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排尿障害は過活動膀胱[OAB(overactive bladder)とも言う,トイレが近い症状]と残尿・尿閉(尿が出しにくい症状)を合わせた言葉で,一般に脳疾患はOABを,末梢神経疾患は残尿・尿閉を,多系統萎縮症や脊髄疾患はOABと残尿・尿閉を同時にきたすことが多い。このうち,OABに対して選択的β3受容体刺激薬/抗コリン薬を,残尿・尿閉に対して間欠導尿,α交感神経遮断薬,コリン作動薬を組み合わせながら投与するとよい。排尿障害の治療を積極的に行い,患者の生活の質を向上させることが望まれる。
Abstract
Urinary dysfunction includes an overactive bladder (OAB), post-void residual (PVR)/retention, or both entities. Brain diseases cause OAB, peripheral neuropathies are associated with significant PVR/retention, and multisystem atrophy/spinal cord diseases result in a combination of OAB and PVR/retention. Selective beta 3 adrenergic receptor agonists or anticholinergic agents are the first-choice treatment for OAB and clean intermittent self-catheterization, alpha-blocker and cholinergic stimulant therapy for significant PVR/retention. These therapies may be useful to maximize patients' quality of life and prevent serious complications, such as urosepsis or kidney dysfunction.
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