복압성 요실금 환자에서 복막외 복강경하 방광경부현수술의 장기추적관찰

초록

PURPOSE: Despite the encouraging short-term results after the laparoscopic Burch operation for female stress urinary incontinence, many investigators reported the decreases of the success rate on long-term follow up studies. These facts have urged us to investigate the change of success rate on long term follow up and related factors of them. MATERIALS AND METHODS: This study was performed for 39 patients who have received laparoscopic Burch operation from May 1995 to December 1996. Mean follow up duration was 41 months (32-50 months). Extraperitoneal approach was performed in all cases, and postoperative 3 months and long term follow-up results were assessed using standardized questionnaire and medical record. Symptom grades were categorized by Stamey grade. Factors affecting postoperative outcome and complications were also analyzed. RESULTS: On 3 month short term follow-up, 64.1% were cured and 28.2% were improved. However, on the long term follow-up, success rates were droped to 46.1% and 25.6% respectively. Factors affecting postoperative outcome were preoperative Stamey grade and VLPP. Age, parity, symptom's duration, body weight had no correlation with post-operative results. Of the 12 patients with preoperative symptoms of urgency and/or urge incontinence, 8 patients reported those were disappeared or decreased postoperatively. Obstructive symptoms occurred in 7 cases, but progressively improved with time. CONCLUSIONS: With these results, we could conclude that initial success rate of laparoscopic Burch operation is high, but it declined with time. However, on the basis of the result that Stamey grade I patient had lower failure rate, we could selectively apply this operation for grade I stress urinary incontinence.

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