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

Abstract

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. 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" (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. 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/1, 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. 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.