神経変性疾患の下部尿路機能障害の診断と標準的治療

抄録

Lower urinary tract dysfunction (LUTD) is common and one of the biggest problems in patients with neurodegenerative disease and the family. Thus accurate diagnosis and sufficient management should be provided for these patients and families. LUTD is usually calcified into storage disorder and voiding disorder. Storage disorder is easily noticed by patients and directly results in impairment of quality of life, whereas voiding disorder is less noticeable to the patients and subclinically results into impairment of hearth condition. Therefore the management of voiding disorder is more important than that of storage disorder for the management of LUTD in patients with neurodegenerative disorder. Thus it is so important to detect the presence and severity of voiding disorder. Polyuria and nocturnal polyuria are also important to know the cause of daytime and night time urinary frequency. For the diagnosis of LUTD in patients with neurodegenerative disorder, detail questionnaire, bladder diary and measurement of residual urine volume (RU) are needed at least and these should be done routinely. The management of LUTD in these patients is according to the severity of voiding disorder. If voiding disorder is severe (RU > 100–200ml), the management of voiding dysfunction is preferred. If voiding disorder is moderate (RU 100–200ml >50–100ml), the management of voiding dysfunction is preferred. In the cases with mild or no voiding disorder (RU < 50–100ml), the management of storage dysfunction is done. In parallel, if polyuria or nocturnal polyuria is recognized, the management of polyuria or nocturnal polyuria is done. In cases with nocturnal polyuria, sleep apnea syndrome failure from being overlooked.