脊髄損傷における下部尿路機能障害の診療ガイドライン　2019年版

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『脊髄損傷における排尿障害の診療ガイドライン（第2版）』（2011年）の全面改訂版．主な改訂内容：(1)主要な項目に関する「総説」を追加．クリニカルクエスチョンと相まって内容の理解が深まるように配慮した．(2)「尿路合併症の防止・（社会的）尿禁制の獲得・生活の質（QOL）の改善」を主なアウトカムとして設定し，これを実現するようなガイドラインたることを目指した．(3)コストベネフィット・保険診療上の留意点にも言及した．

目次

  • はじめに
    　脊髄損傷における下部尿路機能障害の診療アルゴリズム
    　脊髄損傷における下部尿路機能障害の診療アルゴリズム （解説）
    　尿路管理法のまとめ

    第1部　総論
    　§1．脊髄損傷の疫学
    　§2．脊髄損傷における下部尿路機能障害の病態生理
    　§3．脊髄損傷における下部尿路機能障害の診断
    　　I．検査と診断の手順
    　　II．一般的診察
    　　III．尿流動態検査
    　　IV．画像検査・内視鏡検査
    　§4．脊髄損傷における下部尿路機能障害の治療
    　　§4-1．尿路管理法
    　　　I．急性期の尿路管理法
    　　　II．自排尿
    　　　III．清潔間欠導尿 （clean intermittent catheterization：CIC）
    　　　IV．カテーテル留置（尿道カテーテル留置・恥骨上膀胱瘻カテーテル留置）
    　　§4-2．行動療法
    　　　I．生活指導
    　　　II．生活指導以外の行動療法
    　　§4-3．薬物療法
    　　　I．抗コリン薬
    　　　II．β3アドレナリン受容体作動薬（β3受容体作動薬）
    　　　III．α1遮断薬，コリン作動薬，その他の下部尿路に作用する薬剤
    　　§4-4．外科的治療
    　　　I．膀胱拡大術
    　　　II．尿失禁防止術
    　　　III．尿路変向術（失禁型，禁制型）
    　　　IV．括約筋切開術
    　　　V．尿道ステント
    　　§4-5．その他の治療法
    　　　I．経尿道的ボツリヌス毒素膀胱壁内注入療法
    　　　II．ボツリヌス毒素括約筋内注入療法
    　　　III．電気・磁気刺激療法
    　§5．脊髄損傷患者における症候性尿路感染の診断と治療
    　§6．小児の脊髄損傷
    　§7．高齢者の脊髄損傷
    　§8．頸髄損傷
    　§9．自律神経過緊張反射 （自律神経過反射）
    　§10．脊髄損傷の診療におけるコストベネフィット

    第2部　クリニカルクエスチョン （CQ）
    　CQ1：脊髄損傷患者において，腎障害（腎機能障害，上部尿路障害）の危険因子には
    　　　　どのようなものがあるか？
    　CQ2：脊髄損傷患者において，症候性尿路感染の危険因子にはどのようなものがあるか？
    　CQ3：脊髄損傷患者において，尿失禁の危険因子にはどのようなものがあるか？
    　CQ4：脊髄損傷患者において，下部尿路機能障害に関連したQOL低下の危険因子には
    　　　　どのようなものがあるか？
    　CQ5：脊髄損傷患者の腎機能障害を早期にとらえる臨床検査値として，
    　　　　シスタチンCは推奨されるか？
    　CQ6：脊髄損傷患者の尿路管理法の決定において，透視下尿流動態検査は
    　　　　膀胱尿道造影単独よりも推奨されるか？
    　CQ7：脊髄損傷患者において膀胱癌のスクリーニングのために定期的な尿細胞診や
    　　　　膀胱鏡検査は推奨されるか？
    　CQ8：清潔間欠導尿の適応がある脊髄損傷患者において，清潔間欠導尿は
    　　　　反射性排尿やクレーデ排尿/バルサルバ排尿，尿道カテーテル留置や
    　　　　恥骨上膀胱瘻カテーテル留置と比べて推奨されるか？
    　CQ9：脊髄損傷患者における清潔間欠導尿において，親水性コーティング付き
    　　　　ディスポーザブルカテーテルを用いることが推奨されるか？
    　CQ10：夜間多尿あるいは外出時に清潔間欠導尿が困難な脊髄損傷患者において，
    　　　　　間欠式バルーンカテーテルの併用は推奨されるか？
    　CQ11：清潔間欠導尿を実施中の脊髄損傷患者における無症候性膿尿・細菌尿に対して，
    　　　　　抗菌薬投与は推奨されるか？
    　CQ12：カテーテル留置を選択せざるを得ない脊髄損傷患者において，
    　　　　　恥骨上膀胱瘻カテーテル留置は尿道カテーテル留置と比べて推奨されるか？
    　CQ13：カテーテル留置で管理されている脊髄損傷患者において，膀胱洗浄は推奨されるか？
    　CQ14：腎障害や症候性尿路感染の危険因子を有する，あるいは尿失禁を認める
    　　　　　脊髄損傷患者において，抗コリン薬の投与は推奨されるか？
    　CQ15：腎障害や症候性尿路感染の危険因子を有する，あるいは尿失禁を認める
    　　　　　脊髄損傷患者において，β3受容体作動薬の投与は推奨されるか？
    　CQ16：保存的治療に抵抗性の膀胱蓄尿機能障害を有する脊髄損傷患者において，
    　　　　　膀胱拡大術は推奨されるか？
    　CQ17：保存的治療に抵抗性の尿失禁を有する脊髄損傷患者において，
    　　　　　尿失禁防止術は推奨されるか？
    　CQ18：清潔間欠導尿が困難と考えられる頸髄脊髄損傷患者において，括約筋切開術は，
    　　　　　尿道ステント，膀胱瘻，尿道カテーテル留置と比べて推奨されるか？
    　CQ19：保存的治療に抵抗性の膀胱蓄尿機能障害を有する脊髄損傷患者において，
    　　　　　経尿道的ボツリヌス毒素膀胱壁内注入療法は推奨されるか？
    　CQ20：下部尿路機能障害を有する脊髄損傷患者において，
    　　　　　どのような経過観察が推奨されるか？
    　CQ21：脊髄損傷患者の下部尿路機能障害における保険診療上の留意点は何か？

この書籍の参考文献

参考文献のリンクは、リンク先の都合等により正しく表示されない場合がありますので、あらかじめご了承下さい。

本参考文献は電子書籍掲載内容を元にしております。

はじめに

P.16 掲載の参考文献
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尿路管理法のまとめ

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Medical*Online

第1部 総論

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