골반장기탈출증을 동반한 복압성 요실금에서 tension-free vaginal tape (TVT)과 transobturator tape (TOT)의 치료 성적 비교
Comparison between tension-free vaginal tape (TVT) and transobturator tape (TOT) with concomitant surgery for pelvic organ prolapse
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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 0.05 미만을 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.
Abstract
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.
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