超高齢社会における女性の尿失禁の的確な診断と治療(特別講演3,第66回日本産科婦人科学会・学術講演会)

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タイトル別名
  • Proper Diagnosis and Treatment for Female Lower Urinary Symptoms in the Aging Society

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The population older than 65 years old exceeds 25% in Japan and aging of Japan is progressing most quickly in the world. In regard with health care of middle-aged and elderly women, urinary dysfunction that affects the quality of life (QOL) has become a big issue. Since most of women who are suffering from urination troubles such as urinary incontinence and difficulty voiding consult gynecologist, it is important for obstetrician and gynecologist to have proper medical skill to diagnose and treat urinary dysfunctions. Lower urinary tract is anatomically supported by the anterior vagina and the anterior vagina is the pubocervical fascia which is composed of elastic membrane located between the ischial spine and pubis symphysis. Stress urinary incontinence (SUI) occurs by urethral hypermobility without optimal urethral compression when this support mechanism is disordered. Annular sphincter of lower urinary tract is weak and a vagina wall relaxes by the pregnancy, childbirth, hormonal absence, physical trauma and aging. The relaxation of a vagina induces involuntary contraction of a bladder detrusor, and causes the overactive bladder (OAB) consisting mainly of a feeling of urgency of urination or frequent urination. Unpleasant symptoms by urination disorder including urinary frequency, urinary urgency, urinary incontinence, dysuria and residual urine are categorized as lower urinary tract symptoms (LUTS) and potentially affect many post-menopausal women. Involuntary bladder contraction and stress urinary incontinence often merge (mixed incontinence, MI) and an interview sheet evaluating urinary volume, frequency, nocturia, and incontinence is required to diagnose LUTS properly. The unique interview sheet which author developed makes diagnosis of mixed urinary incontinence easy and can perform exact medical treatment. In addition, the author reported that β2 adrenergic agent improved SUI and MI by a combination with pelvic floor muscle t raining. It is shown in a guideline as the recommendation level A that anticholinergic drugs carry out excellent to OAB. Recently, β3 adrenergic agonist has been developed by the Japanese pharmaceutical company as a new medicine to OAB. The anatomical SUI has been cured by tension free vaginal tape (TVT) as minimum invasive surgery. Female LUTS is a definitive subject of QOL disorder in the aging society and author eager to ask obstetrician and gynecologist to learn that LUTS is conquerable by performing precise conservative and surgical medical treatment in women's health care.

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