前立腺全摘除術前後の排尿機能の変化 : 高齢女性との比較を交えて

Abstract

根治的前立腺摘除術(RP)後の高齢男性の排尿パターンを高齢女性との比較を交えて検討した。解析数は男性102名, 女性40名であった。1)国際尿失禁会議質問表を用いた手術後の尿失禁の検討では, 術後1年以内の患者群よりも1年以上経過した患者群の方が失禁の頻度, 量ともに改善する傾向が認められた。2)過活動膀胱症状質問表を用いた検討では, 尿意の切迫感スコアは術後経過が長いほど上昇する傾向を示した。3)国際前立腺症状スコアを用いて高齢女性の排尿機能を検討した結果では, voiding symptomよりもstorage symptom score優位の排尿障害パターンが示された。4)手術前の高齢男性はvoiding symptom優位の排尿障害パターンを示したが, 術後はstorage symptom score優位の排尿障害パターンへと変化しており, 術後の男性患者は高齢女性の排尿障害パターンに類似している可能性が示唆された。

The lower urinary tract anatomy in men after radical prostatectomy (RP) resembles that in women. Out of 112 male patients who had undergone RP for localized prostate cancer, 102 (91%) of them responded to a questionnaire survey. The mean age of the responders at the time of RP was 65.9 +/- 5.3 years. The time of response after RP ranged from 2 months to 6 years (median: 44 months). The instruments used for the assessment of urinary status were the International Prostate Symptom Score (IPSS) and QOL score, the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and Overactive Bladder Symptom Score (OABSS). Urinary status of 40 elderly female patients aged 59.5 +/- 6.9 years who consulted our outpatient clinic due to conditions (microhematuria, simple renal cyst, etc.) unrelated to lower urinary tract disorders were assessed with the IPSS. In the male patients, total IPSS and QOL score showed significant improvement over time after RP (P = 0.0004, P = 0.0015, respectively). In particular, the voiding symptom score of IPSS showed significant improvement (P < 0.0001). The improvement of incontinence within 1 year after RP was confirmed with ICIQ-SF (p = 0.06). In contrast, the storage symptom score of IPSS after RP was not different with time after RP. Furthermore, the OABSS rose with time after RP (p = 0.08). On the other hand, in the elderly female controls, the storage symptom score of IPSS was significantly higher than voiding symptom score (P = 0.0019). Men who underwent RP showed significant improvement in their voiding symptoms and continence status, but the storage symptoms, progressively worsened following RP. Consequently, careful follow-up and appropriate medical intervention are needed in men after RP as in aging women.