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06.09.2019 | Originalien

Die Reizblase – Abklärung und Therapie

verfasst von: Gianluca Rizzi, Dr. med. Marko Kozomara

Erschienen in: Urologie in der Praxis | Ausgabe 3/2019

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Zusammenfassung

Die Reizblase ist ein Beschwerdebild, bei welchem ein imperativer Harndrang mit oder ohne Dranginkontinenz auftritt. Je nach Ausprägungsgrad kann sie einen signifikanten Einfluss auf die Lebensqualität der Betroffenen haben. Die Prävalenz der überaktiven Harnblase ab dem 40. Lebensjahr beträgt ca. 17 % bei Frauen und Männern und kann mit zunehmendem Alter bis zu 32 % betragen. Zudem stellt sie ein sozioökonomisch relevantes Krankheitsbild dar. Ursächlich können verschiedenste urologische, nichtneurologische sowie neurologische Erkrankungen in Frage kommen. Zur Abklärung ist eine systematische Anamneseerhebung unerlässlich. Diagnostisch sollte stufenweise von der Anamneseerhebung über die klinische Untersuchung zur Laborkontrolle und apparativen Diagnostik (Zystoskopie, Urodynamik, Radiologie) vorgegangen werden, damit nachfolgend eine optimierte Therapie erfolgen kann. Insbesondere bei neurogenen Harnblasenfunktionsstörungen stehen primär der Schutz des oberen Harntraktes und der Blase im Vordergrund, sekundär aber auch die Verbesserung der Lebensqualität, die Erhaltung der Kontinenz sowie die Optimierung der Harnblasenentleerung. Therapeutisch stehen verschiedenste konservative, medikamentöse, elektromodulative und operative Optionen zur Verfügung.
Literatur
1.
Zurück zum Zitat Füsgen I, Niederstadt C (2004) Das unterschätzte Tabuthema. Geriatr J 2:14–17 Füsgen I, Niederstadt C (2004) Das unterschätzte Tabuthema. Geriatr J 2:14–17
2.
Zurück zum Zitat Drake MJ (2014) Do we need a new definition of the overactive bladder syndrome? ICI-RS 2013. Neurourol Urodyn 33:622–624CrossRefPubMed Drake MJ (2014) Do we need a new definition of the overactive bladder syndrome? ICI-RS 2013. Neurourol Urodyn 33:622–624CrossRefPubMed
3.
Zurück zum Zitat Abrams P, Cardozo L, Fall M et al (2003) The standardisation of terminology in lower urinary tract function: Report from the standardisation sub-committee of the International Continence Society. Urology 61:37–49CrossRefPubMed Abrams P, Cardozo L, Fall M et al (2003) The standardisation of terminology in lower urinary tract function: Report from the standardisation sub-committee of the International Continence Society. Urology 61:37–49CrossRefPubMed
4.
Zurück zum Zitat Herzog AR, Fultz N (1990) Epidemiology of urinary incontinence: Prevalence, incidence, and correlates in community populations. Urology 36:2–10 Herzog AR, Fultz N (1990) Epidemiology of urinary incontinence: Prevalence, incidence, and correlates in community populations. Urology 36:2–10
5.
Zurück zum Zitat Markland AD, Goode PS, Redden DT, Borrud LG, Burgio KL (2010) Prevalence of urinary incontinence in men: Results from the national health and nutrition examination survey. J Urol 184:1022–1027CrossRefPubMed Markland AD, Goode PS, Redden DT, Borrud LG, Burgio KL (2010) Prevalence of urinary incontinence in men: Results from the national health and nutrition examination survey. J Urol 184:1022–1027CrossRefPubMed
6.
Zurück zum Zitat Milsom I, Abrams P, Cardozo L, Roberts RG, Thuroff J, Wein AJ (2001) How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int 87:760–766CrossRefPubMed Milsom I, Abrams P, Cardozo L, Roberts RG, Thuroff J, Wein AJ (2001) How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int 87:760–766CrossRefPubMed
7.
Zurück zum Zitat Shamliyan TA, Wyman JF, Ping R, Wilt TJ, Kane RL (2009) Male urinary incontinence: Prevalence, risk factors, and preventive interventions. Rev Urol 11:145–165PubMedPubMedCentral Shamliyan TA, Wyman JF, Ping R, Wilt TJ, Kane RL (2009) Male urinary incontinence: Prevalence, risk factors, and preventive interventions. Rev Urol 11:145–165PubMedPubMedCentral
8.
