복압성요실금의 치료에서 방광경부현수술과 질전벽 슬링수술의 비교

Abstract

Purpose: We usually treat anatomical incontinence (Al) with bladder neck suspension and intrinsic sphincter deficiency (ISD) with pubovaginal sling. However, there have been many reports of poor long-term outcome of bladder neck suspension and many complications of pubovaginal sling. Therefore anterior vaginal wall sling has been more frequently used in treating stress urinary incontinence because of its simplicity, diversity and good treatment result after short-term follow-up in both Al and ISD, recently. We compared the outcome of bladder neck suspension with anterior vaginal wall sling. Materials and Methods: Between February 1989 and January 2000, 218 patients underwent anti-incontinence surgery at our institution. Of these patients we included 67 patients who underwent bladder neck suspension and 68 patients who underwent anterior vaginal wall sling. Preoperative evaluations included history, vaginal examination, stress test, Q-tip test, 1 hour pad test, chain cystography or ultrasonography of female pelvis and urodynamic study including valsalva leak point pressure. Mean follow-up periods were 61.0 months for bladder neck suspension and 25.7 months for anterior vaginal wall sling. All patients were investigated retrospectively by chart review and telephone survey. Results: Mean operative time was 77.6 minutes and 65.2 minutes in bladder neck suspension and anterior vaginal wall sling, respectively. Complication rate was comparable as 22.4% and 26.5%. Success rate were 97.0% and 98.4% in postoperative 1st year, 88.1% and 96.7% in 2nd year and 83.4% and 94.8% in 3rd year. Failures were encountered in 25 cases in bladder neck suspension and 5 cases in anterior vaginal wall sling including 2 cases of ISD. Conclusions: Anterior vaginal wall sling is a superior technique for treating SUI to bladder neck suspension due to its simplicity, diversity and good treatment result after short-term follow-up. In order to rule out an adverse effect of vaginal wall aging, a loner follow-up period is needed to assess the exact efficacy of anterior vaginal wall sling. Key word : Stress urinary incontinence, Anterior vaginal wall sling, Bladder neck suspension