복압성 요실금 환자에서 Valsalva Leak Point Pressure 측정의 임상적 유용성
Clinical Usefulness of Valsalva Leak Point Pressure as a Diagnostic Tool in Stress Urinary Incontinence
이동수, 박흠례,
소속 상세정보
이동수 ( )
고려대학교
박흠례 ( )
고려대학교 의과대학 비뇨기과학교실
KMID : 0358319980390090890
Abstract
결론
환자의 증상정도와 VLPP는 일정한 연관성을 보여 요실금증상정도가 심할수록 VLPP는
낮아지는 소견을 보였다. 특히 grade Ⅰ의 요실금증상이 있었던 환자에서는 낮은
VLPP(<60㎝H2O)는 전혀 없었으나 g1ade Ⅱ 요실금에서는 187%에서도 낮은
VLPP가 관찰되어 요도의 과다유동성을 동반한 glade Ⅱ증상의 요실금여성에서 YLPP 측정
이 수술방법을 결정하는 중요한 인자라고 생각된다 아울러 VLPP 검사치가 ISD를 판정하는
데 모호하다고 판정될 때에는 다른 임상적인 지표들을 같이 고려하여 치료방법을 결정해야
할 것으로 생각된다
#초록#
Purpose : The valsalva leak Point pressure(VLPP) has been suggested as an objective
tool for diagosing female stress urinary incontinence(SUI) accompained by intrinsic
sphictor deficiency(ISD) Our aims were to determine the predictive value of VLPP in
patients with ISD and correlation between VLPP and other parameters as a diagnostic
tool for ISD.
Material and Methods : Sixty-seven patients with stress urinary incontinence were
evaluated propectively with symptom grade(Stamey grade). Q-tip test, 1hr pad test, and
VLPP. Correlations of VLPP and these clinical parameters were computed. VLPP of 60㎝
H2O was determined as a cut-off value of ISD and compared with other
parameters(symptom grade, hypermobility).
Results : Of the total 67 patients, SUI was grade Ⅰin 20(29.8%) Ⅱ in 32(47.8%) and
Ⅲ in 15(22.4%). Of the 67 patients, 48 had VLPP of more than 60㎝H2O.
Among these, SUI was grade Ⅰ in 20(100%), Ⅱ in 26(81.3%) and Ⅲ in 2(13.3%). There
were significant differences in the incidence between grade Ⅲ and grade Ⅰ or Ⅱ
(P<0.01). Of the 19 patients with VLPP of 60㎝H2O or less, SUI grade Ⅲ
in 77 in 13(86.7%); where SUI was grade Ⅰin 0(0%) and Ⅱ in 6(18.7%) with statistical
significance between grade Ⅲ and grade Ⅰ or Ⅱ. Urethral hypermobility was noted in
56(83.6%); this was Ⅰ in 20(100%), Ⅱ in 26(81.8%) and Ⅲ in 10(67%). Among the SUI
patients without hypermobility, none had symptoms of grade Ⅰ: whereas 33.3% of grade
Ⅲ patients didn't show hypermobility. There appeared significant correlation(p<0.001)
between the VLPP and symptom grade(correlation coefficient=0.68). Moderate correlations
were present between either symptom grade or VLPP and amount of urine
leakage(correlation coefficient=0.5). No statistically significant relationship existed
between either VLPP or symptom grade and urethral hypermobility.
Conclusion: subjective degree(such as symptom severity or amount of urine loss) of
stress incontinence seems useful in predicting the likelihood of low valsalva leak point
pressure which suggests intrinsic sphinctor deficiency. By the result that some women
of grade Ⅱ incontinence with urethral hypermobility exhibited low VLPP, measurement
of VLPP could be a valuable tool in choosing the treatment modality of stress urinary
incontinence.
키워드
female stress urinary incontinence; Intrinsic sphincter deficiency; Valsalva leak point pressure;
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