排尿障害の診断の基準と保存的薬物療法

Abstract

The symptoms of benign prostatic hypertrophy consist of two major groups, obstructive symptoms and irritative symptoms. Uroflowmetry is a safe, easy and accurate method to assess the obstructive symptoms. Furthermore, electromyography of abdominal wall and the monitoring of rectal pressure is helpful to know involvement of abdominal straining. Cystometry provides us objective findings of bladder irritability in bladder outlet obstruction. Detrusor hyperreflexia was revealed in 55%, and uninhibited detrusor contraction was revealed in 22.5% of the patients with benign prostatic hypertrophy. The most sophisticated technique to estimate the volume of prostatic adenoma is transrectal ultrasonotomography. The value, cranio-caudal X left-right X antero-posterior axis length, has been proved to closey correlate to the resected volume of the prostatic adenoma. However there was no correlation between the estimated prostatic volume and the severity of dysuria. The comparison of the uroflow rates before and after loading phentolamine is a helpful method to determine the sympathetic influence to lower urinary tract obstructions. This test differentiates functional obstruction from organic obstruction. Conservative pharmacological therapy on the patients with benign prostatic hypertrophy were also studied. The value of efficacy of prazocine hydrochloride (0.5-6.0 mg/day), Eviprostat (6Tab/day), Prostetin (200-400 mg/day), Hachimi-Jiogan (5 g and 7.5 g/day) on subjective symptoms were 47.8 86.2, 58.5, 52.9 and 66.7% respectively. Ninety-one of the 141 patients with benign prostatic hypertrophy who visited the out-patient clinic in 1983 were given pharmacological treatment initially.