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Journal für Urologie und Urogynäkologie/Österreich

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25.08.2021 | Originalien

Inkontinenzchirurgie des Mannes: aktuelle Konzepte

verfasst von: Dr. Ghazal Ameli, Univ.-Prof. Dr. Wilhelm A. Hübner

Erschienen in: Journal für Urologie und Urogynäkologie/Österreich | Ausgabe 3/2021

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Zusammenfassung

Die Harninkontinenz des Mannes kann multifaktorielle Ursachen haben. Beim alternden Mann werden häufig Drangsymptome durch Alterungsprozesse sowie strukturelle Veränderungen der Prostata ausgelöst. Demgegenüber ist die Ursache der Belastungsinkontinenz überwiegend iatrogen und tritt am häufigsten nach der radikalen Prostatektomie auf. Weiterhin werden beim Mann oft Mischformen sowie auch eine Überlaufinkontinenz aufgrund einer Prostatahyperplasie diagnostiziert.

Bei nicht ausreichender Besserung unter konservativen Maßnahmen wird eine operative Therapie empfohlen. Dabei liegt der Auswahl des chirurgischen Konzepts die Beschreibung der Ursache zugrunde, z. B. TURP (transurethrale Resektion der Prostata) bei Überlaufinkontinenz oder Botulinumtoxin in den Detrusor bei persistierender Drangsymptomatik.

Vor allem bei der Behandlung der postoperativen Belastungsinkontinenz spielen chirurgische Konzepte eine Schlüsselrolle. Hierfür stehen heute diverse Optionen zur Verfügung, dazu zählen künstliche Schließmuskel, Schlingensysteme, „bulking agents“ und Ballonsysteme.

Eine operative Therapie sollte grundsätzlich jedem Patienten mit persistierender postoperativer Harninkontinenz und Therapiewunsch angeboten werden. Die Auswahl des geeigneten Verfahrens sollte neben patientenspezifischen Befunden in erster Linie anhand von Limitationen bzw. Kontraindikationen der verschiedenen Verfahren erfolgen. Zusätzlich fließen Faktoren wie persönliche Expertise des Behandlers sowie Präferenz des Patienten in die Entscheidung ein. Eine gezielte Diagnostik und genaue Abklärung der Inkontinenzursache sind die Schlüssel für die Auswahl einer adäquaten Therapie.

Nächster Artikel Neue Hormontherapien beim metastasierten Prostatakarzinom

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Titel: Inkontinenzchirurgie des Mannes: aktuelle Konzepte
verfasst von: Dr. Ghazal Ameli
Univ.-Prof. Dr. Wilhelm A. Hübner
Publikationsdatum: 25.08.2021
Verlag: Springer Vienna
Erschienen in: Journal für Urologie und Urogynäkologie/Österreich / Ausgabe 3/2021
Print ISSN: 1023-6090
Elektronische ISSN: 1680-9424
DOI: https://doi.org/10.1007/s41972-021-00140-y

Springer Medizin Österreich

Zusammenfassung

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