Analysis of preferences for treatment modalities in outpatients with nocturia with special reference 夜間頻尿を有する外来患者における治療法選択に関する検討-補完代替医療を中心に-

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  • Analysis of preferences for treatment modalities in outpatients with nocturia with special reference

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【目的】下部尿路障害を有する患者は種々の治療法を希望する傾向があるため,夜間頻尿を有する外来患者における各種治療法の選択と夜間排尿回数および夜間頻尿による生活の質(QOL)との関係について,補完代替医療を中心に検討した.【対象と方法】2005年12月から2006年11月の間に,明治国際医療大学泌尿器科外来を受診した80名の患者に対して,夜間頻尿の有無を確認するために3日間の排尿日誌の記録を依頼した.1回以上の夜間排尿が確認された者に対して,国際前立腺症状スコア(IPSS)QOL indexを改変した夜間頻尿によるQOLと5種類の治療法すなわち補完代替医療(CAM),薬物療法,水分塩分の減量,運動,睡眠の改善に対する受療希望に関する質問票を用いた面接調査を行った.各治療法に対して「受けたい」,「わからない(必要なら受ける)」,「受けたくない」の3項目から回答を得た.さらに対象者を夜間の排尿回数と夜間排尿によるQOLから,それぞれ3つのグループに分類し,各治療法に対する希望について比較検討した.【結果】排尿日誌の記録の不備などにより,27名の患者が除外され,最終的に53名が対象となった.夜間の排尿回数と夜間排尿によるQOLには有意な相関があった.各治療法に対して「受けたい」と回答した患者の割合は,それぞれCAMが27%,薬物療法は81%,水分塩分の減量は38%,運動は62%,睡眠の改善は40%であった.夜間の排尿回数とCAMや薬物療法に対する受療希望との間に有意な相関が示された.また夜間排尿によるQOLとCAMに対する受療希望の間にも有意な関連が認められた.【結語】夜間頻尿患者の求める治療法は様々であり,その選択は個人的な希望や夜間の排尿回数,夜間排尿によるQOLに基づいていた.また相当数の患者がCAMを希望していた.CAMを含め患者に適した治療法を決定する際は,夜間頻尿患者において種々の治療に対する彼らの希望を尋ねることが臨床上特に重要であると考えられた.

Aim: Patients with lower urinary tract symptoms (LUTS) tend to seek various treatment modalities. The aim of this study is to examine preferences for treatment modalities and their relationships with the number of noctuira episode and quality of life (QOL) due to nocturia in outpatients with nocturia using a questionnaire with special reference to complementary and alternative medicine (CAM). Subjects and methods: Eighty outpatients who visited our clinic were requested to complete a 3-day bladder diary to confirm that they had nocturia. Those who had one or more nocturnal voidings were also interviewed using an original questionnaire regarding their QOL due to nocturia, which had been modified from a validated Japanese version of the International Prostate Symptom Score (IPSS) QOL index, and their desire to undergo fi ve treatment modalities; i.e., CAM, prescription medication, water and salt intake reduction, taking exercise, and sleep improvement. The patients were asked to rate preferences for each modality using three discrete scales; i.e., “wish to undergo”, “undecided (may undergo treatment if strongly recommended)”, and “do not wish to undergo”. Then, the participants were divided into three groups based on the number of nocturia episodes and their QOL score, which were then compared with each other with regard to their desire to undergo the five treatment modalities. Results: Twenty-seven patients were excluded from the analysis because of incorrect bladder diary recording, and 53 patients were analyzed in this study. There was a significant correlation between the number of nocturia episodes and QOL due to nocturia. Twenty six percent of the patients wanted CAM, 81% desired prescription medication, 38% chose water and salt intake reduction, 62% chose exercise, and 40% opted for sleep improvement. There were signifi cant relationships between number of nocturia episodes and the desire for CAM and medication. There was also a significant relationship between the QOL score and the desire for CAM. Conclusion: Patients with nocturia seek various kinds of treatment, and their choice depends on personal preference, number of nocturia episodes and impaired QOL due to nocturia. Considerable number of patients seek CAM. It is clinically important for physicians to ask nocturics about their treatment preference when deciding on a suitable treatment strategy including CAM.

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