요역동학검사로 분석한 하부운동신경원병소의 신경인성방광
Hyung Jee Kim, Pil Seon Choi, Gil Ho Lee esosock : From the Department of Urology, Dankook University College of Medicine, Cheonan, Korea-Abstract- Purpose : The aim of present study is to investigate the possibility of upper urinary tractdeterioration i
신현덕, 최필선, 양성현,
소속 상세정보
신현덕 ( )
단국대학교 의과대학 비뇨기과학교실
최필선 ( )
단국대학교 의과대학 비뇨기과학교실
양성현 ( )
단국대학교 의과대학 비뇨기과학교실
KMID : 0358319980390070671
Abstract
서론
상부운동신경원병소에서는 요역동학검사상 배뇨근 과반사성방광이 많은 것으로 알려져 있
으며, 하부운동 신경원병소에서 기인한 신경인성방광의 일반적인 요역동학검사의 양상은 이
완성이 흔한 것으로 알려져 있다. 신경인성방광을 가진 환자의 관리에 있어서 가장 중요한
목적은 신기능의 보존에 있으므로 상부요로의 손상을 야기시킬 수 있는 요역동학적 인자,
즉 배뇨근-외요도괄약근실조, 낮은 유순도 그리고 높은 방광내압 등을 조기 발견하여 이에
합당한 처치를 하는 것이 중요하다 이러한 이유로 상부운동신경원병소를 가지고 있는 환자
가 하부운동신경원에 병소를 가지고 있는 환자보다 합병증 및 후유증이 심하여 하부신경원
병소를 가지고 있는 환자들이 상대적으로 등한시되는 경향이 있었다. 그러나 하부신경 원병
소를 가진 신경 인성방광환자에게 요역동학검사를 시행한 결과 모든 환자가 이완성 방광소
견을 보이는 것이 아니라 다양한 소견을 보이므로 이에 따른 치료법을 달리해야 되므로 정
확하고 규칙적인 요역동학검사를 시행할 필요성이 있다. 따라서 본 연구는 하부신경원병소
를 가진 신경인성방광환자를 대상으로 요역동학검사를 하여 그의 소견과 향후 발생할 수 있
는 신기능 손상과의 관계를 알아보았다.
#초록#
Purpose : The purpose of this study is to evaluate the efficacy of biofeedback 1
treatment and functional electrical stimulation in stress incontinence patients as a
physiotherapy and to know which factors affect on the outcome.
Materials and Methods : A group of 65 patients with stress incontinence were treated
with combined alternating biofeedback and intravaginal electrical stimulation during 12
sessions, each 21 minutes in length, during 6 weeks. All patients had type Ⅰ or Ⅱ
stress incontinence.
Results : At immediate post treatment, subjective cure(complete dryness) rate was
15% and improvement(recovery to avoid other forms of treatment) rate was 60% and
failure rate was 25%. Thus, the overall success rate for this treatment was 75%. In 49
patients who had all scheduled sessions and good compliance, subjective cure rate was
14% and improvement rate was 71%, but in 16 patients not to have good compliance,
cure rate was 19%, improvement rate was 25%. In compliant patients, the result of 3
months after treatment showed cure rate was 11%, improvement rate was 54%.
Compliance with reatment was the most significant parameter predictive of a good
outcome(p<0.01) and the degree of stress incontinence was also significant in compliant
patients(p<0.05). No clinical correlation with outcome was found in age, type, severity of
cystocele, pelvic muscle strength, initial degree of vaginal contraction. Intravaginal
pressure increased by an average of 10cmH20. Increased vaginal pressure
was found in 93% of the patients and at least 50%improvement was 61%. Urge
incontinence and urgency were present in 10(15%) and 19(29%) of the patients and
improvement including cure was found 90% in urge incontinence and 89% in urgency.
Conclusions : Biofeedback treatment and functional electrical stimulation is more
effective for the patients who have good compliance, low degree stress incontinence and
combined bladder irritation symptoms. In order to attain and maintain good results, a
well structured biofeedback and functional electrical stimulation program that teaches
specific muscle exercise should be used and the patients should be followed by a
maintenance program and reinforcement. (Korean J Urol 1998; 39: 670∼83)
키워드
Stress urinary incontinence; Biofeedback; Functional electrical stimulation;
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