TVT group than TOT group and urinary retention within 1 month (TVT, 35.17%; TOT, 21.05; P=0.02), and urinary tract infection (TVT, 11.72%; TOT, 3.75%; P=0.02) more frequently appeared in TVT group than TOT group. Other postoperative complications such as vaginal hematoma (TVT, 6.89%; TOT, 6.76%; P=0.86), bowel injury (TVT, 0%; TOT, 1.5%; P=0.64), vaginal mesh erosion (TVT, 7.58%; TOT, 4.51%; P=0.47), urinary retention after 1 month (TVT, 2.76%; TOT, 3.00%; P=0.35), de novo urgency (TVT 7.58%, TOT: 6.01%, P=0.48) were not different between two groups. Conclusion: Both procedures appear to be equally effective in the surgical treatment of SUI associated with POP. However, TOT seems to be a more safe procedure in postoperative complications.

복압성 요실금 치료를 위한 Transobturator tape과 Tension-free vaginal tape obturator시술의 치료 성적 비교

이은주 ( Eun Joo Lee ),전명재 ( Myung Jae Jeon ),정현주 ( Hyun Joo Jung ),김세광 ( Sei Kwang Kim ),배상욱 ( Sang Wook Bai ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.11

목적: 복압성 요실금 치료를 위한 Transobturator tape과 Tension-free vaginal tape obturator시술의 치료성적 및 합병증을 전향적으로 비교하고자 하였다. 방법: 2005년 4월부터 2007년 1월까지 본원에 내원하여 복압성 요실금으로 진단받은 332명의 환자들을 대상으로 전향적으로 연구를 시행하였다. 골반장기탈출증 2기 이상인 환자와 요역동학 검사상 배뇨근 과활동성을 보이는 환자는 연구 대상에서 제외하였으며 TOT 혹은 TVT-O를 양자택일하여 시행하였다. 수술 후 1, 3, 6, 12개월에 완치 여부와 합병증을 비교하였고 추적관찰에 성공한 환자는 총 306명으로 TOT 185명, TVT-O 121명이었다. 통계 분석은 student t-test, chi square test를 이용하였다. 결과: 임상적 특성은 두 그룹간에 통계학적으로 유의한 차이가 없었고, 수술 후 1, 3, 6, 12개월 후 완치율도 그룹간에 유의한 차이가 없었으며 모두 1년 이상의 기간 동안 80% 이상의 완치율을 보였다. 배뇨곤란, 새로 발생한 절박뇨, 요로감염, 질미란 발생은 추적관찰기간 동안 유의한 차이가 없었으나, 서혜부 통증의 경우 TVT-O군에서 유의하게 높았다 (TOT; 3.78% vs TVT-O; 9.92%, P=0.030). 결론: 복압성 요실금 치료로서 TOT, TVT-O시술 모두 안전하고 효과적인 수술 방법이다. 서혜부 통증의 발생은 TVT-O에서 더 높게 보고되었는데 이는 tape의 해부학적 위치로 인한 폐쇄신경 및 음부신경 주변으로의 염증과 관련된 자극과 연관성이 있다고 사료된다. Objective: The aim of this study was to compare the treatment outcome of Transobturator tape (TOT) and Tension-free vaginal tape obturator (TVT-O) as the treatment of stress urinary incontinence (SUI). Methods: This prospective study included 332 women who were urodynamically diagnosed as stress urinary incontinence from April 2005 to January 2007. Patients showing pelvic organ prolapse higher than stage II by the Pelvic Organ Prolapse Quantification system or patients with detrusor overactivity were excluded from this study. The patients were alternatively selected to undergo TOT (n=192) or TVT-O (n=140) procedure and followed up at 1, 3, 6, 12 months postoperatively to compare the treatment outcome. Three hundred and six of them were available at 1 year follow up, 185 had the TOT operation, 121 the TVT-O procedure. The student t-test, chi square test were used for statistical analysis. Results: There were no statistically significant differences in general characteristics between two groups. No differences were found between 2 groups in the cure rates, postoperative complication such as voiding difficulty, De novo urgency, urinary tract infection, vaginal mesh erosion except groin pain. The groin pain rate of two groups showed significant difference. (TOT; 3.78% vs TVT-O; 9.92%, P=0.030). Conclusions: This study indicates that the TOT and TVT-O procedures are safe and effective treatments for female stress urinary incontinence. However, TVT-O shows high incidence of groin pain rate and it may be related to nerve irritation by inflammation of surrounding tissue around the pudendal and obturator nerve, according to anatomical differences of the tape position in two procedures.

여성 복압성요실금에 대한 Tension-free Vaginal Tape(TVT) 수술 성적

문찬,강윤일,김경영,문형윤,노준,김철성 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.3

Background: We wanted to evaluated the long term results of the tension-free vaginal tape (TVT) Procedure for treating strss urinary incontinence in women. Method: During Octover 1, 1998 to December 31, 2005, we evaluated the 52 women who underwent the TVT procedure for stress urinary incontinence at least 1 year following surgery. Preoperatively, Patients were evaluated with history taking, Physical examinations and urodynamic study, Operation and hospitalization data were evaluated with duration of procedure, hospital days, foley catheter removal days and use of analgesics, Postoperative evaluations included the uroflowmetry, residual urine volume, surgical outcomes, complications and patients' satisfaction with the procedure. Results: The follow-up period was a mean of 16 months. Preoperative I-QoL total score was 58.0. Comparision the result between preoperative and postoperative Q max was significantly shoter in the postoperative result. TVT procedure remained cure in 96.2% (cured: 82.7%, improved: 13.5%) and successful in 96.1%. Also, 49(94.2%) Patients would like to recommended the TVT procedure to others. There was no serious or long-term complications, Conclusions: The TVT procedure appear to be effective and safe for the surgical treatment of female stress urinary incontinence and showed a good long-term cure rate.

Tension-free Vaginal Tape수술 후 발생하는 급성요폐에 영향을 미치는 위험인자

박성찬,홍범식,주명수 大韓泌尿器科學會 2003 Korean Journal of Urology Vol.44 No.6

Tension-free Vaginal Tape 수술에서 테이프 장력의 변화가 수술 결과와 배뇨기능에 미치는 영향

김세영,이상곤,오재록,고동수,양동환,김진범,이성호 대한배뇨장애요실금학회 2007 International Neurourology Journal Vol.11 No.2

방광류를 동반한 요실금 환자의 치료에서 Tension-free Vaginal Tape (TVT) 및 TVT 기구를 이용한 수술방법

배재현,이정구 大韓泌尿器科學會 2002 Korean Journal of Urology Vol.43 No.11

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 복압성요실금에서 Tension-free Vaginal Tape (TVT)의 시술 위치에 따른 치료 효과의 비교

성열근,정세일,권헌영 大韓泌尿器科學會 2002 Korean Journal of Urology Vol.43 No.7