폐쇄공을 통한 요실금 수술 후 재발한 환자에서 이차적 시도로서 테이프 단축술과 Tension-free Vaginal Tape 재시술의 비교
Comparison of Secondary Procedures for Recurrent Stress Urinary Incontinence after a Transobturator Tape Procedure: Shortening of the Tape versus Tension-free Vaginal Tape Redo
고준성, 김효신, 김현우, 이용석, 김석일, 이규성, 주명수, 이지열,
소속 상세정보
고준성 ( Koh Jun-Sung )
가톨릭대학교 의과대학 비뇨기과학교실
김효신 ( Kim Hyo-Sin )
가톨릭대학교 의과대학 비뇨기과학교실
김현우 ( Kim Hyun-Woo )
가톨릭대학교 의과대학 비뇨기과학교실
이용석 ( Lee Yong-Seok )
가톨릭대학교 의과대학 비뇨기과학교실
김석일 ( Kim Suk-Il )
가톨릭대학교 의과대학 예방의학교실
이규성 ( Lee Kyu-Sung )
성균관대학교 의과대학 비뇨기과학교실
주명수 ( Choo Myung-Soo )
울산대학교 의과대학 서울아산병원 비뇨기과학교실
이지열 ( Lee Ji-Youl )
가톨릭대학교 의과대학 비뇨기과학교실
KMID : 0358320070480111149
Abstract
Purpose: Although the reported failure rate of the transobturator tape procedure(TOT) is low, recurrence after this procedure have been reported, and no standard treatment has yet been established for the recurrence. We compared a shortening of the previously implanted tape with a repeat tension-free vaginal tape(TVT) procedure after a failed TOT procedure.
Materials and Methods: We enrolled eighteen women(mean age: 54.38± 9.15 years, range: 38-72) who underwent shortening of the previously implanted tape or they underwent a repeated TVT procedure due to persistent or recurrent SUI. Of the 18 women, 10 patients underwent shortening of implanted tape and the others underwent repeat TVT. All the patients were evaluated preoperatively with a detailed history, pelvic examination, urinalysis, voiding diary and urodynamic study that included the Valsalva leak point pressure(VLPP). The postoperative outcomes were assessed by a review of admissions and the medical charts.
Results: The mean interval from first surgery to recurrence was 6.88±2.61 months for Monarc, 12 months for TVT-O and 4.71±2.42 months for T-sling. Of the 10 patients who underwent shortening of the implanted tape, 7(70%) patients were cured and the others failed. Of the 8 patients who underwent repeat TVT, 7(87.5%) patients were cured and one was significantly improved. The success rate is significantly higher in the repeated TVT group(p＜0.05).
Conclusions: Both a shortening of the previously implanted tape and a repeated TVT procedure are safe, effective, viable options in the event of initial TOT sling failure. However, the success rate of the repeated TVT group is higher than that of the shortening of implanted tape group, especially for patients with an internal sphincteric deficiency. Therefore, a repeated TVT procedure is a first option in the event of initial TOT sling failure
키워드
Urinary Incontinence;Urethra;Tension-free vaginal tape;Transobturator tape
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