중부 요도 슬링 수술의 실패 위험인자(단기 추적관찰): 순수 복압성요실금과 복합성요실금이 다른가?
Are Risk Factors for Failure after Mid-Urethral Sling Operation Different between Patients with Pure Stress and Those with Mixed Urinary Incontinence in the Short-Term Follow-Up?
정성진, 황인식, 김성수, 이승태, 민경은, 한병규, 홍성규, 변석수, 이상은,
소속 상세정보
정성진 ( Jeong Seong-Jin )
서울대학교 의과대학 분당서울대학교병원 비뇨기과학교실
황인식 ( Hwang In-Sik )
서울대학교 의과대학 분당서울대학교병원 비뇨기과학교실
김성수 ( Kim Seong-Soo )
서울대학교 의과대학 분당서울대학교병원 비뇨기과학교실
이승태 ( Lee Seung-Tae )
서울대학교 의과대학 분당서울대학교병원 비뇨기과학교실
민경은 ( Min Kyung-Eun )
서울대학교 의과대학 분당서울대학교병원 비뇨기과학교실
한병규 ( Han Byoung-Kyu )
서울대학교 의과대학 분당서울대학교병원 비뇨기과학교실
홍성규 ( Hong Sung-Kyu )
서울대학교 의과대학 분당서울대학교병원 비뇨기과학교실
변석수 ( Byun Seok-Soo )
서울대학교 의과대학 분당서울대학교병원 비뇨기과학교실
이상은 ( Lee Sang-Eun )
서울대학교 의과대학 분당서울대학교병원 비뇨기과학교실
KMID : 0358320090500060573
Abstract
Purpose: Although application of the mid-urethral sling (MUS) operation has expanded to more complicated cases such as patients with mixed urinary incontinence (MUI), the success rates in patients with MUI have been reported to be lower than those in patients with pure stress urinary incontinence (SUI). We evaluated and compared the risk factors for failure after MUS surgery in patients with pure SUI and in those with MUI.
Materials and Methods: Two hundred twenty-eight women were categorized as having pure SUI (Group A, 163 patients) or MUI (Group B, 65 patients). Preoperative evaluations including a symptom questionnaire, physical examination, and urodynamic study were performed. Patients underwent retropubic (17.5%) or trans-obturator (82.5%) MUS surgery.
Results: The demographic characteristics that differed between the 2 groups were body mass index, presence of cystocele, and severity of incontinence. The success rate in Group A (95.7%) was higher than that in Group B (84.6%) (p=0.015, chi-square test). In Group A, VLPP, PdetQmax, and weight of the 1-hour pad test were identified as risk factors for failure of the operation in the univariate analysis, but only weight of the 1-hour pad test was an independent risk factor in the multivariate analysis (adjusted odds ratio [OR]=3.5; 95% confidence interval [CI]=1.204-8.895, p=0.045). In Group B, menopause without hormone replacement, AUA Symptom Index-QoL score, maximal cystometric capacity (MCC), and involuntary detrusor contraction (IDC) were the risk factors in the univariate analysis, but only MCC (adjusted OR=0.9; 95% CI=0.645-0.984, p=0.032) and IDC (adjusted OR=2.3; 95% CI=1.014-3.309, p=0.044) were independent risk factors in the multivariate analysis.
Conclusions: Unlike in pure SUI, weight of the 1-hour pad test was not a significant predictor of failure of surgery in MUI. Meanwhile, MCC and IDC, which indicate the pathophysiologic status of the detrusor muscle itself, were important predictors of failure of surgery in MUI.
키워드
Stress urinary incontinence;Urge urinary incontinence;Suburethral slings;Risk factors
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