今日の臨床サポート

排尿困難

著者: 田中博 市立札幌病院 泌尿器科

監修: 力石辰也 聖マリアンナ医科大学

著者校正/監修レビュー済:2016/08/05
患者向け説明資料

概要・推奨   

症状のポイント:
  1. 排尿困難とは排尿症状と排尿後症状を含み、具体的には排尿遅延、尿勢低下、尿線途絶、腹圧排尿、終末滴下、残尿感などの症状である。:
  1. 排尿困難を訴える患者は蓄尿症状などほかの下部尿路症状も有することが多く、全般的な下部尿路症状の評価が必要である。
  1. そのためには国際前立腺症状スコア(IPSS:)や主要下部尿路症状スコア(CLSS:)などの症状質問票を用いて包括的な評価を行う。
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薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
田中博 : 未申告[2021年]
監修:力石辰也 : 未申告[2021年]

病態・疫学・診察

疫学情報・病態・注意事項  
  1. 下部尿路症状は尿の貯留(蓄尿)や排出(排尿)に関係する症状を広く意味し、患者、介護者あるいはパートナーが主観的に認知したものである。
  1. 下部尿路症状はその背景に下部尿路機能障害があることを示唆するものであるが、尿路感染症など下部尿路機能障害以外の原因でも起こる。
  1. 下部尿路症状は蓄尿症状、排尿症状、排尿後症状の3つが主な症状であり、その他に性交に伴う症状、骨盤臓器脱に伴う症状、生殖器・下部尿路痛、生殖器・下部尿路痛症候群および下部尿路機能障害を示唆する症候群がある[1]<図表>
  1. 排尿困難とは排尿症状と排尿後症状を含み、具体的には排尿遅延、尿勢低下、尿線途絶、腹圧排尿、終末滴下、残尿感などの症状である。
  1. 排尿遅延は排尿開始が困難で、排尿準備ができてから排尿開始までに時間がかかるという愁訴である[1]
  1. 尿勢低下は尿の勢いが弱いという愁訴であり、通常は以前の状態との比較あるいは他人との比較による[1]
  1. 尿線途絶は尿線が排尿途中で1回以上途切れるという愁訴である[1]
  1. 腹圧排尿は排尿の開始、尿線の維持または改善のために、力を要するという愁訴である[1]
  1. 終末滴下は排尿の終末が延長し、尿が滴下する程度まで尿流が低下するという愁訴である[1]
  1. 残尿感とは排尿後に膀胱が完全に空になっていないという愁訴である[1]
  1. 下部尿路症状は基本的には男性、女性ともに共通してみられるが、その頻度に関しては男女差を認める。欧州と北米の18歳以上の一般住民を対象に行われた疫学調査では、何らかの下部尿路症状を認めた割合は女性の66.6%、男性の62.5%であった。蓄尿症状は女性に多く(女:59.2%、男性:51.3%)、排尿症状は男性に多く認められた(男性:25.7%、女性:14.2%)[2]<図表>
  1. 下部尿路症状は単一の症状を自覚する例は少なく、蓄尿症状、排尿症状、排尿後症状の複数の症状を自覚する例が多い[3]<図表>
  1. 下部尿路症状の有症状率は年齢が増加するにつれて上昇する。わが国の40歳以上の住民を対象とした下部尿路症状の疫学調査でも同様の結果が報告されている[4]<図表>
問診・診察のポイント  
  1. 排尿困難は排尿障害を示唆する症状である。ただし、排尿障害だけが排尿困難の原因ではなく、また排尿障害がある例でも排尿困難を訴えないことがある。

