臨床泌尿器科76巻12号

2022年11月発行

特集 ブレずに安心! 尿もれのミカタ

〈女性〉

骨盤臓器脱に多くみられる尿失禁：その特徴と対策

著者： 三輪好生¹ 山口茜¹

所属機関： ¹岐阜赤十字病院泌尿器科・ウロギネセンター

ページ範囲：P.900 - P.906

文献概要

▶ポイント

・骨盤臓器脱（POP）の術後に新たな腹圧性尿失禁（SUI）を約30％で認め，術前に認めたSUIの約30％が術後に消失する．

・POP患者には切迫性尿失禁（UUI）を高率に合併するが，手術により約半数が消失する．また術後新たな過活動膀胱（OAB）を12％で認める．

・POP手術の術前から，術後のSUIを予測することは難しいため同時手術の適応には慎重を要する．

参考文献

1） Samuelsson EC, et al : Signs of Genital Prolapse in a Swedish Population of Women 20 to 59 Years of Age and Possible Related Factors. Am J Obstet Gynecol 180 : 299-305, 1999

2） Kato J, et al : Pelvic Organ Prolapse and Japanese Lifestyle : Prevalence and Risk Factors in Japan. Int Urogynecol 33 : 47-51, 2022

3） Laurence JM, et al : Prevalence and Co-Occurrence of Pelvic Floor Disorders in Community-Dwelling Women. Obstet Gynecol 111 : 678-685, 2008

4） Slieker-ten Hove MC, et al : The Prevalence of Pelvic Organ Prolapse Symptoms and Signs and Their Relation with Bladder and Bowel Disorders in a General Female Population. Int Urogynecol J Pelvic Floor Dysfunct 20 : 1037-1045, 2009

5） Ramanah R, et al : Effects of Pelvic Organ Prolapse Repair on Urinary Symptoms : A Comparative Study Between the Laparoscopic and Vaginal Approach. Neurourol Urodyn 31 : 126-131, 2012

6） Gosling JA, et al : Decrease in the Autonomic Innervation of Human Detrusor Muscle in Outflow Obstruction. J Urol 136 : 501-504, 1986

7） Van Koeveringe GA, et al : Effect of Partial Urethral Obstruction on Force Development of the Guinea Pig Bladder. Neurourol Urodyn 12 : 555-566, 1993

8） Steers WD, et al : Alterations in Afferent Pathways from the Urinary Bladder of the Rat in Response to Partial Urethral Obstruction. J Comp Neurol 310 : 401-410, 1991

9） Salvatore S, et al : Efficacy of Tolterodine in Women with Detrusor Overactivity and Anterior Vaginal Wall Prolapse : Is It the Same? BJOG 114 : 1436-1438, 2007

10） Tomoe H : Improvement of Overactive Bladder Symptoms After Tension-Free Vaginal Mesh Operation in Women with Pelvic Organ Prolapse : Correlation with Preoperative Urodynamic Findings. Int J Urol 22 : 577-580, 2015

11） Foster RT, et al : A Prospective Assessment of Overactive Bladder Symptoms in a Cohort of Elderly Women Who Underwent Transvaginal Surgery for Advanced Pelvic Organ Prolapse. Am J Obst Gynecol 197 : 82 e1-4, 2007

12） Maher C : Surgical Management of Pelvic Organ Prolapse in Women. Cochrane Database Syst Rev 14 : CD004014, 2010

13） Long CY, et al : Predictors of Improved Overactive Bladder Symptoms After Transvaginal Mesh Repair for the Treatment of Pelvic Organ Prolapse : Predictors of Improved OAB After POP Repair. Int Urogynecol J 22 : 535-542, 2011

14） Otubo A, et al : Presurgical Bladder Wall Thickness Is a Useful Marker to Predict the Postsurgical Improvement of Symptoms in Patients with Pelvic Organ Prolapse-Related Overactive Bladder. Lower Urinary Tract Symptom 13 : 347-355, 2021

15） Basu M, et al : Effect of Prolapse Repair on Voiding and The Relationship to Overactive Bladder and Detrusor Overactivity. Int Urologynnecol J Pelvic Floor Dysfunct 20 : 499-504, 2009

16） Bai SW, et al : The Significance of Bladder Trabeculation in the Female Lower Urinary System : An Objective Evaluation by Urodynamic Studies. Yonsei Med J 46 : 673-678, 2005

17） Frigerio M, et al : Risk Factors for Persistent, de novo and Overall Overactive Bladder Syndrome After Surgical Prolapse Repair. Eur J Obstet Gynecol Reprod Biol 233 : 141-145, 2019

18） Ellstrom Engh Amet, et al : Can de novo Stress Incontinence After Anterior Wall Repair Be Predicted? Acta Obstet Gynecol Scand 90 : 488-493, 2011

19） Borstad E : Surgical Strategies for Women with Pelvic Organ Prolapse and Urinary Stress Incontinence. Int Urogynecol J 21 : 179-186, 2010

20） Al-Mandeel H : Incidence of Stress Urinary Incontinence Following Vaginal Repair of Pelvic Organ Prolapse in Objectively Continent Women. Neurourol Urodyn 30 : 390-394, 2011

21） Maher C, et al : Surgery for Women with Apical Vaginal Prolapse. Review Cochrane Database Syst Rev Issue 10 : CD012376, 2016

22） Alas AN, et al : de novo Stress Urinary Incontinence After Pelvic Organ Prolapse Surgery in Women Without Occult Incontinence. Int Urogynecol J 28 : 583-590, 2017

23） 三輪好生, 他 : 腹腔鏡下仙骨腟固定術における術後腹圧性尿失禁とメッシュの固定方法に関する検討. 日排尿機能会誌28 : 351-355, 2018

24） Ubachs JM, et al : Partial colpocleisis by a modification of LeFort's operation. Obstet Gynecol 42 : 415-420, 1973

25） 野村昌良, 他 : 骨盤臓器脱患者における腹圧性尿失禁の腹腔鏡下仙骨腟固定術前後の変化. 日排尿機能会誌29 : 435-438, 2019