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최종보 대한배뇨장애요실금학회 2008 International Neurourology Journal Vol.12 No.1
Voiding dysfunction is very common in Alzheimer's disease, especially urinary incontinence with reported frequencies of 11-90%. Urinary incontinence occurs secondarily from dementia, can result in medical morbidity, impaired self-esteem of the patents, caregiver's stress, early institutionalization of the patients, and considerable financial cost. Many studies have found that the frequency and severity of incontinence is positively correlated with the severity of dementia and the inability to walk or transfer. Research on the management of urinary incontinence in demented patients has focused almost exclusively on toileting programs and drug treatments for detrusor overactivity. To date, anticholinergic and antispasmodic medications have not been shown to be effective in treating incontinence in demented persons. Therefore we have to study about the etiology and treatment of Alzheimer's disease. (J Korean Continence Soc 2008;12:10-17)
여성 복압성 요실금 환자에서 TVT 술식 후 발생한 배뇨곤란의 Hegar 확장기를 이용한 치료경험
문형윤,노준,김철성,장대수,조원진,임동훈,백승 대한배뇨장애요실금학회 2005 International Neurourology Journal Vol.9 No.1
The tension-free vaginal tape procedure (TVT) has become a state of the art operation for female stress urinary incontinence. The most common problems after the TVT seen are voiding difficulties. Although the incidence of urinary retention appears to be low after the TVT procedure, it is recommended that patients be counseled about the risk and carefully monitored for voiding symptoms during the first 3 weeks postoperatively. When obstruction after the TVT is clinically evident, immediate tape adjustment in the operating room by open vaginal incision, may be indicated. We report of voiding difficulty 8 weeks after the TVT who was successfully managed with urethral dilation. (J. Korean Continence Society 2005;9:46-48)
비신경인성 여성 배뇨장애환자에서 4주간의 Doxazosin GITS의 효용성과 안정성: 단기 추적 결과
이규성,서주태,주명수,김준철,한덕현,김지영,정진우,추설호 대한배뇨장애요실금학회 2008 International Neurourology Journal Vol.12 No.1
Purpose: We administered doxazosin gastrointestinal therapeutic system (GITS) to women with non-neurogenic voiding dysfunction to evaluate its therapeutic effects. Materials and Methods: Women who had voiding dysfunctions for at least 3 mo were included. Inclusion criteria were age ≥18yr, an International Prostate Symptom Score (IPSS) ≥15, and a maximum flow rate (Qmax) <15mL/sec and/or postvoid residual (PVR) ≥150mL. Patients with neurogenic voiding dysfunction or anatomical bladder outlet obstruction were excluded. All patients were classified according to the Blaivas-Groutz nomogram. After 4 weeks, treatment outcomes were evaluated. Results: Sixty-two patients were evaluated of mean age 53.8 (32-78)yr. According to the Blaivas-Groutz nomogram, 24 patients had no or mild obstruction (group A) and 38 had moderate or severe obstruction (group B). After treatment, mean IPSS decreased significantly and by more than 5 points in 42 (67.7%). Mean bother scores, Qmax, and PVR also changed significantly. Thirty-seven (59.7%) showed Qmax increases of more than 50%. No significant difference were observed between the groups in terms of IPSS, bother score, Qmax, PVR, micturition frequencies, or functional bladder capacity changes. Adverse effects related to medication were de novo stress urinary incontinence (SUI) (1 case) and underlying SUI aggravation (1 case). By satisfaction assessments, 16 patients (25.8%) were 'mainly satisfied', 31 (50%) were 'slightly satisfied', and 15 (24.2%) were 'dissatisfied'. Conclusion: Doxazosin GITS was found to be effective in female patients with voiding dysfunction regardless of obstruction grade. The α-adrenoceptor antagonists should be viewed as initial treatment option for women with a non-neurogenic voiding dysfunction. (J Korean Continence Soc 2008;12:19-26)
Tension-free Vaginal Tape (TVT)수술 후 발생한 배뇨곤란에서 시행한 테이프 절단에 대한 연구
이동환,김준철,이지열,서홍진 대한배뇨장애요실금학회 2005 International Neurourology Journal Vol.9 No.1
Purpose: Tension-free vaginal tape (TVT) procedure is widely used as an initial operative method in stress urinary incontinence because of high success rate and low morbidity. However, some patients have complained of voiding difficulties after TVT. We evaluated 14 patients who underwent mesh cutting because of obstructive symptoms after TVT. Materials and Methods: 14 patients who underwent mesh cutting because of prolonged obstructive symptoms after TVT were included for the study. Their voiding symptoms were evaluated by Qmax, voiding time and postvoid residual urine. These parameters which were done before TVT, post-TVT and post-mesh cutting were compared. Results: 4 out of 14 patients were intrinsic sphincter deficiency (valsalva leak point pressure <60 cmH2O) and no patient had detrusor overactivity before TVT. After TVT, Qmax was decreased from 25.4±3.5 ml/sec to 9.4±2.4 ml/sec, and voiding time was prolonged from 26.7±6.6 sec to 65.5±24.8 sec. However, the volume of postvoid residual urine was unchanged. After mesh cutting, Qmax was increased to 21.7±7.7 ml/sec and voiding time was decreased to 27.2±7.6 sec. Subjective voiding symptoms were improved immediately in 13 out of 14 patients (92.9%), although 1 patient showed small amount of urine leakage when coughing. And also, in 1 out of 2 patients, detrusor overactivity which was shown after TVT was disappeared. Conclusion: We believe that we do not need to hesitate to cut the mesh in patients who are suffering from severe obstructive symptoms after TVT. (J. Korean Continence Society 2005;9:13-16)