Zurück zum Zitat Milsom I, Coyne KS, Nicholson S, Kvasz M, Chen CI, Wein AJ (2014) Global prevalence and economic burden of urgency urinary incontinence: A systematic review. Eur Urol 65:79–95CrossRefPubMed Milsom I, Coyne KS, Nicholson S, Kvasz M, Chen CI, Wein AJ (2014) Global prevalence and economic burden of urgency urinary incontinence: A systematic review. Eur Urol 65:79–95CrossRefPubMed
9.
Zurück zum Zitat Kohli R, Herrmann AB, Babel J (2010) Szenarien zur Bevölkerungsentwicklung der Schweiz 2010–2060. Statistik der Schweiz, Bd. 01. BFS, Neuchâtel Kohli R, Herrmann AB, Babel J (2010) Szenarien zur Bevölkerungsentwicklung der Schweiz 2010–2060. Statistik der Schweiz, Bd. 01. BFS, Neuchâtel
10.
Zurück zum Zitat Del Popolo G, Panariello G, Del Corso F, De Scisciolo G, Lombardi G (2008) Diagnosis and therapy for neurogenic bladder dysfunctions in multiple sclerosis patients. Neurol Sci 29(Suppl 4):S352–S355CrossRefPubMed Del Popolo G, Panariello G, Del Corso F, De Scisciolo G, Lombardi G (2008) Diagnosis and therapy for neurogenic bladder dysfunctions in multiple sclerosis patients. Neurol Sci 29(Suppl 4):S352–S355CrossRefPubMed
11.
Zurück zum Zitat Best KL, Ethans K, Craven BC, Noreau L, Hitzig SL (2017) Identifying and classifying quality of life tools for neurogenic bladder function after spinal cord injury: A systematic review. J Spinal Cord Med 40:505–529CrossRefPubMed Best KL, Ethans K, Craven BC, Noreau L, Hitzig SL (2017) Identifying and classifying quality of life tools for neurogenic bladder function after spinal cord injury: A systematic review. J Spinal Cord Med 40:505–529CrossRefPubMed
12.
Zurück zum Zitat Badia X, Garcia-Losa M, Dal-Re R (1997) Ten-language translation and harmonization of the International Prostate Symptom Score: Developing a methodology for multinational clinical trials. Eur Urol 31:129–140CrossRefPubMed Badia X, Garcia-Losa M, Dal-Re R (1997) Ten-language translation and harmonization of the International Prostate Symptom Score: Developing a methodology for multinational clinical trials. Eur Urol 31:129–140CrossRefPubMed
13.
Zurück zum Zitat Timmermans L, Falez F, Melot C, Wespes E (2013) Validation of use of the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) for impairment rating: A transversal retrospective study of 120 patients. Neurourol Urodyn 32:974–979CrossRefPubMed Timmermans L, Falez F, Melot C, Wespes E (2013) Validation of use of the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) for impairment rating: A transversal retrospective study of 120 patients. Neurourol Urodyn 32:974–979CrossRefPubMed
14.
Zurück zum Zitat Homma Y, Ando T, Yoshida M et al (2002) Voiding and incontinence frequencies: Variability of diary data and required diary length. Neurourol Urodyn 21:204–209CrossRefPubMed Homma Y, Ando T, Yoshida M et al (2002) Voiding and incontinence frequencies: Variability of diary data and required diary length. Neurourol Urodyn 21:204–209CrossRefPubMed
15.
Zurück zum Zitat Tannenbaum C, Corcos J (2008) Outcomes in urinary incontinence: Reconciling clinical relevance with scientific rigour. Eur Urol 53:1151–1161CrossRefPubMed Tannenbaum C, Corcos J (2008) Outcomes in urinary incontinence: Reconciling clinical relevance with scientific rigour. Eur Urol 53:1151–1161CrossRefPubMed
16.
Zurück zum Zitat Carvalhal GF, Smith DS, Mager DE, Ramos C, Catalona WJ (1999) Digital rectal examination for detecting prostate cancer at prostate specific antigen levels of 4 ng./ml. or less. J Urol 161:835–839CrossRefPubMed Carvalhal GF, Smith DS, Mager DE, Ramos C, Catalona WJ (1999) Digital rectal examination for detecting prostate cancer at prostate specific antigen levels of 4 ng./ml. or less. J Urol 161:835–839CrossRefPubMed
17.
Zurück zum Zitat Panicker JN, Fowler CJ, Kessler TM (2015) Lower urinary tract dysfunction in the neurological patient: Clinical assessment and management. Lancet Neurol 14:720–732CrossRefPubMed Panicker JN, Fowler CJ, Kessler TM (2015) Lower urinary tract dysfunction in the neurological patient: Clinical assessment and management. Lancet Neurol 14:720–732CrossRefPubMed
18.
