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대한배뇨장애요실금학회 International Neurourology Journal International Neurourology Journal 제14권 제1호
발행연도
2010.1
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26 - 33 (8page)

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Purpose: We evaluated the influence of preoperative physical examination (PE) and urodynamic study (UDS) findings on objective postoperative bladder emptying, the subjective development of bladder storage symptoms, and patient-reported success of correction of stress urinary incontinence (SUI). Materials and Methods: From January 2007 to August 2008, a total of 159 female patients with SUI underwent transobturator midurethral sling surgery (TOT). The patients were selected for SUI, with no overactive bladder (OAB) symptoms, no detrusor overactivity (DO) on UDS, no pelvic organ prolapse, and no history of prior anti-incontinence surgery. Of these patients, 128 patients (aged 38-74 years; mean age, 51.8±7.1 years) with follow-up of at least 12 months were included in the analysis. All patients had PE and UDS findings, including Q-tip testing, free maximal flow rates (Qmax), filling cystometry, Valsalva leak point pressure, detrusor pressure at maximal flow, and maximal urethral closing pressure. The primary outcome was postoperative voiding dysfunction, defined as the subjective feeling of not empting one’s bladder completely and a postvoid residual ≥100 ml. A secondary outcome, "cure" of SUI, was defined as "a negative result on the cough stress test and no subjective complaint of urine leakage." We analyzed the preoperative parameters by univariate and multivariate regression for voiding dysfunction, de novo OAB, cure rate, and the patients’ satisfaction. Results: Patients with a preoperative Qmax < 15 ml/s (7 patients) had a tendency for postoperative voiding dysfunction compared with those with a Qmax 15 ml/s (15 patients) (35.0% vs. 13.9%, respectively; p=0.046). No other preoperative parameters had a statistically significant influence on postoperative voiding dysfunction. Receiver operating characteristic (ROC) analysis revealed that Qmax was a good predictor because the area under the ROC curve value of Qmax was 0.81 (95% CI: 0.73 to 0.89, p<0.001). The univariate and multivariate analysis of the preoperative PE and UDS parameters demonstrated that no significant differences and no independent risk factors were related to the postoperative de novo OAB, cure rate, or the patients’ satisfaction. Conclusions: These findings suggest that preoperative UDS results, especially Qmax, could be used to predict postoperative voiding dysfunction after the TOT procedure.
#Urinary Incontinence #Treatment outcome #Urodynamics

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참고문헌 (20)

참고문헌 신청
Abrams P / 1988 / The standardisation of terminology of lower urinary tract function. The International Continence Society Committee on Standardisation of Terminology / Scand google schola Bakas P / 2002 / Q-tip test and tension-free vaginal tape in the management of female patients with genuine stress incontinence / Gynecol Obstet Invest 53 : 170 ~ 173 google schola Cetinel B / 2004 / Are there any factors predicting the cure and complication rates of tension-free vaginal tape? / Int Urogynecol J Pelvic Floor Dysfunct 15 : 188 ~ 193 google schola Chang-Jun Yoon / 2007 / Three-year Outcomes of the Innovative Replacement of Incontinence Surgery Procedure for Treatment of Female Stress Urinary Incontinence: Comparison wi google schola Deng DY / 2007 / Presentation and management of major complications of midurethral slings: Are complications under-reported? / Neurourol Urodyn 26 : 46 ~ 52 google schola

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