과민성 방광모델로서 자연발생 고혈압 쥐에서 비마취하 요역동학 검사로 관찰한 항콜린성 제제인 tolterodine의 배뇨 압력 및 용적에 대한 경구 및 주사 효과
이소영,권용현,윤상민,진롱후,장진혁,강용진,이택 대한배뇨장애요실금학회 2009 International Neurourology Journal Vol.13 No.2
Purpose: We investigated the effect of oral or intravenous tolterodine on cystometric parameters in awake spontaneously hypertensive rats (SHRs) as a model of overactive bladder (OAB). The aim of our study was to observe the experimental conditions required to reproduce the clinical pharmacological effects of tolterodine, as seen in humans, to decrease bladder pressure or increase bladder capacity. Materials and methods: We studied the effects of the most widely used antimuscarinic drug, tolterodine, on cystometric parameters via two different administrations (oral and intravenous) in awake SHRs. Results: Oral administration of tolterodine 10 mg/kg-1 body weight in awake rats did not change any cystometric parameters significantly. Intravenous administration of tolterodine 0.3 mg/kg-1 body weight significantly decreased basal pressure (BP) and micturition pressure (MP), but showed no effect on micturition interval (MI) or bladder capacity (BC). Conclusion: Despite a high dose of tolterodine via an oral or an intravenous route, a decrease in BP or MP was the only effect on cystometrographic parameters in awake rats, whereas MI and BC were not significantly affected. Therefore, it is difficult to reproduce in awake rats as an acute response the cystometric increase in the MI that is observed in humans after chronic administration of antimuscarinic agents.
배뇨근 저활동성의 복압성 요실금 환자에서 중부 요도 슬링이 배뇨에 미치는 영향
이상협,김진일,이선주 대한배뇨장애요실금학회 2009 International Neurourology Journal Vol.13 No.1
Purpose: The aim of this study was to analyze the influence on voiding symptoms when performing sling operation on patients with stress urinary incontinence with detrusor underactivity. Materials and Methods: We analyzed medical records of 100 patients who received the sling operation. Based on their preoperative urodynamic study, we defined "stress urinary incontinence with detrusor underactivity (SUI with DU)" group as these findings; peak flow less than 11 ml/s or void with abdominal pressure instead of detrusor contraction or residual urine volume more than 100 ml. And the others were defined as the "stress urinary incontinence only (SUI)"group. We compared two groups and analyzed the changes of pre- and postoperative uroflowmetry. Results: The number of patients with the "SUI with DU" group was 30 and that with the "SUI" group was 70. In the "SUI with DU" group, there were no changes in peak flow rate and residual urine volume between postoperative uroflowmetry and preoperative urodynamic study (15.1 ± 7.9 vs. 14.7 ± 7.1 ml/s, 123.1 ± 79.2 vs. 127.3 ± 91.9 ml) (p>0.05). Twenty four patients underwent urinary drainage with nelatone catheter either on postoperative first or second day. However, 22 patients did not need to continue self catheterization. Conclusion: Sling operation could be performed on patients who are diagnosed as stress urinary incontinence with detrusor underactivity without aggravating their voiding symptoms. (J Korean Continence Soc 2009;13:73-79)
대상포진에 의한 배뇨장애에서 치료 방법에 따른회복기간의 비교
박범수,김진일,이선주 대한배뇨장애요실금학회 2007 International Neurourology Journal Vol.11 No.1
Purpose: We compared the recovery periods in zoster-associated voiding dysfunction according to the treatment modality to establish the best treatment policy. Materials and Methods: From January 2004 to August 2006, medical records of 250 patients admitted for zoster infection were reviewed. Of 250 patients, patients complaining of lower urinary tract symptoms (LUTS) were selected. The clinical and urodynamic features, and treatment outcomes were analyzed. Results: Thirty eight (15.2%) of 250 patients had zoster-associated LUTS. Urinary retention was the most common symptom. Urodynamically, detrusor underactivity was the most common finding (71.8%). Twenty were followed, of which 5 received oral medication, 10 received clean intermittent catheterization (CIC), 4 received indwelling catheterization (IC) and remained 1 was observed without treatment. All patients regained normal voiding function. Mean recovery period was 12 days. According to the treatment modality, mean recovery period was 21 days in medication group, 10 days in CIC group, and 6 days in IC group. The mean recovery period was significantly shorter in CIC or IC group than medication group (p=0.013, 0.005). Conclusion: Zoster-associated voiding dysfunction is a reversible condition. Thus, patients with mild symptoms can be observed. However, if symptoms are severe or retention develops, catheterization is recommended rather than medication alone. (J. Korean Continence Society 2007;11:36-40)