臨床泌尿器科78巻8号

2024年07月発行

特集 前立腺肥大症の診療トランスフォーメーション―低侵襲的外科治療の台頭 〈診断〉

術前にカテーテル挿入を伴う尿流動態検査が必要な前立腺肥大症とは？

著者： 関戸哲利¹

所属機関： ¹東邦大学医療センター大橋病院 泌尿器科

ページ範囲：P.530 - P.537

▶ポイント

・尿閉や清潔間欠導尿を要する多量の残尿が膀胱出口部閉塞に起因するのか排尿筋無収縮に起因するのかを鑑別したい場合には，術前に尿流動態検査を実施することが勧められる．

・歩行障害や認知機能障害を認める患者で，腰仙部神経学的所見に異常が認められる場合には，術前に尿流動態検査を実施することが勧められる．

参考文献

1） Homma Y, et al : Clinical guidelines for male lower urinary tract symptoms and benign prostatic hyperplasia. Int J Urol 24 : 716-729, 2017

2） Malde S, et al : Systematic Review of the Performance of Noninvasive Tests in Diagnosing Bladder Outlet Obstruction in Men with Lower Urinary Tract Symptoms. Eur Urol 71 : 391-402, 2017

3） Drake MJ, et al : Diagnostic Assessment of Lower Urinary Tract Symptoms in Men Considering Prostate Surgery : A Noninferiority Randomised Controlled Trial of Urodynamics in 26 Hospitals. Eur Urol 78 : 701-710, 2020

4） Lerner LB, et al : Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia : AUA GUIDELINE PART II-Surgical Evaluation and Treatment. J Urol 206 : 818-826, 2021

5） Gotoh M, et al : Prognostic value of pressure-flow study in surgical treatment of benign prostatic obstruction. World J Urol 17 : 274-278, 1999

6） Wada N, et al : Long-term symptomatic outcome after transurethral resection of the prostate : A urodynamics-based assessment. Int J Urol 26 : 1071-1075, 2019

7） Kageyama S, et al : Can persisting detrusor hyperreflexia be predicted after transurethral prostatectomy for benign prostatic hypertrophy? Neurourol Urodyn 19 : 233-240, 2000

8） Tanaka Y, et al : Is the short-term outcome of transurethral resection of the prostate affected by preoperative degree of bladder outlet obstruction, status of detrusor contractility or detrusor overactivity? Int J Urol 13 : 1398-1404, 2006

9） Blaivas JG, et al : Surgical treatment of detrusor underactivity : a short term proof of concept study. Int Braz J Urol 43 : 540-548, 2017

10） Creta M, et al : Detrusor overactivity and underactivity : implication for lower urinary tract symptoms related to benign prostate hyperplasia diagnosis and treatment. Minerva Urol Nephrol 73 : 59-71, 2021

11） Kim M, et al : Diagnostic value of urodynamic bladder outlet obstruction to select patients for transurethral surgery of the prostate : Systematic review and meta-analysis. PLoS One 12 : e0172590, 2017

12） Kim M, et al : Effect of Preoperative Urodynamic Detrusor Underactivity onTransurethral Surgery for Benign Prostatic Hyperplasia : ASystematic Review and Meta-Analysis. J Urol 199 : 237-244, 2018

13） Wroclawski ML, et al : Functional and safety outcomes after benign prostatic enlargement surgeries in men with detrusor underactivity compared with normal detrusor contractility : Systematic review and meta-analysis. Neurourol Urodyn 43 : 126-143, 2024

14） Young GJ, et al : Prostate Surgery for Men with Lower Urinary Tract Symptoms : Do We Need Urodynamics to Find the Right Candidates? Exploratory Findings from the UPSTREAM Trial. Eur Urol Focus 8 : 1331-1339, 2022

15） Ito H, et al : Predicting Prostate Surgery Outcomes from Standard Clinical Assessments of Lower Urinary Tract Symptoms To Derive Prognostic Symptom and Flowmetry Criteria. Eur Urol Focus 10 : 197-204, 2024

16） Roy HA, et al : Assessment of patients with lower urinary tract symptoms where an undiagnosed neurological disease is suspected : A report from an International Continence Society consensus working group. Neurourol Urodyn 39 : 2535-2543, 2020

17） Sakakibara R, et al : A guideline for the management of bladder dysfunction in Parkinson's disease and other gait disorders. Neurourol Urodyn 35 : 551-563, 2016

18） Ho GR, et al : Voiding Dysfunction Due to Urethral Sphincter Dysfunction Might Be an Early Neurological Presentation of Central Nervous System Disorders in Aged Patients. J Pers Med 13 : 693, 2023

19） Ginsberg DA, et al : The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction : Diagnosis and Evaluation. J Urol 206 : 1097-1105, 2021