目次巻頭言 .............................................................................................................................................................................................................................................................................................................................................................. ii
著者略歴........................................................................................................................................................................................................................................................................................................................................... viii
● 実践研修 排尿機能検査 ....................................................................................................................................................................................................................................... 11 下部尿路の解剖と生理
1 . 下部尿路の解剖................................................................................................................................................................................................................................................

2......................................................................................................................................................................................................................................................................................

221）男性の下部尿路.................................................................................................................................................................................................................................................................................
32）女性の下部尿路
3）蓄尿・尿排出に関する解剖学的因子............................................................................................................................................................................................ 34）男性と女性の解剖学的な差.................................................................................................................................................................................................................................. 3.................................................................................................................................................................................................................................................................................

2 . 下部尿路の生理（蓄尿と尿排出のメカニズム）.......................................................................................................................................

441）下部尿路の神経支配と自律神経受容体........................................................................................................................................................................................................................................................................
62）蓄尿のメカニズム
3）排尿のメカニズム ........................................................................................................................................................................................................................................................................ 74）蓄尿と排尿における膀胱，括約筋の協調機能....................................................................................................................................................... 8...................................................................................................................................................................................

2 下部尿路機能障害の評価法.........................................................................................................................................................................................................................

9.............................................................................................................................................................................................................................................................................................................................................

91 . 問診2 . 身体所見..................................................................................................................................................................................................................................................................................................................

131）外陰部の診察 ..................................................................................................................................................................................................................................................................................... 132）直腸診.................................................................................................................................................................................................................................................................................................................. 133）ストレステスト............................................................................................................................................................................................................................................................................ 134）Q チップテスト ........................................................................................................................................................................................................................................................................... 14

3 . 尿失禁定量テスト
4 . 排尿日誌
5 . QOL（生活の質）評価
6 . 尿流動態検査......................................................................................................................................................................................................................................................................

14..................................................................................................................................................................................................................................................................................................................

16.................................................................................................................................................................................................................................................

19............................................................................................................................................................................................................................................................................................

22221）尿流測定（uroflowmetry）........................................................................................................................................................................................................................................................................................................
222）残尿測定3）膀胱内圧検査（cystometry, CMG）........................................................................................................................................................................................... 224）ビデオウロダイナミクス（videourodynamics）....................................................................................................................................... 225）外尿道括約筋筋電図 ......................................................................................................................................................................................................................................................... 226）内圧尿流検査（pressure-flow study; PFS）......................................................................................................................................................... 237）腹圧下漏出時圧測定（abdominal leak point pressure; ALPP）...................................................................... 238）尿道内圧測定（urethral pressure profile; UPP）..................................................................................................................................... 23..................................................................................................................................................................................................................................

7 . その他の検査iv............................................................................................................................................................................................................................................................................................

23目次

3 下部尿路機能と薬剤........................................................................................................................................................................................................................................................

1 . 利尿薬，カフェイン（紅茶，お茶，コーヒー），アルコール類
2 . かぜ薬（総合感冒薬）
3 . 抗不整脈薬
4 . 向精神薬

24......................................................

24.........................................................................................................................................................................................................................................................

24.......................................................................................................................................................................................................................................................................................................

25..................................................................................................................................................................................................................................................................................................................

25251）三環系抗うつ薬.......................................................................................................................................................................................
252）抗精神病薬，パーキンソン病治療薬........................................................................................................................................................................................................................................................................................................
253）抗痴呆薬............................................................................................................................................................................................................................................................................

5 . 抗コリン薬
6 . 麻薬性鎮痛薬
7 . 交感神経α遮断薬
8 . 交感神経α受容体刺激作用を有する薬
9 . 交感神経β受容体刺激作用を有する薬10 . カルシウム拮抗薬
11 . 交感神経β遮断薬.......................................................................................................................................................................................................................................................................................................

25............................................................................................................................................................................................................................................................................................

26........................................................................................................................................................................................................................................................................

26......................................................................................................................................................................

26......................................................................................................................................................................

28......................................................................................................................................................................................................................................................................

28........................................................................................................................................................................................................................................................................

