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현경헌,박형무,배도환 중앙대학교 의과대학 의과학연구소 1990 中央醫大誌 Vol.15 No.3
This present study was undertaken to evaluate the characteristic anatomic configuration of bladder and urethra in patients with stress urinary incontinence before and after anterior colporrhaphy and the efficacy of this operation as a corrective surgery for anatomic changes. For these purposes, metallic beaded chain urethrocystography was conducted in 42 patients with stress urinary incontinence before and after anterior colporrhaphy and 10 normal continent control at Department of Obstetrics and Gynecology, Chung-Ang University Hospital from March 1986 to September 1989. The results were as follows: 1. Posterior urethrovesical angle and urethral inclination angle on straining were greater and posterior urethrovesical junction was lower in stress urinary incontinence than in normal continence. 2. Stress urinary incotinent patients with abnormal urethal axis (Type Ⅱ) showed significantly greater posteior urethrovesical and urethral inclination angles and lower posterior urethrovesical junction than in patients with normal urethral axis (TypeⅠ). 3. After anterior colporrhaphy, posterior urethrovesical and urethral inclination angles were significantly smaller and posterior urethrovesical junction was significantly elevated than before operation. But loss of posterior urethrovesical angle was not corrected in 38.1% of all patient with stress urinary incontinence and posterior urethrovesical junction was still placed below the S-S_5 line in 57.l'%. Most of the type Ⅱ patients, especially, showed these findings. From these results, we concluded that stress urinary incontinence is the results of anatomically defective supports of urethrovesical junction and urethra and stress urinary incontinence with abnormal urethral axis suggests more severe defective anatomic supports. Anterior colporraphy is not considered as a proper surgical method for stress urinary incontinence based on anatomical views because this procedure doesn't satisfactorily correct abnormal urcthrovesical anatomic configurations.
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현경헌(KH Hyun),윤병녕(BN Yoon),이원강(WK Lee),배도환(DH Pai) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.7
저자들은 1983년 11월 본원 산부인과에서 수술후 병리조직검사로 확인된 원발성 질혹색종 1예를 경험하였기에 문헌고찰과 함계 보고하는 바이다. Vaginal melanoma has been considered in the past to be always secondary since it had been accpted that melanocytes did not occur in the vagina This objection is no longer valid Melanocytes are present in 3% of vaginas. Their presene provides a theoretic cell or origin for malignant melanoma of the vagina Primary malignant melanomal of the vagina is extremly rare disease and the prognosis of the patient bearing malignant malanoma of the vagina is very poor inspite of variety of therapeutic measures. A caes of primary malignant melanoma of the vagina we experienced was presented with a brief review of literature.
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긴장성요실금 환자에서 전질벽 협축술 전후의 방광과 요도의 해부학적 형태에 대한 연구
배도환,박형무,현경헌,이재창 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.4
본 연구는 1986년 3월부터 1989년 9월까지 만 3년6개월간 중앙대학교 의과대학 산부인과 에 입원하여 전질벽협축술을 시행받은 긴장성요실금 환자 42명과 정상 대조군여성 10명을 대상으로 금속성 염주상 연쇄요도방광조영술을 시행하여 방광과 요도의 해부학적 구조를 비 교함으로서 긴장성 요실금에서 방광과 요도의 해부학적 특징과 병인을 연구하고, 절질벽협축 술 전후의 방광요도의 해부학적 변화를 분석하여, 전질벽협술의 효용성을 객관적으로 평가해 보고자 하였다. 이에 다음과 같은 결과를 얻었다. 1. 긴장성 요실금 환자군에서 정상 대조군에 비해 방광의 높이와 깊이는 유의하게 증가되어 있었다. 그러나 방광의 넓이는 유의한 차가 없었다. 2. 긴장성요실금 환자군에서 긴장시 정상 대조군에 비해 후두요도방광각 및 요도경사각은 유 의하게 증가되어 있었으며, 후부요도방광접합부는 유의하게 하강되어 있었다. 3. 긴장성요실금 환자군을 요도축에 따라 정상인군(I)과 비정상인군(II)으로 나누었으며, II군은 I군에 비해 후부요도방광각은 유의하게 증가되어 있었고 후부요도방광접합부는 유의하게 더욱 하강되어 있었다. 4. 긴장성요실금으로 전질벽협출술을 시행한 후 긴장시 측정한 후부요도방광각과 요도경사각은 수술전에 비해 매우 유의하게 감소되었으며 후부요도접합부는 유의한 상승을 보였다. 그러나 전질벽협축술후에도 38%에서는 후부요도방광각의 소실이 교정되지 않았으며, 57.1%에서 는 후부요도방광접합부가 비정상적으로 S-Sv선 하방에 위치하였다. 특히 수술전 비정상적인 요도축을 보였던 긴장성요실금 환자군에서는 전질벽협축술후에도 긴장시 87.5%에서 후부요 도방광각의 소실이 교정되지 않았고, 전예에서 후부요도방광접합부가 S-Sv선 하방에 위치하였다. 이상의 결과에서 긴장성요실금은 방광경부 및 요도의 해부학적 지지의 결핍으로 발생되며 특히 요도축이 비정상적인 경우에는 그 결핍의 정도가 더욱 중함을 시사한다고 생각된다. 전 질벽협축술을 이러한 해부학적 변형을 교정한다는 목적으로 볼 때 만족스러운 술식으로 생각되지 않으며 특히 요도축이 비정상인 환자군에서는 피해야할 것으로 판단된다. This present study was undertaken to evaluate the characteristic anatomic configuration of bladder and urethra in patients with stress urinary incontinence before and after anterior colporrhaphy and the efficacy of this operation as a corrective surgery for anatomic changes. For these purpose, metallic beaded chain urethrocystrography was conducted in 42 patients with stress urinary incontinence before and after anterior colporrhaphy and 10 normal continent control at Department of Obstetrics and Gynecology, Chung-Ang University Hospital from March 1986 to September 1989. The results were as follows: The height and depth of bladder were significantly increased in patients with stress urinary incontinence compared with normal control but not the width. Posterior urethrovesical angle and urethral inclination angle on straining were greater and posterior urethrovesical junction was lower in stress urinary incontinence than in normal continence. Stress urinary incontinent patients with abnormal urethral axis (Type II) showed significantly greater posterior urethrovesical and urethral inclination angles and lower posterior urethrovesical junction than in patients with normal axis (Type I). After anterior colporrhaphy, posterior urethrovesical and urethral inclination angles were significantly smaller and posterior urethrovesical junction was significantly elevated than before operation. But loss of posterior urethrovesical angle was not corrected in 38.1% of all patient with stress urinary incontinence and posterior urethrovesical junction was still placed below the S-Sv line in 57.1%. Most of the type II patients, especially, showed this findings. From these results, we concluded that stress urinary incontinence is the results of anatomically defective supports of urethrovesical junction and urethra and stress urinary incontinence with abnormal urethral axis suggests more severe defective anatomic supports. Anterior colporraphy is not considered as a proper surgical method for stress urinary incontinence based on anatomical views because this procedure doesn`t satisfactorily correct abnormal urethrovesical anatomic configurations.
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