排尿障害の治療

Treatment of lower urinary tract dysfunction

　下部尿路障害(広い意味での排尿障害)は，蓄尿障害と排尿(排出)障害に分けられ，そのおのおのが膀胱機能と尿道機能の障害に分類される．治療方針は，蓄尿障害と排尿障害のどちらかの治療を目的とすることになるが，治療の目標は，バランス膀胱にすることである．保存療法としては行動療法(生活指導，計画療法，理学療法)をまず行う．薬物療法では，膀胱蓄尿障害には抗コリン薬，尿道蓄尿障害にはクレンブテロール，膀胱排尿障害にはコリン作動薬(α-遮断薬併用)，尿道排尿障害にはα-遮断薬が有用である．

Lower urinary tract dysfunction is divided into filling and voiding dysfunction, and each is further divided into bladder (detrusor) and urethral (sphincter) dysfunction. Thus the strategy of treatment for lower urinary tract dysfunction is targeted for either side of the dysfunction. Many elderly patients may have both filling and voiding dysfunction, and thus the treatment should be targeted for "the balanced bladder". The first line conservative treatment is behavioral therapy that include life style intervention, scheduled voiding regimens, and physical therapies. Pharmacotherapy includes anticholinergic agents for overactive bladder, clenbuterol for stress urinary incontinence, cholinergic drugs combined with α-blockers for underactive bladder, and α-blockers for functional bladder outlet obstruction.