経尿道的前立腺切除術長期経過後の下部尿路症状と尿流率

Abstract

経尿道的前立腺切除術(TUR-P)後2-12年経過した1236例を対象に, 下部尿路症状についてアンケートを行った。回答875例, 有効回答847例であった。その結果, 全体では, 国際前立腺症状スコア(IPSS)は軽症498例(58.8%), 中等症302例(35.7%), 重症47例(5.5%)で, QOLに関しては687例(81.1%)が排尿状態に満足していた。また, 術後5年未満419例(手術時平均年齢67.2±6.9歳)と術後5年以上428例(手術時平均年齢67.8±6.9歳)の比較では, IPSSはB群がA群より高値の傾向を認め, IPSSの各症状は尿勢低下, 夜間尿回数で有意差を認めた。受診勧奨に応じた179例の尿流測定では, 最大尿流量は5年以上経過した症例は著明に低下し, 手術時年齢70歳以上の症例で著明な低下を認めた。以上より, QOLについてはTUR-Pは長期間効果を持続し, TUR-P後の長期成績は, 手術時年齢, 術後経過期間による膀胱排尿筋の加齢変化により規定される可能性がある。

We investigated lower urinary tract symptoms (LUTS) and the urinary flow rates of patients who underwent transurethral resection of the prostate (TUR-P) for benign prostatic hyperplasia to determine the persistence of the efficacy of TUR-P. We mailed questionnaires for evaluation of LUTS to 1236 patients who had received TUR-P. In addition, we encouraged them to visit a clinic for uroflowmetry if possible. LUTS using the International Prostate Symptom Score (IPSS) and QOL index, and uroflowmetry were analyzed in 847 (68.5%) and 150 patients (12.1%), respectively. The IPSS of patients who had received TUR-P more than 5 years earlier was higher than that of patients who had received it in the preceding 5 years. However, more than 80% of the patients in both groups were satisfied with their urinary condition at evaluation. Although no obvious change in the maximum urinary flow rate was observed in the patients who had received TUR-P in the preceding 5 years, it was significantly decreased in the patients who had received it more than 5 years earlier. The tendency was marked in the patients when TUR-P was performed at 70 years of age and older. Although the change in detrusor function determined by the age at surgery and the postoperative period may cause LUTS and reduce the urinary flow rate in the long-term after TUR-P, the efficacy of TUR-P appears to last for long periods in terms of the maintenance of QOL.