TVT수술후 배뇨곤란을 유발하는 수술전 인자

초록

PURPOSE: A tension-free vaginal tape (TVT) operation does not usually affect voiding when a prolene tape is placed in the mid urethra without tension. However, some patients complain of voiding difficulty after a TVT operation. Attempts were made to find any clinical or urodynamic parameters that can predict voiding difficulties after a TVT procedure. MATERIALS AND METHODS 128 patients, who had undergone a TVT operation and completed follow up evaluations by symptom questionnaire and uroflometry, were reviewed. The patients were divided into groups I & II, who had achieved normal voiding or complained of voiding difficulties after the surgery, respectively, according to the results of the questionnaire. The pre and postoperative clinical and urodynamic parameters were compared between the two groups. The urodynamic parameters that can predict post operative voiding difficulty were analyzed. RESULTS 104 patients (81.25%) became completely dry and 24 (18.75%) improved their urinary incontinence. In all cases, the post operative Qmax (peak flow rate) decreased, and the flow time, time to Qmax and residual volume increased significantly. Group II (76 patients) had lower Qmax, Pdetmax (maximal detrusor pressure), PdetQmax (maximal detrusor pressure at peak flow rate) and URA (urethral resistance factor) values than Group I (52 patients). There were no significant differences in the uroflometry parameters, with the exception of an increase in the postvoid- residuals between the two groups. CONCLUSIONS It was found that the TVT operation provoked changes in the voiding pattern. In patients who complained of voiding difficulty after the TVT operation had relatively lower Qmax, Pdetmax and PdetQmax values in the preoperative data than those with normal voiding. It is suggested that patients with relatively low Qmax or PdetQmax values preoperatively should be aware of the possibility of voiding difficulty after the TVT procedure.

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