복압성 요실금의 수술방법인 TOT와 TVT-O의 무작위 전향적 비교 연구

Abstract

Purpose: The aim of our study was to compare the outcomes of the transobturator vaginal tape (TOT) and tension free vaginal tape obturator inside-out (TVT-O) procedures in patients with stress urinary incontinence. Materials and Methods: Between August 2004 and March 2005, 77 women with stress incontinence were randomly assigned to either TOT (n=36) or TVT-O (n=41). The preoperative evaluation included a careful history taking, physical examination, stress test, a quality of life questionnaire and a comprehensive urodynamic examination. Follow up evaluation was carried out after 1 month, 6 months. Patients assessment was made by a clinical examination in the first 1 month and satisfaction rate expressed and uroflowmetry with postvoid residual urine to compare voiding disorder suggesting bladder outlet obstruction after 6 months. Results: Patient characteristics, preoperative quality of life, and urodynamic evaluation were similar between the 2 groups. Mean operative time was similar between the 2 groups (17 min vs 16 min). The rate of postoperative urinary retention was 8.3% (n=3) in the TOT group and 9.8% (n=4) in the TVT-O group. The cutting of tape was required to treat urinary retention in 2.8% (n=1) of the TOT group and 4.9% (n=2) of the TVT-O group at 14 days after the procedure. The rates of cure (66.7% vs 65.9%), improvement (27.8% vs 29.3%), and failure (5.6% vs 4.9%) were similar for the TOT and TVT-O groups, respectively. In terms of bladder outlet obstruction, no difference were found after TOT and TVT-O. Conclusion: Both procedures are equally a simple, safe and effective treatment for female stress urinary incontinence in terms of rate of cure, operation time and complications. However, further studies and long term follow-up are needed for the complications and cure rate. (J. Korean Continence Society 2005;9:82-87)