男性下部尿路症状診療ガイドライン

目次はじめに................................................................................................................................................................ iii

1下部尿路症状とは................................................................................................................................ 11 下部尿路症状................................................................................................................................................ 11）蓄尿症状. ................................................................................................................................................... 22）排尿症状. ................................................................................................................................................... 43）排尿後症状................................................................................................................................................ 54）その他の症状........................................................................................................................................... 52 男性の下部尿路症状................................................................................................................................. 53 下部尿路症状と類似・関連した用語.............................................................................................. 61）排尿症状. ................................................................................................................................................... 62）刺激症状，閉塞症状............................................................................................................................ 63）前立腺症 .................................................................................................................................................... 64）下部尿路機能障害................................................................................................................................. 75）下部尿路閉塞........................................................................................................................................... 76）尿閉.............................................................................................................................................................. 77）溢流性尿失禁........................................................................................................................................... 74 下部尿路症状の臨床的意義.................................................................................................................. 82

疫学・QOL............................................................................................................................................. 111 疫学 ................................................................................................................................................................. 112 QOL（生活の質）...................................................................................................................................... 121）QOL と下部尿路症状の QOL に対する影響........................................................................ 122）QOL の評価方法................................................................................................................................. 163病態と疾患. ............................................................................................................................................. 20
1 前立腺・下部尿路の疾患・病態..................................................................................................... 201）前立腺肥大症........................................................................................................................................ 212）他の前立腺疾患................................................................................................................................... 233）膀胱の疾患・病態.............................................................................................................................. 244）尿道の疾患............................................................................................................................................. 26vi

目次2 神経系の疾患・病態.............................................................................................................................. 271）脳の疾患. ................................................................................................................................................ 272）脊髄の疾患............................................................................................................................................. 283）末梢神経の疾患・病態 .................................................................................................................... 304）その他...................................................................................................................................................... 31
3 その他の疾患・病態.............................................................................................................................. 321）薬剤性...................................................................................................................................................... 322）多尿........................................................................................................................................................... 333）睡眠障害. ................................................................................................................................................ 334）心因性...................................................................................................................................................... 334

診断................................................................................................................................................................ 38
1 病歴の聴取.................................................................................................................................................. 38
2 症状・QOL 質問票................................................................................................................................. 381）国際前立腺症状スコア（IPSS）と QOL スコア................................................................. 412）前立腺肥大症影響スコア（BII）................................................................................................... 413）キング健康質問票（KHQ）............................................................................................................. 414）ICIQ-SF................................................................................................................................................... 415）過活動膀胱症状スコア（OABSS）. ............................................................................................ 426）OAB 質問票（OAB-q）..................................................................................................................... 427）間質性膀胱炎症状スコア・問題スコア（ICSI・ICPI）.................................................... 448）NIH-前立腺炎症状スコア（NIH-CPSI）................................................................................... 449）主要下部尿路症状質問票（CLSS）............................................................................................. 44
3 排尿記録....................................................................................................................................................... 454 身体所見....................................................................................................................................................... 47
5 尿検査............................................................................................................................................................ 476 血液検査....................................................................................................................................................... 477 残尿検査....................................................................................................................................................... 48
8 超音波検査.................................................................................................................................................. 48

男性下部尿路症状診療ガイドラインvii

男性下部尿路症状診療ガイドライン

9 尿流動態検査............................................................................................................................................. 491）尿流検査. ................................................................................................................................................ 492）内圧尿流検査........................................................................................................................................ 493）その他の尿流動態検査.................................................................................................................... 49
10 内視鏡検査（膀胱・尿道内視鏡検査）. ........................................................................................ 49
11 その他の検査............................................................................................................................................. 50
12 検査・診断の手順................................................................................................................................... 50

5治療................................................................................................................................................................ 56
1 治療の推奨グレード.............................................................................................................................. 56
2 薬物治療....................................................................................................................................................... 561）α1アドレナリン受容体遮断薬（α1 遮断薬）........................................................................... 57
2）抗アンドロゲン薬.............................................................................................................................. 66
3）抗コリン薬単独治療あるいは抗コリン薬とα1 遮断薬の併用治療............................ 714）その他の内服薬................................................................................................................................... 74
3 電気・磁気刺激療法.............................................................................................................................. 801）電気刺激. ................................................................................................................................................ 802）磁気刺激. ................................................................................................................................................ 81
4 保存治療....................................................................................................................................................... 82
1）生活指導. ................................................................................................................................................ 82
2）健康食品・代替医療......................................................................................................................... 843）前立腺炎の保存療法......................................................................................................................... 87
5 その他の治療............................................................................................................................................. 881）尿道留置カテーテルと清潔間欠導尿......................................................................................... 882）前立腺肥大症に対する外科的治療............................................................................................ 90

6アルゴリズム......................................................................................................................................... 92
男性下部尿路症状診療のアルゴリズム. .................................................................................... 92
主要症状質問票........................................................................................................................................ 94

付録................................................................................................................................................................ 95
索引................................................................................................................................................................ 99viii