神経因性膀胱を中心とした排尿障害に対する新しいα-adrenergic blockerの効果

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post synapseに作用するα1-adrenergic blockerとし新らしく開発したE-643(エーザイ)を,神経因性膀胱10例,下部尿路通過障害7例に使用し,著効5例,有効7例,無効5例であった.(1)膀胱利尿筋の収縮力には影響しなかった.(2)神経因性膀胱では有効率は80%を示したが,前立腺肥大症,膀胱頸部硬化症などを中心とした下部尿路通過障害では,有効率は57%であった.(3)前立腺肥大症だけで良い効果が得たが,最大尿道閉鎖圧(MUCP)には変化がなくても,前立腺部尿道圧が下降傾向にあることが排尿をスムースにし,残尿を少なくすると考えた.これも利尿筋の収縮力がある例に限られた.(4)いわゆる膀胱頸部硬化症では,ウロダイナミクス検査上,器質的なものと機能的なものがあるが,機能的なものは,膀胱頸部硬化症とは呼ぶべきではない.(5)3例に動悸,眩暈,脱力感などを認め,2例は減量により軽快したが,脱力感1例は投与を中止した.3 mg前後の投与量では,正常血圧者では血圧にはほとんど変動なく,血液生化学的にも異常所見を認めなかったE-643, a newly developed alpha 1-adrenergic blocker with a postsynaptic action, was tried on 17 subjects, 10 patients with neurogenic bladder and 7 patients with lower urethral obstruction. The results of treatment were excellent in 5, good in 7, and poor in 5 of them, the rate of effectiveness therefore being 70.6%. The inhibitory effect of E-643 on the contractility of the detrusor was no stronger than that of other alpha-blockers. The rate of effectiveness for neurogenic bladders was as high as 80% whereas that for lower urethral obstruction was much lower: 57%. Concerning benign prostatic hyperplasia (B.P.H.) alone, this agent was markedly beneficial. In the case of B.P.H the urethra pressure in the prostatic urethra tends to drop and urination is facilitated even without a change in maximum urethral closure pressure, which reduces the amount of residual urine, this sequence of events taking place on condition that the contractility of the detrusor is adequate. According to urodynamic criteria, the underlying causes of the so-called bladder neck contracture can be classified into organic and functional obstruction, but it is mistaken to use this term for functional disturbance of the bladder neck. It seems worthwhile to determine the clinical effect of alpha-blockers on functional urethral obstruction. E-643 produced few if any appreciable signs or symptoms of side effects either subjectively or objectively.
泌尿器科紀要刊行会の論文

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滝本至得
東京都立豊島病院

神経因性膀胱を中心とした排尿障害に対する新しいα-adrenergic blockerの効果

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