尿失禁を伴う高齢者過活動膀胱症例に対する干渉低周波療法の有用性  [in Japanese] EFFICACY ON INTERFERENTIAL LOW FREQUENCY THERAPY FOR ELDERLY OVERACTIVE BLADDER PATIENTS WITH URINARY INCONTINENCE  [in Japanese]

(目的)抗コリン薬での効果が不十分な尿失禁を伴う高齢者過活動膀胱症例に対する干渉低周波療法(IF)の効果につきプロスペクティブに検討した.(対象と方法)65歳以上の80例.全症例に対し塩酸プロピペリン20mg/日の投与が3ヵ月以上行われ,その後のQOL indexが4以上であった.その後,表面電極を用いたIFを単独で3ヵ月間施行し,効果判定を行った.(結果)IFは8回(中央値)の時点で良好な効果が認められ,効果は継続した.有意な改善項目(夜間排尿回数の推移 ; p=0.0004,それ以外の項目 ; p<0.0001)を以下に記載する(数値は[IF開始前の平均値]→[IF後3ヵ月の平均値]). 1) 尿失禁回数 ; 13.3→3.6回/週, 2) 60分間PADテスト ; 17.5→3.1gr., 3) 昼間排尿回数 ; 8.3→7.0回,夜間排尿回数 ; 1.8→1.4回, 4) IPSS ; 12.1→6.3, QOL index ; 5.2→2.4, 5) 1回排尿量 ; 170.2→254.2ml, Qmax ; 18.1→25.7ml/秒, Qave ; 8.9→12.1ml/秒, 6) 1日平均屋外滞在時間 ; 1.5→3.0時間,1日平均行動半径 ; 400→1,200m,ADLスケール ; 8.0→3.4, 7) 血漿浸透圧 ; 295.1→297.8mOsm/l, BNP ; 41.3→19.2pg/ml.(結論)今回の検討結果は,抗コリン薬での治療効果が不良な尿失禁を伴う高齢者過活動膀胱症例に対するIFの安全で有効な臨床効果の可能性を示唆している.

(Aims of study) Examining the clinical efficacy on the interferential low frequency therapy for elderly overactive bladder (OAB) patients with urinary incontinence prospectively, for whom anticholinergics were not effective. (Study design, materials and methods) Subjects are 80 patients over 65 years with urinary incontinence, who are clinically diagnosed with OAB. For over three months, they were administered anticholinergics (20mg/day propiverine hydrochloride), but in an interview after the administration period they responded that their QOL indexes were 4 (mostly dissatisfied) or over. After the anticholinergics had been washed out for over one week, the patients were provided with interferential low frequency therapy (IF) alone for three months using the Uromaster^<(R)> (made by Nihon Medix Co.). Before and after IF, the following items were examined. 1) Frequency of IF treatment required to show optimal effects subjectively, 2) Average incontinence frequency in a week, 3) PAD test for 60 minutes, 4) Frequency and voided volume in the daytime and nighttime, 5) Fluid intake volume, 6) IPSS, QOL index, 7) UFM (voiding time, voided volume, Qmax, Qave), 8) PVR (postvoid residual urine), 9) Specific gravity of urine, 10) Average hours spent outside per day, 11) Average radius of action per day, ADL scale, 12) Blood pressure and pulse in the standing position, 13) Values of clinical examination, 14) Adverse events of IF., 15) Plasma osmotic pressure, 16) BNP (Brain natriuretic peptide). During the trial, no behavioral advice, including fluid intake advice, was provided to the patients. Before starting this study, all patients signed an informed consent agreement. (Results) 1) After a median of eight treatments of IF, the patients showed significant improvements subjectively and this effect continued. Improvement was observed in the following items. All these values showed [The mean value before IF] → [The mean value after IF for three months], and statistically significant differences were identified between before and after IF in all these values (p<0.0001 except nighttime voiding frequency [p=0.0004]). 2) Incontinence frequency ; 13.3→3.6 times/week, 3) PAD test ; 17.5→3.1gr., 4) daytime voiding frequency ; 8.3→7.0 times, nighttime voiding frequency ; 1.8→1.4 times, 6) IPSS ; 12.1→6.3, QOL index ; 5.2→2.4, 7) Voided volume ; 170.2→254.2ml, Qmax ; 18.1→25.7ml/sec, Qave ; 8.9→12.1ml/sec, 10) Average hours spent outside ; 1.5→3.0hrs., 11) Average radius of action ; 400→1,200m, ADL scale ; 8.0→3.4, 12) Blood pressure in the standing position ; 132.9/79.7→127.1/74.7mmHg., 15) Plasma osmotic pressure ; 295.1→297.8 mOsm/l, 16) BNP ; 41.3→19.2 pg/ml. Other items including clinical examination and pulse did not change much, while the adverse events of IF were not recognized. (Interpretation of results) The results indicate the possibility that IF has safe and better effects than anticholinergics on the elderly OAB patients with urinary incontinence. It is clear that the OAB can significantly impair the QOL and reduce the ADL. By improving the urgent incontinence, the QOL will be improved and the physical activity may increase.