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文献 

著者: Paul Abrams, Linda Cardozo, Magnus Fall, Derek Griffiths, Peter Rosier, Ulf Ulmsten, Philip Van Kerrebroeck, Arne Victor, Alan Wein, Standardisation Sub-Committee of the International Continence Society
雑誌名: Urology. 2003 Jan;61(1):37-49.
Abstract/Text
PMID 12559262  Urology. 2003 Jan;61(1):37-49.
著者: Debra E Irwin, Ian Milsom, Steinar Hunskaar, Kate Reilly, Zoe Kopp, Sender Herschorn, Karin Coyne, Con Kelleher, Christian Hampel, Walter Artibani, Paul Abrams
雑誌名: Eur Urol. 2006 Dec;50(6):1306-14; discussion 1314-5. doi: 10.1016/j.eururo.2006.09.019. Epub 2006 Oct 2.
Abstract/Text OBJECTIVE: Estimate the prevalence of urinary incontinence (UI), overactive bladder (OAB), and other lower urinary tract symptoms (LUTS) among men and women in five countries using the 2002 International Continence Society (ICS) definitions.
METHODS: This population-based, cross-sectional survey was conducted between April and December 2005 in Canada, Germany, Italy, Sweden, and the United Kingdom using computer-assisted telephone interviews. A random sample of men and women aged >/= 18 yr residing in the five countries and who were representative of the general populations in these countries was selected. Using 2002 ICS definitions, the prevalence estimates of storage, voiding, and postmicturition LUTS were calculated. Data were stratified by country, age cohort, and gender.
RESULTS: A total of 19,165 individuals agreed to participate; 64.3% reported at least one LUTS. Nocturia was the most prevalent LUTS (men, 48.6%; women, 54.5%). The prevalence of storage LUTS (men, 51.3%; women, 59.2%) was greater than that for voiding (men, 25.7%; women, 19.5%) and postmicturition (men, 16.9%; women, 14.2%) symptoms combined. The overall prevalence of OAB was 11.8%; rates were similar in men and women and increased with age. OAB was more prevalent than all types of UI combined (9.4%).
CONCLUSIONS: The EPIC study is the largest population-based survey to assess prevalence rates of OAB, UI, and other LUTS in five countries. To date, this is the first study to evaluate these symptoms simultaneously using the 2002 ICS definitions. The results indicate that these symptoms are highly prevalent in the countries surveyed.

PMID 17049716  Eur Urol. 2006 Dec;50(6):1306-14; discussion 1314-5. do・・・
著者: Debra E Irwin, Ian Milsom, Zoe Kopp, Paul Abrams, Walter Artibani, Sender Herschorn
雑誌名: Eur Urol. 2009 Jul;56(1):14-20. doi: 10.1016/j.eururo.2009.02.026. Epub 2009 Mar 3.
Abstract/Text BACKGROUND: Lower urinary tract symptoms (LUTS) are prevalent among men.
OBJECTIVE: To describe the prevalence, severity, and symptom bother of LUTS in all men and men with overactive bladder (OAB) symptoms in the EPIC study.
DESIGN, SETTING, AND PARTICIPANTS: A secondary analysis of data from EPIC, a multinational population-based survey of 19,165 adults, was performed. Current International Continence Society definitions were used for individual LUTS and OAB; OAB cases were defined as men reporting urgency.
MEASUREMENTS: Participants were asked about the presence of individual LUTS and associated symptom bother. LUTS severity was measured using the International Prostate Symptom Score (IPSS).
RESULTS AND LIMITATIONS: There was substantial overlap of storage, voiding, and postmicturition symptoms among all men (n=7210) and in men with OAB symptoms (n=502); men with OAB symptoms were more likely to experience multiple LUTS subtypes. Among both populations, nocturia was the most commonly reported symptom, except for urgency (the hallmark symptom) among men with OAB symptoms; terminal dribble and sensation of incomplete emptying were the most common voiding and postmicturition symptoms. The prevalence of all LUTS increased with age among the general population; only storage LUTS increased with age among men with OAB symptoms. Number of LUTS and mean IPSS increased with age in both populations but were higher among men with OAB symptoms at all ages; the proportion reporting moderate-severe LUTS was higher than the general population (30% vs 6%). The proportion of men with OAB symptoms reporting symptom bother increased with urgency severity and severity and number of LUTS. LUTS severity may have been underestimated by the IPSS, which does not assess incontinence.
CONCLUSIONS: Men with LUTS commonly experience coexisting storage, voiding, and postmicturition symptoms, emphasizing the need for comprehensive urologic assessments. Men with OAB symptoms reported more LUTS and greater severity than the general population. Symptom bother was related to number of LUTS and urgency severity.

