前立腺肥大症と排尿障害

Benign prostatic hyperplasia and lower urinary tract symptoms

　前立腺肥大症(BPH)は，一般にも広く認知され高齢者に高頻度に合併するにもかかわらず明確な診断基準はない．また，高齢者に合併する疾患の多くが神経因性膀胱の原因となり，排尿にも影響を与える．BPHをはじめとする尿排出障害の重症度判定には，残尿量，尿路感染，水腎症の評価が重要である．軽症例に対する薬物療法の有用性は高く，過活動膀胱合併例でも残尿評価すれば抗コリン薬併用は有効に使用できる．また重症例には手術療法が適応となるが，近年，多種の低侵襲手術が報告されている．

BPH(benign prostatic hyperplasia) is a common condi-tion in aged men.　There is no diagnostic criterion.

Most old patients have many complicated diseases.　Many of them also can cause dysuria.　For example, diabetes mellitus with poor control always causes dysfunction of the urinary bladder as neurogenic bladder.　For this reason proper assessments are essential for getting better results from treatment.　The volume of residual urine, urinary tract infection and hydronephrosis are important factors for assessment of the seriousness of this disease.　For mild cases, medical treatments are very effective.　Antichorinergic drugs are good for BPH with overactive bladder or urgency.　Better control is expected due to such agents, but assessment of residual urine volume is essential.　For patients with serious conditions, surgical intervention should be indicated.　Recently, a lot of minimally invasive technics have been reported.