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동시에 시행된 질식자궁적출이 Tension-free Vaginal Tape 수술결과에 미치는 영향

The Effects of Simultaneous Vaginal Hysterectomy on the Outcomes of a Tension-free Vaginal Tape Procedure for Female Stress Urinary Incontinence

대한비뇨기과학회지 2008년 49권 9호 p.850 ~ 854
조진국 ( Cho Jin-Kuk ) - 한림대학교 의과대학 비뇨기과학교실

조성태 ( Cho Sung-Tae ) - 한림대학교 의과대학 비뇨기과학교실
김기경 ( Kim Ki-Kyung ) - 한림대학교 의과대학 비뇨기과학교실
송하정 ( Song Ha-Jong ) - 한림대학교 의과대학 비뇨기과학교실
최경우 ( Choi Kyung-Woo ) - 한림대학교 의과대학 비뇨기과학교실

Abstract


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.

키워드

Urinary incontinence;Tension-free vaginal tape;Vaginal hysterectomy
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