Homma Yukio, Gotoh Momokazu, Kawauchi Akihiro, Kojima Yoshiyuki, Masumori Naoya, Nagai Atsushi, Saitoh Tadanori, Sakai Hideki, Takahashi Satoru, Ukimura Osamu, Yamanishi Tomonori, Yokoyama Osamu, Yoshida Masaki, Maeda Kenji
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Int J Urol. 2017 Oct;24(10):716-729. doi: 10.1111/iju.13401. Epub 2017 Jul 26.
The present article is the abbreviated English translation of the Japanese guidelines for male lower urinary tract symptoms and benign prostatic hyperplasia updated as of the end of 2016. The target patients are men aged >50 years complaining of lower urinary tract symptoms, with or without benign prostatic hyperplasia, and the target readers are non-urological general physicians and urologists. Mandatory assessment for general physicians is medical history, physical examination, urinalysis and measurement of serum prostate-specific antigen. Additional mandatory assessment for urologists is symptoms and quality of life assessment by questionnaires, uroflowmetry, residual urine measurement, and prostate ultrasonography. Nocturia requires special attention, as it can result from nocturnal polyuria and/or sleep disturbance rather than lower urinary tract disorders. Functional lower urinary tract disorders with or without benign prostatic hyperplasia are primarily managed by conservative therapy and medications, such as α -blockers and phosphodiesterase-type 5 inhibitors. Use of other medications or combination pharmacotherapy is to be reserved for urologists. 5α-Reductase inhibitors and anticholinergics or β3 agonists are indicated for men with enlarged prostates and overactive bladder symptoms, respectively. Surgical intervention for bladder outlet obstruction is considered for persistent symptoms or benign prostatic hyperplasia-related comorbidities. Surgical modalities should be optimized by the patient's characteristics, performance of equipment and the surgeon's experience.
本文是截至2016年底更新的日本男性下尿路症状及良性前列腺增生指南的英文缩写版译文。目标患者为年龄大于50岁、有或无良性前列腺增生且伴有下尿路症状的男性，目标读者为非泌尿外科普通医生和泌尿外科医生。普通医生的强制性评估项目包括病史、体格检查、尿液分析及血清前列腺特异性抗原测定。泌尿外科医生的额外强制性评估项目包括通过问卷进行症状及生活质量评估、尿流率测定、残余尿量测量及前列腺超声检查。夜尿症需要特别关注，因为它可能由夜间多尿和/或睡眠障碍引起，而非下尿路疾病所致。有或无良性前列腺增生的功能性下尿路疾病主要通过保守治疗及药物进行管理，如α受体阻滞剂和5型磷酸二酯酶抑制剂。其他药物的使用或联合药物治疗则由泌尿外科医生决定。5α还原酶抑制剂和抗胆碱能药物或β3激动剂分别适用于前列腺增大和膀胱过度活动症症状的男性。对于持续性症状或与良性前列腺增生相关的合并症，考虑对膀胱出口梗阻进行手术干预。手术方式应根据患者特征、设备性能及外科医生经验进行优化。
