女性骨盤底障害と排尿障害

Female pelvic floor dysfunction and voiding dysfunction

　腹圧性尿失禁，骨盤臓器脱といった骨盤底障害は，中高年女性のQOLに大きな影響を及ぼす．低侵襲メッシュ手術の導入により，本邦でも骨盤底障害への関心が高まった．腹圧性尿失禁は，問診，ストレステストでかなり把握できるが，確定診断には尿流動態検査で腹圧上昇に一致して，膀胱収縮を伴わずに尿漏出を認めることが必要である(尿流動態性腹圧性尿失禁)．腹圧時尿漏出圧(ALPP)は重症度や尿道括約筋不全(ISD)の判断に役立つ．膀胱や子宮が腟口から脱出する骨盤臓器脱は，下垂症状だけでなく，尿排出障害や過活動膀胱を引き起こし，一方で腹圧性尿失禁を軽減する方向に働く(潜在性腹圧性尿失禁)．問診，脱を還納した状態でのストレステスト(バリアーテスト)，尿流動態検査による検討が行われる．

Female pelvic floor dysfunction often impairs the QOL (quality of life) of middle-aged and elderly women.　The introduction of minimally-invasive mesh surgery has increased the number of Japanese doctors who are interested in this field.　SUI (stress urinary incontinence) can be liberally diagnosed by history taking and stress test, but the definite diagnosis is established by urodynamics, preferably videourodynamics.　ALPP (abdominal leak point pressure) is useful to assess the severity and ISD (intrinsic sphincter deficiency).　POP (pelvic organ prolapse) is associated with voiding difficulty, overactive bladder, and SUI.　Despite some limitations, the barrier test (stress test during prolapse reduction) is helpful to access occult SUI.