CAJ | 학술논문

目的：探讨由内向外经闭孔无张力悬吊术（tension-free vaginal tape obturator，TVT-O）和由外向内经闭孔无张力悬吊术（transobturator suburethral tape，TOT）修复女性压力性尿失禁对性生活的影响。方法对2011年12月至2012年5月分别接受TVT-O及TOT的44例女性患者于术前及术后一年进行调查研究。其中TVT-O组24例，年龄40～67（52.5±6.6）岁；TOT组20例，年龄38～74（55.4±8.4）岁。采用盆腔器官脱垂/尿失禁患者性功能问卷简表（PISQ-12）对患者进行问卷调查并进行评分。结果两组手术均顺利进行，术前有性生活的35例患者（TVT-O组20例、TOT组15例）手术前后PISQ-12评分比较，两组差异均无统计学意义（P＞0.05）。术前无性生活的部分患者，因为症状改善术后恢复性生活；术前有性生活的患者，术后均未停止性生活。经闭孔尿道中段无张力悬吊两种术式（TVT-O与TOT）治疗女性压力性尿失禁的患者中有性生活的，性生活改善率（PISQ-12评分增加）分别为35%和40%，两组改善率差异没有统计学意义（P＞0.05）。术前性生活有溢尿的16例患者中，9例术后PISQ-12评分升高；术前性生活无溢尿的19例患者中，4例术后PISQ-12评分升高；两者性生活改善率差异有统计学意义（P＜0.05）。结论 TVT-O和TOT治疗女性压力性尿失禁均对患者性生活质量无显著影响，性生活中不自主溢尿者，术后因症状缓解可提高性生活质量。
목적：탐토유내향외경폐공무장력현조술（tension-free vaginal tape obturator，TVT-O）화유외향내경폐공무장력현조술（transobturator suburethral tape，TOT）수복녀성압력성뇨실금대성생활적영향。방법대2011년12월지2012년5월분별접수TVT-O급TOT적44례녀성환자우술전급술후일년진행조사연구。기중TVT-O조24례，년령40～67（52.5±6.6）세；TOT조20례，년령38～74（55.4±8.4）세。채용분강기관탈수/뇨실금환자성공능문권간표（PISQ-12）대환자진행문권조사병진행평분。결과량조수술균순리진행，술전유성생활적35례환자（TVT-O조20례、TOT조15례）수술전후PISQ-12평분비교，량조차이균무통계학의의（P＞0.05）。술전무성생활적부분환자，인위증상개선술후회복성생활；술전유성생활적환자，술후균미정지성생활。경폐공뇨도중단무장력현조량충술식（TVT-O여TOT）치료녀성압력성뇨실금적환자중유성생활적，성생활개선솔（PISQ-12평분증가）분별위35%화40%，량조개선솔차이몰유통계학의의（P＞0.05）。술전성생활유일뇨적16례환자중，9례술후PISQ-12평분승고；술전성생활무일뇨적19례환자중，4례술후PISQ-12평분승고；량자성생활개선솔차이유통계학의의（P＜0.05）。결론 TVT-O화TOT치료녀성압력성뇨실금균대환자성생활질량무현저영향，성생활중불자주일뇨자，술후인증상완해가제고성생활질량。
Objective To evaluate the impact of TVT-O(tension-free vaginal tape obturator) and TOT(transobturator suburethral tape) for female stress urinary incontinence on sex. Methods 44 cases of female stress urinary incontinence were divided into two groups. The 44 women in the survey do not have medical record of severe overactive bladder, pelvic organ prolapse, hysterectomy or supraubc arch sling. 24 women aged between 40 and 67(52.5±6.6) years were in the group of TVT-O, among whom 20 had experienced sex before surgery. Other 20 women aged between 38 and 67(55.4±8.4) years in the group of TOT included 15 cases that had experience of sex. There were no statistical significance between differences of two groups in general information (P>0.05). Before surgery and one year after the surgery, the 44 female patients received the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) and the result showed that the higher the score was, the better the quality of their sex life. Results The surgeries were successful and the comparison of the two groups' scores through PISQ-12 questionnaire showed that no statistical significance was observed between the two groups(P>0.05). 2 of 9 patients(20.45%) who had no sex experience before the surgery resume their sexual life while the other 35 patients(79.55%) were still sexual active after the surgery. The female patients who had sex experience were improved in their sex life by 35% through TVT-O and 40% through TOT and there was no significant difference between two groups in improvement rate(P>0.05). Among 16 patients who had urine leakage in sex life before the surgery, the scores of 9 cases(56.25%) rose while 4 patients among the 19 patients who had no urine leakage in sex life before the surgery got their scores rise and the rate differences between their sex improvement was statistically significant(P<0.05). Conclusion TVT-O and TOT for female stress urinary incontinence have no adverse effects to the patients' sex life; neither can it enhance their sex life. There's no significance difference in the effects that the two surgical treatments exerted to the patients' sex life. However, the quality of sexual life may be enhanced with the symptoms alleviated after surgery for the patients who had urine leakage in sex life.