本例における初期治療として外科的治療(TUR-P)を推奨する

Abstract

The pathophysiology of lower urinary tract dysfunction in the presented case comprised voiding dysfunction and overactive bladder. Two etiologies for voiding dysfunction in this case could be considered, bladder outlet obstruction due to benign prostatic hyperplasia (BPH) or detrusor underactivity. Prospected efficacies of pharmacological and surgical treatment (transurethral resection of prostate: TUR-P) for this case were compared based on a literature review. Alpha-1 blockers improve both voiding and storage symptoms in patients with BPH. However, improvement of maximum flow rate (Qmax) on uroflowmetry is limited within a small range and there is no evidence of significant reduction in residual urine volume. Alpha-1 blockers have no significant efficacy in improvement of objective measures in patients with detrusor underactivity. Although anticholinergics improve overactive bladder symptoms, they are contraindicated for patients with severe voiding dysfunction with residual urine. There is a lack of study on efficacy of apha-1 blocker administration combined with anticholinergics available in our hands for patients with BPH and overactive bladder. On the other hand, TUR-P brings remarkable improvement in voiding and storage symptoms, increase of flow rate and reduction of residual urine as a gold-standard surgical treatment for BPH. Urge incontinence and uninhibited detrusor contraction on cystometry reportedly disappeared in 60% of patients following TUR-P. TUR-P also improves subjective symptom and objective measures in patients with BPH and detrusor underactivity. Based on the literature review, surgery is recommended as a standard initial therapy for the presented patient with significant voiding dysfunction (Qmax 9.4 ml/sac and residual urine 72 ml).