PMID 19278775  Eur Urol. 2009 Jul;56(1):14-20. doi: 10.1016/j.eururo.2・・・
著者: S Madersbacher, A Pycha, C H Klingler, G Schatzl, M Marberger
雑誌名: Neurourol Urodyn. 1999;18(3):173-82.
Abstract/Text The aim of our study was to determine the urodynamic basis for the observation that aging women report comparable benign prostatic hyperplasia (BPH) symptom scores as age-matched men. Sixty-seven women (mean age, 60.4 +/- 1.5 years; mean +/- standard error of the mean) and 70 age-matched men (mean age, 63.7 +/- 0.9 years; P > 0.05) entered this prospective study. Men were referred for the diagnostic workup of lower urinary tract symptoms (LUTS) due to BPH and women predominantly for urinary incontinence. All patients completed the International Prostate Symptom score (IPSS) with quality-of-life assessment and underwent a detailed clinical and urodynamic evaluation including a multichannel pressure-flow study. Results of the IPSS, quality-of-life assessment, and irritative and obstructive component of the IPSS were correlated with urodynamic findings and the respective data were compared in both sexes. The mean IPSS was 15.7 for men and 13.0 for women (P = 0.02), quality-of-life score was higher in women (4.2 vs. 3.4; P = 0.0008). The irritative score was significantly higher in women (8.7 vs. 6.8; P = 0.003). Incidence of detrusor instability (DI), however, was higher in men (women, 38.1%; men, 48.6%; P = 0.015) and bladder capacity was higher in women (425 vs. 333 ml; P = 0.0001). There was no correlation between incidence and degree of DI with the irritative score in both sexes. The obstructive score was significantly higher in men (8.8 vs. 4.4; P = 0.0001). Ninety-one percent (64/70) of men had urodynamically documented bladder outlet obstruction (BOO), whereas this was the case in only 9% (6/67) of women. In parallel to the irritative score, we could not identify a correlation between the degree of urodynamically proven BOO and the obstructive score in both sexes. This urodynamics-based comparison fails to give an explanation for the observation that aging women report similar BPH scores as men. These data suggest that other mechanisms, such as changes in diurnal urine production, structural alterations of the aging detrusor, endocrine disturbances affecting lower urinary tract function, and subtle urodynamic changes are responsible.

PMID 10338437  Neurourol Urodyn. 1999;18(3):173-82.
著者: Hann-Chorng Kuo
雑誌名: Urology. 2005 Nov;66(5):1005-9. doi: 10.1016/j.urology.2005.05.047.
Abstract/Text OBJECTIVES: To analyze the lower urinary tract symptoms (LUTS) and videourodynamic characteristics of female bladder outlet obstruction (BOO).
METHODS: Videourodynamic studies were performed in 207 women with signs and symptoms of BOO. Bladder outlet obstruction was defined as the radiologic evidence of bladder outlet narrowing plus a voiding pressure greater than 35 cm H2O and a maximum flow rate less than 15 mL/s or a voiding pressure greater than 40 cm H2O. Women with BOO were categorized into five groups on the basis of the videourodynamic findings. The LUTS and urodynamic parameters were analyzed according to these classifications.
RESULTS: Videourodynamic study revealed bladder neck obstruction in 18 patients (8.7%), urethral sphincter obstruction in 56 (27.1%), pelvic floor muscle obstruction in 106 (51.2%), high-grade pelvic organ prolapse and BOO in 13 (6.3%), and urethral stricture in 14 (6.8%). Urgency frequency was reported by 94% and difficult urination by 57% of the total patients. Among the 17 patients with urinary retention, obstruction was noted at the urethral sphincter in 10, pelvic floor muscle in 5, bladder neck in 1, and urethral stricture in 1. Detrusor overactivity was found in 52.7% of total patients and was most frequent in those with urethral sphincter obstruction (78.6%). Patients with bladder neck obstruction had the highest voiding pressure and lowest maximum flow rate.
CONCLUSIONS: Differences in videourodynamic characteristics of women with BOO might be associated with the underlying pathophysiology of the bladder, urethral, and pelvic floor muscle dysfunction.

