복압성 요실금 치료를 위한 Transobturator tape과 Tension-free vaginal tape obturator시술의 치료 성적 비교
The comparison of treatment outcome of Transobturator tape and Tension-free vaginal tape obturator as the treatment of stress urinary incontinence
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목적: 복압성 요실금 치료를 위한 Transobturator tape과 Tension-free vaginal tape obturator시술의 치료성적 및 합병증을 전향적으 로 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 이용하 였다. 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.
Abstract
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.
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