過活動膀胱の病態と治療 - 薬物療法推進の立場から -

Abstract

Pharmacolgical treatment is the main stay in the treatment of overactive bladder (OAB). However, it can be difficult to treat the patients with OAB and voiding difficulty. The present patient was a 75-year-old male, who had wet OAB and voiding difficulty with slight enlargement of the prostate (ultrasound-estimated prostate volume; 28 ml) and a medical history of cerebral infarction. The analysis of clinical data gained from the patients with lower urinary tract symptoms in our institution suggested that the etiology of OAB in this patient was neurogenic bladder with high probability (nearly 80%), and the probability of the existence of bladder outlet obstruction (BOO) was approximately 40%. Given the high probability of the neurogenic OAB, the first-line therapy should be a pharmacological treatment. If he had BOO, the treatment should start with alpha-adrenoceptor blockers, and also the combination of anticholinergic drugs and alpha-blockers would be beneficial. If he had impaired detrusor contractility, we have no evidence-based proposal for his treatment.