배뇨근수축력저하 환자에서 Bethanechol과 알파-1 아드레날린 차단제 요법의 효과
The Effect of Bethanechol Chloride with an ?-adrenergic Blocker in Patients with Impaired Detrusor Contractility
김지영, 홍정희, 이규성,
소속 상세정보
김지영 ( Kim Ji-Young )
성균관대학교 의과대학 삼성서울병원 비뇨기과학교실
홍정희 ( Hong Jeong-Hee )
단국대학교 의과대학 비뇨기과학교실
이규성 ( Lee Kyu-Sung )
성균관대학교 의과대학 삼성서울병원 비뇨기과학교실
KMID : 0358320070480101040
Abstract
방광의 요 배출이 적절치 않다면 이는 과도한 방광출구 폐색이나 배뇨근수축력저하에서 기인한다. 방광출구폐색과 배뇨근수축력저하는 요속 저하의 주요 원인으로, 하부 요로증상과 단순 요속검사만으로는 이를 감별할 수 없다. 특히 배뇨근수축력저하는 압력요류검사를 통해서 진단되며, 낮은 배뇨근압 또는 파형양상의 배뇨근 수축의 특징을 보인다.
Bethanechol은 배뇨근수축력저하 환자에서 요 배출을 향상시키기 위해 지난 60여 년 이상 경험적으로 사용되어 왔으며,1 방광 평활근의 긴장도를 증가시켜 방광 수축을 유발하는 것으로 알려져 있다. 하지만, 임상적 효능이 일관되게 입증되지 못하였고, 연구자에 따라 결과가 다양하게 보고 되어 온 것이 사실이다.
Purpose:Bethanechol enhances detrusor contraction and ?1-blockers reduce bladder outlet resistance. We evaluated the effects of bethanechol with doxazosin in patients with impaired detrusor contractility.
Materials and methods: Fifty-six patients that had confirmed detrusor underactivity with at least 150ml of postvoid residual urine volume(PVR) based on a urodynamic study were enrolled. The initial dosage of bethanechol given was 75mg/day, and the dosage was gradually increased to 150mg/day if necessary. Doxazosin gastro-intestinal therapeutic system(GITS)(4mg) was also given. The effect of the treatment was evaluated by a urine flow test, the amount of PVR, and frequency of clean intermittent catheterization(CIC).
Results:The mean follow-up period was 6 months(range, 1 to 9 months). After treatment, the mean PVR decreased from 251.8±149.6ml to 136.4± 153.2ml(p＜0.001) and was less than 100ml in 22(39%) of the 38 patients that showed a decrease. The maximum flow rate(Qmax) increased from 8.7±4.7ml/s to 11.1±5.6ml/s(p=0.024) and was more than 5ml/s in 13 patients(23%). Five of the 18 patients that previously required CIC could discontinue this treatment and another nine patients showed a decrease in the frequency. The mean daily frequency of CIC was reduced from 3.2 to 1.5(p=0.004). Ten of the 12 patients that were not able to void became capable of voluntary voiding. Five patients(9%) complained of adverse reactions and four of them were taken off the medication.
Conclusions:The combination therapy of bethanechol with doxazosin improved emptying ability in patients with impaired detrusor contractility. (Korean J Urol 2007;48:1040-1043)
키워드
Neurogenic bladder;Bethanechol;Alpha-adrenergic blockers
원문 및 링크아웃 정보
등재저널 정보