抄録
(目的)本邦における前立腺肥大症(BPH)に対する外科療法の実施状況と,各治療法に関する医療者の意識を把握し,将来的な治療方法の統一評価を図る際の参考資料を提供する.(方法)全国155医療施設を対象に,BPHの代表的外科療法に対する過去の経験と平成12年度の実施状況,ならびに各種意識(治療法の経済性,安全性,侵襲度,全般効果,総合的有用性,選択基準ならびに将来性)に関するアンケート調査を実施した.(結果)過去に経験した治療法,および平成12年度に実施した治療法のいずれも,経尿道的前立腺切除術(TURP)に統いてthick-loopを用いた経尿道的前立腺電気蒸散術(TUVP)が多かった.意識調査では,経済性がTURP,全般効果は開腹術,安全性はラジオ波高温度治療(TURF)がそれぞれ最も優れ,総合的有用性はTURPに続いてTUVPが高いと認識されていた.今後の普及が見込める治療法として順位の高かったものは,TUVP,組織内レーザー凝固術(ILCP),経尿道的マイクロ波高温度治療術(TUMT)であった.(結論)各低侵襲治療法はいずれもTURPと比べて安全性と侵襲度において優れ,全般効果と経済性では劣り,総合的有用性でTURPを凌駕すると認識されたものはなかった.そのなかでTUVP(thick-loop)は全般効果や経済性でもTURPにほぼ匹敵し,今後の普及が見込まれる治療法であった.今後,BPHにおける外科療法の位置づけを確立するには,その安全性や侵襲度とともに長期有効性の十分な検討が必要と考えられた.
(Background and purpose) We conducted a questionnaire survey concerning the prevalence and preference with regard to various types of surgical treatment for benign prostatic hypertrophy (BPH), in order to gather preliminary data that may be helpful for standardizing the surgical treatment of BPH. (Method) A questionnaire survey was mailed to institutes in which a council member of the Japanese Endourology and ESWL Society was present. The questions dealt with the type and volume of surgical treatment experienced previously, and the treatments which had been performed in each institute during 2000. Preferences concerning cost effectiveness, safety, degree of invasion, efficacy, overall usefulness, and the possibility of prevalence from now on at general hospitals were also asked with regard to each surgical treatment. (Results) Of the 155 institutes to which the questionnaire was sent, 70 responded (45% response rate). TUVP (transurethral vaporization of the prostate by thick-loop) was second to TURP (transurethral resection of the prostate) both regarding the volume of the surgical treatment that had been experienced previously, and the volume that had been performed during 2000. TURP was recognized as the most preferred treatment with regard to both cost effectiveness and overall usefulness, while TURF (transurethral radiofrequency thermotherapy) was preferred both for safety and reduced invasiveness, and open surgery for efficacy. Minimal invasive surgical treatment, such as TUVP, followed by ILCP (interstitial laser coagulation of the prostate) and TUMT (transurethral microwave thermotherapy) was recognized as the most preferable treatment for dealing with the prevalence from now on at general hospitals. (Conclusion) Each minimal invasive surgical treatment was recognized as being safer and less invasive, but less effective and less useful compared to TURP Among these surgical treatments, TUVP by thick-loop was recognized as being second choice to TURP with regard to efficacy and overall usefulness. As a matter of course, it would seem to be essential to evaluate long-term efficacy in addition to both safety and invasiveness when trying to standardize the surgical treatment for BPH.