PMID 16286113  Urology. 2005 Nov;66(5):1005-9. doi: 10.1016/j.urology.・・・
著者: Gina A Defreitas, Philippe E Zimmern, Gary E Lemack, Sharokh F Shariat
雑誌名: Urology. 2004 Oct;64(4):675-9; discussion 679-81. doi: 10.1016/j.urology.2004.04.089.
Abstract/Text OBJECTIVES: To improve the definition of pressure-flow study cutoff values for anatomic female bladder outlet obstruction (BOO) by comparing these parameters in women with clinical obstruction with those of normal controls.
METHODS: In the past 3 years, 82 consecutive women with clinical anatomic BOO were investigated according to an institutional review board-approved protocol that included imaging and urodynamic studies. The data from these women were then added to those of our previously published cohort of 87 patients. The controls were 20 female volunteers without any urologic complaints and without a history of bladder or urethral surgery who had undergone a urodynamic study. Three groups of women with BOO were identified in the most recent cohort: 20 with Stage III-IV cystocele, 23 who had undergone previous anti-incontinence surgery, and 39 with distal periurethral fibrosis or stricture. The optimal combination of the maximal flow rate (Qmax) and detrusor pressure at maximal flow rate (PdetQmax) for determining BOO was calculated using nonparametric receiver operating characteristic curves for the entire cohort of 169 women with obstruction.
RESULTS: Age, Qmax, and PdetQmax were similar among the three BOO groups. The area under the receiver operating characteristic curve for BOO was 0.762 for Qmax (95% confidence interval 0.661 to 0.864, P <0.001) and 0.721 for PdetQmax (95% confidence interval 0.617 to 0.824, P <0.001). After adjusting for the effect of age, PdetQmax (P <0.001) and Qmax (P <0.011) were independently associated with BOO.
CONCLUSIONS: After adjusting for age and using normal controls rather than an incontinent control population, we present pressure-flow study cutoff values to aid in the urodynamic study diagnosis of women with anatomic BOO.

PMID 15491697  Urology. 2004 Oct;64(4):675-9; discussion 679-81. doi: ・・・
著者: Rajesh B C Kavia, Soumendra N Datta, Ranan Dasgupta, Sohier Elneil, Clare J Fowler
雑誌名: BJU Int. 2006 Feb;97(2):281-7. doi: 10.1111/j.1464-410X.2006.06009.x.
Abstract/Text OBJECTIVE: To report the experience of the last 4 years from a centre to which women with voiding difficulties and urinary retention were referred nationally, describing what investigations were helpful in making a diagnosis and the management strategies used.
PATIENTS AND METHODS: Women with voiding difficulties and urinary retention remain a diagnostic and management challenge, and those with no anatomical or neurological basis for their symptoms may be dismissed, assuming that their retention has a psychogenic basis. The finding of an electromyographic (EMG) abnormality of the striated urethral sphincter explaining their disorder (Fowler's syndrome) has led to the referral of women for consideration of that diagnosis. Thus we audited the referrals to the centre over a 4-year period of such women.
RESULTS: In all, 247 women (mean age 35 years) with complete (42%) or partial retention (58%) were referred; 175 (71%) had urethral pressure profilometry, 141 (57%) had a transvaginal ultrasonographic measurement of the sphincter volume, and 95 (39%) had sphincter EMG. The mean maximum urethral closure pressure difference between patients with an EMG abnormality (101.5 cmH(2)O) and the patients with known other causes of voiding dysfunction (66.2 cmH(2)O) was 35.3 cmH(2)O (P < 0.05). In patients with complete retention there was a significant difference in sphincter volume between those who were EMG-positive (2.14 mL) or EMG-negative (1.64 mL) (P < 0.05).
CONCLUSION: These investigations helped to classify the cause of retention in two-thirds of cases. The commonest diagnosis was Fowler's syndrome, in which sacral nerve stimulation is the only intervention that restores voiding.

