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요실금 수술 후 발생한 배뇨장애의 처치

Management of voiding dysfunction after anti-incontinence operation

황병철|구천회
대한산부인과학회 (Korean Soceity of Obstetrics and Gynecology)|2010.09|Obstetrics & Gynecology Science|제53권 제9호|pp. 761-768

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참고문헌

키워드

Voiding dysfunction배뇨장애Anti-incontinence surgery요실금 수술
주제분류산부인과학

초록

최근 요실금 수술이 증가함에 따라 수술 후 배뇨장애가 문제가 되고 있다. 요실금 수술 후 배뇨장애를 가진 환자는 주로 저장증상 또는 배뇨증상이 나타나며 진단을 위해서는 수술 전 환자의 배뇨상태를 파악하는 것이 도움이 된다. 요실금 수술 후 배뇨장애의 진단은 병력 청취, 이학적 검사, 요검사, 잔뇨량 검사를 기초로 하며 요역동학 검사, 방광경 검사를 이용한 정보도 유용하다. 치료로는 우선 자가됴뇨, 수분제한, 항콜린성약제, 골반근육운동 등의 보존적 치료를 시행하며 효과가 없을 경우 수술적 치료를 한다. 이전 요실금 수술이 중부요도 슬링인지 다른 시술인지에 따라서 수술 시기 및 방법이 달라지므로 이를 구별하는 것이 중요하다. 최근 중부요도 슬링의 경우 빠른 시기에 테이프를 이완하거나 절단하는 방법으로 좋은 성적이 보고되고 있다. 요실금 수술 후 배뇨장애를 예방하는 가장 좋은 방법은 수술 시 과도한 장력을 피하는 것이므로, 항상 이를 염두에 두고 수술을 시행하여야 하겠다.

Abstract

With the increasing number of surgery for incontinence, voiding dysfunction after anti-incontinence surgery will continue to be a problem. The patient with postoperative voiding dysfunction may present with primarily storage symptoms or voiding symptoms, or a combination of both. Detailed knowledge of the preoperative voiding status may aid in the diagnosis of voiding dysfunction. Diagnosis is based on history, physical examination, urinalysis and postvoid residual volume, but additional informations from urodynamic study and cystoscopy are useful. Patients with postoperative voiding dysfunction should be initially treated conservatively with intermittent or continuous catheterization, fluid restriction, anticholinergics and pelvic floor physiotherapy. When conservative treatment fails, surgical intervention should be done. It is important to distinguish between midurethral sling and other procedures because the timing and type of intervention vary. In case of midurethral sling, loosening or cutting the tape has had excellent results. Prevention of obstruction during surgery may be the best way to avoid reoperation.

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