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下部泌尿器系の症状を持つこの男性は,膀の出口の阻害を患っているのでしょうか? : 合理的な臨床試験:体系的なレビュー
Karen A D'Silva1, Philipp Dahm2, Camilla L Wong3
1Department of Medicine, University of Toronto, Toronto, Ontario, Canada2Division of Geriatrics, St Michael's Hospital, Toronto, Ontario, Canada.
JAMA
|August 7, 2014
まとめ
男性の膀出口阻害を診断するには,症状だけでは不十分です. 膀スキャンは,空白後の残留量を正確に測定するために推奨され,下尿路症状の診断と管理に役立ちます.
科学分野:
- 泌尿器科 泌尿器科とは
- 診断の精度 診断の精度
- 医療技術 医療技術について
背景:
- 男性の尿路下部症状 (LUTS) は,膀出口阻害 (BOO) を示す可能性があります.
- BOOの早期診断は,侵襲的な検査を避け,症状を効果的に管理するために非常に重要です.
- 排尿後の残留 (PVR) 尿量を正確に測定することは,BOOの評価に不可欠です.
研究 の 目的:
- LUTSを持つ男性におけるBOOのためのオフィスベースのテストの診断精度を体系的にレビューする.
- カテーテリゼーションと比較して尿量の測定における膀スキャンの精度を評価する.
主な方法:
- MEDLINE,EMBASE,コクラン図書館のデータベースを体系的にレビュー (1950年 - 2014年3月).
- 非侵襲的な診断検査や膀スキャンを基準基準 (尿動力学やキャセテリゼーション) と比較する前向きな研究も含まれています.
- 症状/アンケートの診断の正確性と,PVRの容量のための膀スキャンとキャセテリゼーションの相関を分析した.
主要な成果:
- 個々の症状とアンケートでは,BOOの診断精度が限られていた (確率比は1.0を含む).
- 20以上の国際前立腺症状スコア (IPSS) は,BOOの可能性 (LR+,1.5) を増加させるが,スコア<20は決定的ではなかった (LR-,0.82).
- 膀スキャンでは,尿量 (r=0.93) を測定するための膀カテーテリゼーションと高い相関性が示されました.
結論:
- 症状とアンケートだけでは,LUTSを持つ男性におけるBOOの診断には不十分です.
- 膀スキャンはPVR尿量測定に正確であり,評価に用いられるべきである.
- 膀スキャンによるPVRの正確な測定は,管理を導き,潜在的に侵襲的な処置を減らすことができます.
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