Zurück zum Zitat Stöhrer M, Kramer G, Löchner-Ernst D, Goepel M, Noll F, Rübben H (1994) Diagnosis and treatment of bladder dysfunction in spinal cord injury patients. Eur Urol Update Ser 3:170–175 Stöhrer M, Kramer G, Löchner-Ernst D, Goepel M, Noll F, Rübben H (1994) Diagnosis and treatment of bladder dysfunction in spinal cord injury patients. Eur Urol Update Ser 3:170–175
19.
Zurück zum Zitat McGuire EJ, Woodside JR, Borden TA, Weiss RM (1981) Prognostic value of urodynamic testing in myelodysplastic patients. J Urol 126:205–209CrossRefPubMed McGuire EJ, Woodside JR, Borden TA, Weiss RM (1981) Prognostic value of urodynamic testing in myelodysplastic patients. J Urol 126:205–209CrossRefPubMed
20.
Zurück zum Zitat Drake M, Apostolidis A, Emmanuel A et al (2013) Neurologic urinary and faecal incontinence. In: Abrams P, Cardozo L, Khoury S et al (Hrsg) Incontinence 5th International Consultation on Incontinence, Paris. ICUD-EAU, Paris, S 827–1000 Drake M, Apostolidis A, Emmanuel A et al (2013) Neurologic urinary and faecal incontinence. In: Abrams P, Cardozo L, Khoury S et al (Hrsg) Incontinence 5th International Consultation on Incontinence, Paris. ICUD-EAU, Paris, S 827–1000
21.
Zurück zum Zitat Gormley EA, Lightner DJ, Faraday M, Vasavada SP (2015) Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol 193:1572–1580CrossRefPubMed Gormley EA, Lightner DJ, Faraday M, Vasavada SP (2015) Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol 193:1572–1580CrossRefPubMed
22.
Zurück zum Zitat Groen J, Pannek J, Castro Diaz D et al (2016) Summary of European Association of Urology (EAU) guidelines on neuro-urology. Eur Urol 69:324–333CrossRefPubMed Groen J, Pannek J, Castro Diaz D et al (2016) Summary of European Association of Urology (EAU) guidelines on neuro-urology. Eur Urol 69:324–333CrossRefPubMed
23.
Zurück zum Zitat Buser N, Ivic S, Kessler TM, Kessels AG, Bachmann LM (2012) Efficacy and adverse events of antimuscarinics for treating overactive bladder: Network meta-analyses. Eur Urol 62:1040–1060CrossRefPubMed Buser N, Ivic S, Kessler TM, Kessels AG, Bachmann LM (2012) Efficacy and adverse events of antimuscarinics for treating overactive bladder: Network meta-analyses. Eur Urol 62:1040–1060CrossRefPubMed
24.
Zurück zum Zitat Kessler TM, Bachmann LM, Minder C et al (2011) Adverse event assessment of antimuscarinics for treating overactive bladder: A network meta-analytic approach. PLoS ONE 6:e16718CrossRefPubMedPubMedCentral Kessler TM, Bachmann LM, Minder C et al (2011) Adverse event assessment of antimuscarinics for treating overactive bladder: A network meta-analytic approach. PLoS ONE 6:e16718CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Herschorn S, Chapple CR, Abrams P et al (2017) Efficacy and safety of combinations of mirabegron and solifenacin compared with monotherapy and placebo in patients with overactive bladder (SYNERGY study). BJU Int 120:562–575CrossRefPubMed Herschorn S, Chapple CR, Abrams P et al (2017) Efficacy and safety of combinations of mirabegron and solifenacin compared with monotherapy and placebo in patients with overactive bladder (SYNERGY study). BJU Int 120:562–575CrossRefPubMed
26.
Zurück zum Zitat Welk B, Hickling D, McKibbon M, Radomski S, Ethans K (2018) A pilot randomized-controlled trial of the urodynamic efficacy of mirabegron for patients with neurogenic lower urinary tract dysfunction. Neurourol Urodyn 37:2810–2817CrossRefPubMed Welk B, Hickling D, McKibbon M, Radomski S, Ethans K (2018) A pilot randomized-controlled trial of the urodynamic efficacy of mirabegron for patients with neurogenic lower urinary tract dysfunction. Neurourol Urodyn 37:2810–2817CrossRefPubMed
27.