PMID 16430630  BJU Int. 2006 Feb;97(2):281-7. doi: 10.1111/j.1464-410X・・・
著者: Shang-Jen Chang, Cheng-Hsing Hsieh, Stephen Shei-Dei Yang
雑誌名: Neurourol Urodyn. 2012 Jan;31(1):105-8. doi: 10.1002/nau.21225. Epub 2011 Oct 28.
Abstract/Text PURPOSE: To investigate the association between constipation and the results of uroflowmetry with post-void residual urine (PVR) tests in healthy children.
MATERIALS AND METHODS: We enrolled healthy children aged between 4 and 12 years for evaluation of voiding and defecation function. A parent of children completed the questionnaire, and the children were asked to do uroflowmetry and PVR. Constipation is defined as defecation frequency ≤ 2 times/week or type 1-2 stool forms on Bristol stool scale. Uroflowmetry curve and PVR were eligible for analysis if voided volume was between 50 ml and expected capacity for age.
RESULTS: Totally, 778 children (415 boys and 363 girls) with a mean age of 7.2 ± 2.2 years were eligible for analysis. The prevalence of constipation was 10.9% by low defecation frequency, and 28.4% by Bristol stool scale, respectively. Regarding the rate of constipation, there were no statistically significant differences between genders. Compared to children without low defecation frequency, constipated children had higher PVR (9.0 vs. 5.9 ml, P = 0.01), higher rate of PVR > 20 ml (17.7% vs. 7.1%, P = 0.01) and lower voiding efficiency (93.2% vs. 94.9%, P = 0.04). Compared to children without type 1-2 Bristol stool, constipated children did not have higher PVR (7.2 ml vs. 5.8 ml, P = 0.10), nor lower voiding efficiency (94.0% vs. 95.0%, P = 0.11). Urgency symptom score and rate of abnormal flow patterns were comparable between children with or without constipation.
CONCLUSION: Constipation defined as low defecation frequency was associated with incomplete bladder emptying in healthy children.

Copyright © 2011 Wiley Periodicals, Inc.
PMID 22038844  Neurourol Urodyn. 2012 Jan;31(1):105-8. doi: 10.1002/na・・・
著者: Joseph Abarbanel, Esther-Lee Marcus
雑誌名: Urology. 2007 Mar;69(3):436-40. doi: 10.1016/j.urology.2006.11.019.
Abstract/Text OBJECTIVES: To determine the prevalence of impaired detrusor contractility (IDC) with and without detrusor hyperactivity (DH) among community-dwelling elderly with lower urinary tract symptoms and to identify which patients are at a greater risk of having a hypocontractile detrusor.
METHODS: We performed a retrospective chart review of all patients 70 years old or older with storage and/or voiding lower urinary tract symptoms who had undergone urodynamic pressure-flow studies in a urodynamic referral center during a 2-year period.
RESULTS: During the study period, 181 patients (82 men [45%] and 99 women [55%]), aged 70 years or older (mean age 75.7 +/- 4.8), underwent urodynamic studies. IDC was detected in 39 (48%) of the 82 men and in 12 (12%) of the 99 women. Two thirds of the men and one half of the women with IDC also had involuntary detrusor contractions during the filling phase and/or low bladder compliance. The prevalence of IDC/DH-IDC was significantly greater in those with a history of urinary retention and an indwelling urethral catheter.
CONCLUSIONS: Detrusor-impaired contractility is an important pathophysiologic mechanism in older patients with lower urinary tract symptoms, especially in men. Establishing the diagnosis by urodynamic pressure-flow studies is crucial for determining treatment--potentially harmful to this vulnerable population--from objective parameters rather than by empirical decisions.

