KMID : 0358320080490121112
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Korean Journal of Urology 2008 Volume.49 No. 12 p.1112 ~ p.1118
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Preoperative Factors Predicting the Outcome of a Midurethal Sling Operation for Treating Women with Mixed Incontinence
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Kim Jae-Jun
Bae Jae-Hyun Lee Jeong-Gu
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Abstract
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Purpose: We wanted to investigate outcomes after midurethral sling(MUS) operations for treating women with mixed urinary incontinence(MUI) and we wanted to identify the factors for achieving a favorable outcome.
Materials and Methods: The retrospective data was collected for 279 women with MUI and who underwent a MUS operation with at least 2 years follow up. The following measures were recorded before MUS: a disease-specific validated questionnaire, 1-hour pad tests, standardized stress tests and urodynamic study. The patients were divided as followed; a predominance of bothering symptoms(stress-predominance, urgency- predominance) and the presence of detrusor overactivity(DO). The patients with DO were further classified into the high detrusor pressure (HPDO) group and the low pressure(LPDO) group with a reference level of 15cmH2O of maximum detusor pressure at which involuntary contraction occurred during filling cystometry. The patient¡¯s postoperative global impression of improvement, the Bristol Female Lower Urinary Tract Symptom(BFLUTS) score, improvement of stress incontinence(SUI) and urgency were analyzed.
Results: The overall success rate of SUI was 96.4%. The predominance of bothering symptoms or the presence of DO did not influence the over all SUI success rate. In a subgroup of women with DO, those women with LPDO showed a significantly higher SUI cure rate than those with HPDO. Urge incontinence resolved in 176(63.1%) and it improved in 60(21.5%), while it was aggravated or it persisted in 43(15.4%). Women with stress- predominant MUI, DO and LPDO experienced better resolution of urgency incontinence, an improved quality of life(QoL) and a higher global impression of improvement.
Conclusions: Our results suggest that women with stress-predominant MUI and without DO or with LPDO are more likely to be cured of their urge urinary incontinence after a MUS operation for treating mixed urinary incontinence.
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KEYWORD
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Mixed urinary incontinence, Overactive detrusor, Midurethral sling procedure
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