28

4 下部尿路機能障害をきたす主な疾患
1 . 前立腺肥大症..................................................................................................................................................................

29............................................................................................................................................................................................................................................................................................

29291）症状2）評価・診断............................................................................................................................................................................................................................................................................................... 29
a．基本評価 ....................................................................................................................................................................................................................................................................................... 29
b．国際前立腺症状スコア.............................................................................................................................................................................................................................. 29
c．排尿機能と前立腺形態の評価.................................................................................................................................................................................................. 30d．内圧尿流検査（pressure-flow study）............................................................................................................................................................... 30
e．その他の検査 .................................................................................................................................................................................................................................................................... 303）治療 ........................................................................................................................................................................................................................................................................................................................... 30...........................................................................................................................................................................................................................................................................................................................

2 . 神経因性膀胱............................................................................................................................................................................................................................................................................................

31311）神経因性膀胱とは2）神経因性膀胱の分類と原因疾患.......................................................................................................................................................................................................... 313）病態と症状............................................................................................................................................................................................................................................................................................... 32a．排尿筋過活動を呈する神経因性膀胱...................................................................................................................................................................... 32b．排尿筋低活動を呈する神経因性膀胱 ..................................................................................................................................................................... 324）合併症.................................................................................................................................................................................................................................................................................................................. 335）疾患の例 ........................................................................................................................................................................................................................................................................................................ 34
a．脳血管障害.............................................................................................................................................................................................................................................................................. 34
b．パーキンソン病 .......................................................................................................................................................................................................................................................... 34
c．二分脊椎症.............................................................................................................................................................................................................................................................................. 34
d．椎間板ヘルニア，腰部脊椎管狭窄症（高齢者に多い）................................................................................................ 346）神経因性膀胱の治療 ......................................................................................................................................................................................................................................................... 34
a．治療目的 ....................................................................................................................................................................................................................................................................................... 34
b．治療 ......................................................................................................................................................................................................................................................................................................... 34..................................................................................................................................................................................................................................................................

v

3 . 尿失禁............................................................................................................................................................................................................................................................................................................................

36371）尿失禁の分類....................................................................................................................................................................................................................................................................
．腹圧性尿失禁
37a....................................................................................................................................................................................................................................................................
37b．切迫性尿失禁....................................................................................................................................................................................................................................................................
37
c．溢流性尿失禁....................................................................................................................................................................................................................................................................
37d．機能性尿失禁
e．反射性尿失禁 .................................................................................................................................................................................................................................................................... 37
f． その他................................................................................................................................................................................................................................................................................................. 372）尿失禁の原因となる基礎疾患について ............................................................................................................................................................................. 38a．腹圧性尿失禁 .................................................................................................................................................................................................................................................................... 38
b．切迫性尿失禁.................................................................................................................................................................................................................................................................... 38c．溢流性尿失禁 .................................................................................................................................................................................................................................................................... 38
d．機能性尿失禁.................................................................................................................................................................................................................................................................... 39
e．反射性尿失禁 .................................................................................................................................................................................................................................................................... 393）尿失禁の治療 ..................................................................................................................................................................................................................................................................................... 39a．腹圧性尿失禁の治療........................................................................................................................................................................................................................................ 39
b．切迫性尿失禁の治療 ....................................................................................................................................................................................................................................... 43c．溢流性尿失禁の治療........................................................................................................................................................................................................................................ 43
d．機能性尿失禁の治療 ....................................................................................................................................................................................................................................... 44.....................................................................................................................................................................................................................................................................................

4 . 過活動膀胱（overactive bladder; OAB）.............................................................................................................................................................

44441）過活動膀胱の定義...........................................................................................................................................................................................................................................................................................................................
442）疫学3）病態と病因............................................................................................................................................................................................................................................................................................... 444）過活動膀胱の QOL に対する影響 .................................................................................................................................................................................................. 455）診断 ........................................................................................................................................................................................................................................................................................................................... 45
a．診断における symptom-based の意義 ......................................................................................................................................................... 45b．検査法 ................................................................................................................................................................................................................................................................................................ 466）治療 ........................................................................................................................................................................................................................................................................................................................... 46
a．薬物治療 ....................................................................................................................................................................................................................................................................................... 46
b．行動療法 ...................................................................................................................................................................................................................................................................................... 47..................................................................................................................................................................................................................................................................