PMID 17382138  Urology. 2007 Mar;69(3):436-40. doi: 10.1016/j.urology.・・・
著者: Katia M C Verhamme, Miriam C J M Sturkenboom, Bruno H Ch Stricker, Ruud Bosch
雑誌名: Drug Saf. 2008;31(5):373-88.
Abstract/Text Urinary retention is a condition in which impaired emptying of the bladder results in postvoidal residual urine. It is generally classified into 'acute' or 'chronic' urinary retention. Because of the complex mechanism of micturition, many drugs can interact with the micturition pathway, all via different modes of action. Although the incidence of urinary retention, in particular acute urinary retention, has been well studied in observational studies and randomized controlled trials, data on the incidence of drug-induced urinary retention are scarce. Data from observational studies suggest that up to 10% of episodes might be attributable to the use of concomitant medication. Urinary retention has been described with the use of drugs with anticholinergic activity (e.g. antipsychotic drugs, antidepressant agents and anticholinergic respiratory agents), opioids and anaesthetics, alpha-adrenoceptor agonists, benzodiazepines, NSAIDs, detrusor relaxants and calcium channel antagonists. Elderly patients are at higher risk for developing drug-induced urinary retention, because of existing co-morbidities such as benign prostatic hyperplasia and the use of other concomitant medication that could reinforce the impairing effect on micturition. Drug-induced urinary retention is generally treated by urinary catheterization, especially if acute, in combination with discontinuation or a reduction in dose of the causal drug. Studies have been carried out examining the effects of preventive measures for anaesthesia-related urinary retention, both during and after surgery, particularly into the effect of using opioids in combination with non-opioid analgesic drugs on the incidence of postoperative urinary retention. Although combination therapy reduces the opioid-related adverse events, the effect on urinary retention yields contradictory results. This article reviews the literature on drug-induced urinary retention and focuses on its incidence, the different classes of drugs that have been associated with it, and options for its management and prevention.

PMID 18422378  Drug Saf. 2008;31(5):373-88.
著者: Paul Cathcart, Jan van der Meulen, Jim Armitage, Mark Emberton
雑誌名: J Urol. 2006 Jul;176(1):200-4; discussion 204. doi: 10.1016/S0022-5347(06)00509-X.
Abstract/Text PURPOSE: We report how the incidence of primary and recurrent acute urinary retention changed in England between 1998 and 2003. In addition, we present data on changes with time in the use of prostatectomy after acute urinary retention and recurrent acute urinary retention.
MATERIALS AND METHODS: Data were extracted from the Hospital Episode Statistics database of the Department of Health in England. Patients were included in the study if an International Classification of Diseases, Tenth Revision code for acute urinary retention or an operative procedure code for transurethral prostate resection was present in any diagnosis or procedure fields of the Hospital Episode Statistics database. A total of 165,527 men were identified to have been hospitalized with acute urinary retention in the study period.
RESULTS: The incidence of primary acute urinary retention was 3.06/1,000 men yearly. Acute urinary retention was spontaneous in 65.3% of cases. The incidence of acute urinary retention decreased from 3.17/1,000 men yearly in 1998 to 2.96/1,000 yearly in 2003. Surgical treatment following spontaneous acute urinary retention decreased 20% from 32% in 1998 to 26% in 2003. This trend coincided with a 20% increase in the rate of recurrent acute urinary retention.
CONCLUSIONS: The slight decrease in the incidence of primary acute urinary retention suggests that the shift away from surgical treatment for benign prostatic hyperplasia has not resulted in an increase in acute urinary retention. The increase in recurrent acute urinary retention suggests that the observed decrease in surgery after acute urinary retention may have put more men at risk for acute urinary retention recurrence.