Zurück zum Zitat Gratzke C, van Maanen R, Chapple C et al (2018) Long-term safety and efficacy of mirabegron and solifenacin in combination compared with monotherapy in patients with overactive bladder: A randomised, multicentre phase 3 study (SYNERGY II). Eur Urol 74:501–509CrossRefPubMed Gratzke C, van Maanen R, Chapple C et al (2018) Long-term safety and efficacy of mirabegron and solifenacin in combination compared with monotherapy in patients with overactive bladder: A randomised, multicentre phase 3 study (SYNERGY II). Eur Urol 74:501–509CrossRefPubMed
28.
Zurück zum Zitat Abrams P, Kelleher C, Staskin D et al (2015) Combination treatment with mirabegron and solifenacin in patients with overactive bladder: Efficacy and safety results from a randomised, double-blind, dose-ranging, phase 2 study (symphony). Eur Urol 67:577–588CrossRefPubMed Abrams P, Kelleher C, Staskin D et al (2015) Combination treatment with mirabegron and solifenacin in patients with overactive bladder: Efficacy and safety results from a randomised, double-blind, dose-ranging, phase 2 study (symphony). Eur Urol 67:577–588CrossRefPubMed
31.
Zurück zum Zitat Del Popolo G, Filocamo MT, Marzi LV et al (2008) Neurogenic detrusor overactivity treated with English botulinum toxin A: 8‑year experience of one single centre. Eur Urol 53:1013–1019CrossRefPubMed Del Popolo G, Filocamo MT, Marzi LV et al (2008) Neurogenic detrusor overactivity treated with English botulinum toxin A: 8‑year experience of one single centre. Eur Urol 53:1013–1019CrossRefPubMed
32.
Zurück zum Zitat Reitz A, Stohrer M, Kramer G et al (2004) European experience of 200 cases treated with botulinum‑A toxin injections into the detrusor muscle for urinary incontinence due to neurogenic detrusor overactivity. Eur Urol 45:510–515CrossRefPubMed Reitz A, Stohrer M, Kramer G et al (2004) European experience of 200 cases treated with botulinum‑A toxin injections into the detrusor muscle for urinary incontinence due to neurogenic detrusor overactivity. Eur Urol 45:510–515CrossRefPubMed
33.
Zurück zum Zitat Cruz F, Herschorn S, Aliotta P et al (2011) Efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: A randomised, double-blind, placebo-controlled trial. Eur Urol 60:742–750CrossRefPubMed Cruz F, Herschorn S, Aliotta P et al (2011) Efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: A randomised, double-blind, placebo-controlled trial. Eur Urol 60:742–750CrossRefPubMed
34.
Zurück zum Zitat Mangera A, Apostolidis A, Andersson KE et al (2014) An updated systematic review and statistical comparison of standardised mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders. Eur Urol 65(5):981–990CrossRefPubMed Mangera A, Apostolidis A, Andersson KE et al (2014) An updated systematic review and statistical comparison of standardised mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders. Eur Urol 65(5):981–990CrossRefPubMed
35.
Zurück zum Zitat Leitner L, Guggenbühl-Roy S, Knüpfer SC et al (2016) More than 15 years of experience with intradetrusor onabotulinumtoxinA injections for treating refractory neurogenic detrusor overactivity: Lessons to be learned. Eur Urol 70:522–528CrossRefPubMed Leitner L, Guggenbühl-Roy S, Knüpfer SC et al (2016) More than 15 years of experience with intradetrusor onabotulinumtoxinA injections for treating refractory neurogenic detrusor overactivity: Lessons to be learned. Eur Urol 70:522–528CrossRefPubMed
36.
Zurück zum Zitat Owen RK, Abrams KR, Mayne C, Slack M, Tincello DG (2017) Comparison of the effectiveness of repeated injections of onabotulinum toxin A for refractory idiopathic detrusor overactivity: Analysis of an open label extension of a randomized trial (the RELAX study). Neurourol Urodyn 36(4):1201–1207CrossRefPubMed Owen RK, Abrams KR, Mayne C, Slack M, Tincello DG (2017) Comparison of the effectiveness of repeated injections of onabotulinum toxin A for refractory idiopathic detrusor overactivity: Analysis of an open label extension of a randomized trial (the RELAX study). Neurourol Urodyn 36(4):1201–1207CrossRefPubMed
37.
Zurück zum Zitat Tellenbach M, Schneider M, Mordasini L, Thalmann GN, Kessler TM (2013) Transcutaneous electrical nerve stimulation: An effective treatment for refractory non-neurogenic overactive bladder syndrome? World J Urol 31:1205–1210CrossRefPubMed Tellenbach M, Schneider M, Mordasini L, Thalmann GN, Kessler TM (2013) Transcutaneous electrical nerve stimulation: An effective treatment for refractory non-neurogenic overactive bladder syndrome? World J Urol 31:1205–1210CrossRefPubMed
38.