5 尿流動態検査の実際
1 . 尿流動態検査..........................................................................................................................................................................................................................................................

48............................................................................................................................................................................................................................................................................................

481）尿流動態検査の役割 ......................................................................................................................................................................................................................................................... 482）尿流動態検査の適応 ......................................................................................................................................................................................................................................................... 48
3）検査方法の種類............................................................................................................................................................................................................................................................................ 484）尿流動態検査前後の一般的注意事項....................................................................................................................................................................................... 49a．検査前 ................................................................................................................................................................................................................................................................................................ 49
b．検査中 ................................................................................................................................................................................................................................................................................................ 49
c．検査後 ................................................................................................................................................................................................................................................................................................ 49

2 . 尿流測定（uroflowmetry）
3 . 残尿測定4 . 膀胱内圧検査（cystometry）
5 . 外尿道括約筋筋電図（sphincter electromyography）
vi..................................................................................................................................................................................................................................

50..................................................................................................................................................................................................................................................................................................................

53......................................................................................................................................................................................................................

54.................................................................................................

57

目次

6 . 内圧尿流検査（pressure-flow study; PFS）..............................................................................................................................................

59591）検査の実際 ̶ 1..........................................................................................................................................................................................................................................................................
）検査の実際
̶6722..........................................................................................................................................................................................................................................................................

7 . 腹圧下漏出時圧測定（abdominal leak point pressure; ALPP）
8 . 尿道内圧測定（urethral pressure profile; UPP）................................................

75.......................................................................................................................

77................................................................................................................................................................

79..................................................................................................................................................................................................................................................................................................................

79............................................................................................................................................................................................................................................................................................................................

806 尿流動態検査実例（ケーススタディ）
1 . 検査方法
2 . 正常例801）男性（正常例）...................................................................................................................................................................................................................................................................................
822）女性（正常例）...................................................................................................................................................................................................................................................................................

3 . 下部尿路閉塞............................................................................................................................................................................................................................................................................................

84841）男性2）女性 ........................................................................................................................................................................................................................................................................................................................... 85...........................................................................................................................................................................................................................................................................................................................

4 . 排尿筋過活動（男性）
5 . 排尿筋収縮力低下（女性）
6 . 腹圧性尿失禁（内因性括約筋不全; ISD）
7 . その他.........................................................................................................................................................................................................................................................

86...................................................................................................................................................................................................................................

87...............................................................................................................................................................

88............................................................................................................................................................................................................................................................................................................................

90901）膀胱知覚過敏2）知覚鈍麻＋下部尿路閉塞 ...................................................................................................................................................................................................................................... 923）低コンプライアンス膀胱 ...................................................................................................................................................................................................................................... 93.....................................................................................................................................................................................................................................................................................

8 . アーチファクトの種類と対策................................................................................................................................................................................................................

94941）測定中の確認：測定中の直腸圧低下.............................................................................................................................................................................
952）測定中の確認：直腸バルーン自然抜去
3）排尿中尿流曲線にスパイク............................................................................................................................................................................................................................. 964）測定中の問題：腸蠕動圧と排尿時カテーテル自然抜去 ........................................................................................................... 975）排尿時に直腸圧の 0 点が動いた......................................................................................................................................................................................................... 986）排尿中カテーテル抜去 ............................................................................................................................................................................................................................................... 997）腹圧の差し引き不十分 .......................................................................................................................................................................................................................................... 100.......................................................................................................................................................................................

9 . アーチファクトを防ぐために

7 参考図書...........................................................................................................................................................................................................

101...............................................................................................................................................................................................................................................................................................................

102● 下部尿路機能に関する用語基準（国際禁制学会 2002 年用語基準）.................................................................................................................................................................................. 104● 排尿機能検査士制度規則 ..................................................................................................................................................................................................................................... 120● 排尿機能検査士制度規則施行細則 .................................................................................................................................................................................... 122● 索引................................................................................................................................................................................................................................................................................................................................................... 124vii