PMID 16753401  J Urol. 2006 Jul;176(1):200-4; discussion 204. doi: 10.・・・
著者: Brian A Selius, Rajesh Subedi
雑誌名: Am Fam Physician. 2008 Mar 1;77(5):643-50.
Abstract/Text Urinary retention is the inability to voluntarily void urine. This condition can be acute or chronic. Causes of urinary retention are numerous and can be classified as obstructive, infectious and inflammatory, pharmacologic, neurologic, or other. The most common cause of urinary retention is benign prostatic hyperplasia. Other common causes include prostatitis, cystitis, urethritis, and vulvovaginitis; receiving medications in the anticholinergic and alphaadrenergic agonist classes; and cortical, spinal, or peripheral nerve lesions. Obstructive causes in women often involve the pelvic organs. A thorough history, physical examination, and selected diagnostic testing should determine the cause of urinary retention in most cases. Initial management includes bladder catheterization with prompt and complete decompression. Men with acute urinary retention from benign prostatic hyperplasia have an increased chance of returning to normal voiding if alpha blockers are started at the time of catheter insertion. Suprapubic catheterization may be superior to urethral catheterization for short-term management and silver alloy-impregnated urethral catheters have been shown to reduce urinary tract infection. Patients with chronic urinary retention from neurogenic bladder should be able to manage their condition with clean, intermittent self-catheterization; low-friction catheters have shown benefit in these patients. Definitive management of urinary retention will depend on the etiology and may include surgical and medical treatments.

PMID 18350762  Am Fam Physician. 2008 Mar 1;77(5):643-50.
著者: Steven A Kaplan, Alan J Wein, David R Staskin, Claus G Roehrborn, William D Steers
雑誌名: J Urol. 2008 Jul;180(1):47-54. doi: 10.1016/j.juro.2008.03.027. Epub 2008 May 15.
Abstract/Text PURPOSE: The definitions of acute and chronic urinary retention remain empirical and subject to wide interpretation. Standardized criteria have not been established and many questions remain unanswered. Moreover, the definition of significant post-void residual urine is unclear. We reviewed several aspects of urinary retention that require clarification with the objective of stimulating discussion among urologists to establish an accurate and coherent definition of urinary retention and significant post-void residual urine, and clarify risk factors.
MATERIALS AND METHODS: A MEDLINE search for articles written in English and published before April 2007 was done using a list of terms related to urinary retention. Articles not directly relevant to urinary retention or post-void residual urine were excluded.
RESULTS: The term urinary retention lacks precise clinical or urodynamic meaning. Use of this term to describe a symptom, a sign, and a condition further complicates the issue. Many factors can contribute to the development of retention, including bladder outlet obstruction, detrusor underactivity, and neurogenic bladder conditions. Community based studies and clinical trials in patients with benign prostatic enlargement and/or lower urinary tract symptoms yield different estimates of the incidence of retention and only provide information on the epidemiology of acute urinary retention. However, age, previous retention episodes, lower urinary tract symptoms, chronic inflammation, serum prostate specific antigen level, prostate size, and urodynamic variables appear to be predictors of acute urinary retention. Alpha-receptor antagonists and 5alpha-reductase inhibitors may be useful in preventing urinary retention episodes and progressive benign prostatic enlargement. Clinical trials on the short-term use of antimuscarinics have not provided evidence that these agents increase the risk of retention; data on longer term administration are needed.
CONCLUSIONS: Clinicians are adopting less invasive approaches (eg pharmacology or catheterization) to treating patients who present with the symptoms, sign, and condition of urinary retention. Faced with an abundance of new data on acute urinary retention, urologists need to reach a consensus about the risks of urinary retention; this may promote movement toward patient centered prevention strategies with tailored treatment options.

PMID 18485378  J Urol. 2008 Jul;180(1):47-54. doi: 10.1016/j.juro.2008・・・

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