非泌尿器科医によるα1ブロッカー治療が無効で経尿道的前立腺切除を行った前立腺肥大症症例の検討

Abstract

非泌尿器科医によるα1ブロッカー治療が無効で, 著者ら泌尿器科にて経尿道的前立腺切除(TUR-P)を行った前立腺肥大症60例について検討した.その結果, 1)α1ブロッカー投与期間は中央値12ヵ月で, 29例(48.3%)が1年以上投薬されていた.2)ガイドラインによる領域別重症度判定では, 初診時のI-PSS, QOL index, 排尿機能, 前立腺形態はいずれの領域も中等症が約90%を占めていた.3)抗コリン剤が併用されていた6例中4例(66.7%)では200ml以上の残尿量を認めた.4)TUR-Pの奏効率(著効・有効)は86.7%と高かった.5)アンケート調査による結果では, 地域の非泌尿器科医は排尿に関する自・他覚所見よりもむしろ血清PSA値を重視する傾向にあり, 自覚症状や他覚所見の重要性や抗コリン剤併用の危険性を認識させる必要があると思われた

We evaluated the clinical courses of 60 patients with symptomatic benign prostatic hyperplasia (BPH) who underwent transurethral resection of the prostate (TUR-P) in our hospital after ineffective alpha-1 blocker treatment by non-urologists between January 2001 and September 2004. Overall severity just before TUR-P estimated by the criteria for severity in BPH was mild in 0%, moderate in 37%, and severe in 63%. Urinary retention was noted in 5 patients (8.3%). Nine patients (15.0%), four of whom had received an anti-cholinergic agent, had a residual urine volume over 200 ml. Excellent or good overall efficacy of TUR-P according to the criteria for efficacy of treatment in BPH was 86.7%. According to a questionnaire survey, only 28.9% of non-urologists in the Abashiri district had knowledge of the clinical practice guideline for BPH. We should strengthen the partnership among urologists and non-urologists to appropriately treat patients having BPH by using evidence-based information such as the clinical practice guideline.