Zurück zum Zitat Tugtepe H, Thomas DT, Ergun R et al (2015) The effectiveness of transcutaneous electrical neural stimulation therapy in patients with urinary incontinence resistant to initial medical treatment or biofeedback. J Pediatr Urol 11:137.e1–137.e5CrossRef Tugtepe H, Thomas DT, Ergun R et al (2015) The effectiveness of transcutaneous electrical neural stimulation therapy in patients with urinary incontinence resistant to initial medical treatment or biofeedback. J Pediatr Urol 11:137.e1–137.e5CrossRef
39.
Zurück zum Zitat Gaziev G, Topazio L, Iacovelli V et al (2013) Percutaneous Tibial Nerve Stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions: A systematic review. BMC Urol 13:61CrossRefPubMedPubMedCentral Gaziev G, Topazio L, Iacovelli V et al (2013) Percutaneous Tibial Nerve Stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions: A systematic review. BMC Urol 13:61CrossRefPubMedPubMedCentral
40.
Zurück zum Zitat Schneider MP, Gross T, Bachmann LM et al (2015) Tibial nerve stimulation for treating neurogenic lower urinary tract dysfunction: A systematic review. Eur Urol 68:859–867CrossRefPubMed Schneider MP, Gross T, Bachmann LM et al (2015) Tibial nerve stimulation for treating neurogenic lower urinary tract dysfunction: A systematic review. Eur Urol 68:859–867CrossRefPubMed
41.
Zurück zum Zitat Heywood NA, Pearson JS, Nicholson JE et al (2018) The short-term effects of posterior tibial nerve stimulation on anorectal physiology in patients with faecal incontinence: A single centre experience. Therap Adv Gastroenterol 11:1756284818786111CrossRefPubMedPubMedCentral Heywood NA, Pearson JS, Nicholson JE et al (2018) The short-term effects of posterior tibial nerve stimulation on anorectal physiology in patients with faecal incontinence: A single centre experience. Therap Adv Gastroenterol 11:1756284818786111CrossRefPubMedPubMedCentral
42.
Zurück zum Zitat Kessler TM, La Framboise D, Trelle S et al (2010) Sacral neuromodulation for neurogenic lower urinary tract dysfunction: Systematic review and meta-analysis. Eur Urol 58:865–874CrossRefPubMed Kessler TM, La Framboise D, Trelle S et al (2010) Sacral neuromodulation for neurogenic lower urinary tract dysfunction: Systematic review and meta-analysis. Eur Urol 58:865–874CrossRefPubMed
43.
Zurück zum Zitat Stohrer M, Kramer G, Goepel M, Lochner-Ernst D, Kruse D, Rubben H (1997) Bladder autoaugmentation in adult patients with neurogenic voiding dysfunction. Spinal Cord 35:456–462CrossRefPubMed Stohrer M, Kramer G, Goepel M, Lochner-Ernst D, Kruse D, Rubben H (1997) Bladder autoaugmentation in adult patients with neurogenic voiding dysfunction. Spinal Cord 35:456–462CrossRefPubMed
44.
Zurück zum Zitat Gurung PM, Attar KH, Abdul-Rahman A, Morris T, Hamid R, Shah PJ (2012) Long-term outcomes of augmentation ileocystoplasty in patients with spinal cord injury: A minimum of 10 years of follow-up. BJU Int 109:1236–1242CrossRefPubMed Gurung PM, Attar KH, Abdul-Rahman A, Morris T, Hamid R, Shah PJ (2012) Long-term outcomes of augmentation ileocystoplasty in patients with spinal cord injury: A minimum of 10 years of follow-up. BJU Int 109:1236–1242CrossRefPubMed
45.
Zurück zum Zitat Bywater M, Kessler TM (2017) Wenn die Blase drängt: Neue therapeutische Möglichkeiten. Praxis (Bern 1994) 106:1175–1181CrossRef Bywater M, Kessler TM (2017) Wenn die Blase drängt: Neue therapeutische Möglichkeiten. Praxis (Bern 1994) 106:1175–1181CrossRef
Metadaten
Titel
Die Reizblase – Abklärung und Therapie
verfasst von
Gianluca Rizzi
Dr. med. Marko Kozomara
Publikationsdatum
06.09.2019
Verlag
Springer Vienna
Erschienen in
Urologie in der Praxis / Ausgabe 3/2019
Print ISSN: 2661-8737
Elektronische ISSN: 2661-8745
DOI
https://doi.org/10.1007/s41973-019-00067-w