Yokoyama Osamu
The Department of Urology, School of Medicine, University of Fukui.
Hinyokika Kiyo. 2005 Sep;51(9):599-601.
The International Continence Society (ICS) recently derived a consensus symptomatic definition of overactive bladder (OAB) as urinary urgency, with or without urge incontinence, usually with frequency and nocturia. These symptom combinations are suggestive of urodynamically demonstrable detrusor overactivity. The etiology of OAB falls into two broad categories: neurogenic and nonneurogenic. It is not easy to confirm the etiology of OAB in patients with bladder outlet obstruction and neurological disease. This debate has attempted to examine the pathophysiology of OAB and to determine the optimal treatment strategy in a patient with two diseases possibly causing OAB. A 75-year-old man visited our hospital due to symptoms of OAB (urgency, nocturia, and urge incontinence) occurring after cerebrovascular accidents. Urge incontinence worsened concomitantly with the appearance of turbid urine. Urinary tract infection was accompanied by 84 ml of post-void residual. The prostate volume and PSA value were 28 ml and 1.2 ng/ml, respectively. The total International Prostate Symptom Score (IPSS) and Quality of Life (QOL) Index were 23 and 5, respectively. IPSS for storage symptoms was higher than that for obstructive symptoms. The maximum flow rate, measured after treatment for UTI, was 9.4 ml/s. Two debaters discuss the treament modality, TURP, or pharmacotherapy.
国际尿失禁学会（ICS）最近得出了膀胱过度活动症（OAB）的共识性症状定义，即尿急，伴有或不伴有急迫性尿失禁，通常还伴有尿频和夜尿症。这些症状组合提示尿动力学可证实的逼尿肌过度活动。OAB的病因可分为两大类：神经源性和非神经源性。对于膀胱出口梗阻和神经系统疾病患者，确定OAB的病因并不容易。本次辩论试图探讨OAB的病理生理学，并确定可能导致OAB的两种疾病患者的最佳治疗策略。一名75岁男性因脑血管意外后出现OAB症状（尿急、夜尿症和急迫性尿失禁）前来我院就诊。随着浑浊尿液的出现，急迫性尿失禁加重。尿路感染伴有84毫升残余尿量。前列腺体积和前列腺特异性抗原（PSA）值分别为28毫升和1.2纳克/毫升。国际前列腺症状评分（IPSS）总分和生活质量（QOL）指数分别为23分和5分。储尿期症状的IPSS高于梗阻性症状的IPSS。尿路感染治疗后测得的最大尿流率为9.4毫升/秒。两位辩论者讨论了治疗方式，即经尿道前列腺切除术（TURP）还是药物治疗。
