Zusammenfassung
Ein tieferes Verständnis der Pathogenese und des natürlichen Verlaufs ermöglicht heute eine differenzierte Behandlung von Patienten mit unterer Harntraktsymptomatik bei benigner Prostatavergrößerung (BPH). Phytopräparate werden aufgrund der inkonklusiven Datenlage nach wie vor kontrovers diskutiert. α1-Blocker bieten sich für symptomatische Patienten mit geringem BPH-Progressionsrisiko (Prostatavolumen <30–40 ml) an. 5α-Reduktaseinhibitoren (5ARI) wirken verzögert; die Symptomlinderung ist geringer als mit α1-Blockern. 5ARIs führen zu einer 20 bis 25%igen Reduktion des Prostatavolumens; das Risiko für akutes Harnverhalten/Prostataoperation wird um die Hälfte gegenüber Placebo reduziert. Die Kombination von α1-Blockern plus 5ARIs ist beiden Monotherapien überlegen, was sich aber nur nach mehrjähriger Behandlung bemerkbar macht.
Abstract
A profound knowledge of pathogenesis and natural history enables a differentiated therapy for elderly men with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). The role of phytotherapy is still controversially discussed and, therefore, not clearly recommended by any BPH-guideline. α1-blockers are the therapy of choice for symptomatic patients at a low risk of disease progression (prostate volume <30–40 ml). 5α-reductase inhibitors (5ARI) reduce the prostate volume by 20–25% and the risk for acute urinary retention/surgery by more than 50% compared to placebo. Combination therapy (α1-blocker plus 5ARI) is superior to either monotherapy, though this advantage is only demonstrable after a prolonged treatment period (>12 months).
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Madersbacher, S., Marszalek, M. Benigne Prostatahyperplasie. Internist 48, 1157–1164 (2007). https://doi.org/10.1007/s00108-007-1843-8
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DOI: https://doi.org/10.1007/s00108-007-1843-8
Schlüsselwörter
- Vergrößerte Prostata
- Konservative Therapie
- α1-Blocker
- 5α-Reduktaseinhibitor
- Phytotherapie
- Risikoadaptiertes Management