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Medikamentöse Therapie der benignen Prostatahyperplasie

Pharmacological treatment of benign prostatic hyperplasia

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Zusammenfassung

Die Mehrheit der Männer mit benignem Prostatasyndrom sucht ärztliche Hilfe aufgrund von Symptomen des unteren Harntraktes (LUTS). Bei Abwesenheit von absoluten Operationsindikationen oder ausgeprägter Obstruktion (BPO) sowie bei Vorliegen von LUTS mit Leidensdruck ist die medikamentöse Therapie eine der möglichen Therapieansätze. Phytopharmaka können bei milder bis moderater Symptomatik eingesetzt werden. α-Blocker reduzieren schnell und effektiv LUTS und die symptomatische Progression. Bei Vorliegen von Blasenspeichersymptomen ohne BPO und bei kleiner Prostata kann ein Anticholinergikum ebenfalls effektiv LUTS vermindern. Der kombinierte Einsatz eines α-Blockers mit einem Anticholinergikum ist bei der Behandlung von LUTS effektiver als die Einzelsubstanzen. 5α-Reduktase-Inhibitoren können besonders bei größerer Prostata LUTS sowie die Wahrscheinlichkeit eines Harnverhalts bzw. die Notwendigkeit einer Prostataoperation vermindern. Die Kombination von α-Blocker plus 5α-Reduktase-Inhibitor ist für die Reduktion von LUTS und die Verhinderung der Krankheitsprogression effektiver als die Einzelsubstanzen.

Abstract

The majority of men with benign prostatic hyperplasia (BPH) seek medical help because of lower urinary tract symptoms (LUTS). Pharmacological treatment of BPH is indicated if the patient has no absolute indications for prostate surgery or benign prostatic obstruction (BPO), but LUTS with a decrease of quality of life. Plant extracts can be prescribed in men with mild to moderate symptoms. α-Blockers can quickly and effectively decrease LUTS and symptomatic disease progression. If patients have predominantly bladder filling symptoms and a small prostate, muscarinic receptor antagonists are a viable treatment option. The combination of an α-blocker plus a muscarinic receptor antagonist is more effective than single drugs used alone. Especially in men with larger prostates, 5α-reductase inhibitors can decrease LUTS and the probability of acute urinary retention as well as need for prostate surgery. The combination of α-blocker plus 5α-reductase inhibitor can reduce LUTS and disease progression more effectively than single drugs.

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Literatur

  1. Abrams P (1994) New words for old: lower urinary tract symptoms for „prostatism“. BMJ 308:929–930

    PubMed  Google Scholar 

  2. Abrams P, Cardozo L, Fall M et al (2002) The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Neurourol Urodyn 21:167–178

    Article  PubMed  Google Scholar 

  3. Abrams P, Kaplan S, De Koning Gans HJ, Millard R (2006) Safety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstruction. J Urol 175:999–1004

    Article  PubMed  Google Scholar 

  4. Barkin J, Guimaraes M, Jacobi G et al (2003) Alpha-blocker therapy can be withdrawn in the majority of men following initial combination therapy with the dual 5α-reductase inhibitor dutasteride. Eur Urol 44:461–466

    Article  PubMed  Google Scholar 

  5. Berges RR, Pientka L, Höfner K et al (2001) Male lower urinary tract symptoms and related health care seeking in Germany. Eur Urol 39:682–687

    Article  PubMed  Google Scholar 

  6. Berges R, Dreikorn K, Höfner K et al (2009) Leitlinien der Deutschen Urologen zur Diagnostik und Differenzialdiagnostik des benignen Prostatasyndroms (BPS). Urologe A 2009: in Druck

    Google Scholar 

  7. Berges R, Dreikorn K, Höfner K et al (2009) Leitlinien der Deutschen Urologen zur Therapie des benignen Prostatasyndroms (BPS). Urologe A: in Druck

    Google Scholar 

  8. Berry SJ, Coffey DS, Walsh PC, Ewing LL (1984) The development of human benign prostatic hyperplasia with age. J Urol 132:474–479

    PubMed  Google Scholar 

  9. Chancellor MB, Rivas DA, Keeley FX et al (1994) Similarity of the American Urological Association Symptom Index among men with benign prostatic hyperplasia (BPH), urethral obstruction not due to BPH and detrusor hyperreflexia without outlet obstruction. Br J Urol 74:200–203

    Article  PubMed  Google Scholar 

  10. Hald T (1989) Urodynamics in benign prostatic hyperplasia. A survey. Prostate Suppl 2:69–77

    Article  PubMed  Google Scholar 

  11. Hutchison A, Farmer R, Chapple C et al (2006) Characteristics of patients presenting with LUTS/BPH in six European countries. Eur Urol 50:555–562

    Article  PubMed  Google Scholar 

  12. Jimenez-Cruz F (2003) Identifying the patients at risk for disease progression. Eur Urol Suppl 2:6–12

    Article  Google Scholar 

  13. Kaplan SA, Roehrborn CG, Rovner ES et al (2006) Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder. JAMA 296:2319–2328

    Article  PubMed  Google Scholar 

  14. Lee JY, Kim HW, Lee SJ et al (2004) Comparison of doxazosin with or without tolterodine in men with symptomatic bladder outlet obstruction and an overactive detrusor. BJU Int 94:817–820

    Article  PubMed  Google Scholar 

  15. McConnell JD, Roehrborn CG, Bautista OM et al (2003) The long-term effect of Doxazosin, Finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 349:2387–2398

    Article  PubMed  Google Scholar 

  16. Michel MC, Schneider T, Krege S, Goepel M (2002) Does gender or age affect the efficacy and safety of tolterodine? J Urol 168:1027–1031

    Article  PubMed  Google Scholar 

  17. Oelke M, Höfner K, Berges RR, Jonas U (2002) Medikamentöse Therapie des benignen Prostatasyndroms mit α1-Rezeptorblockern. Urologe A 41:425–441

    Article  PubMed  Google Scholar 

  18. Oelke M, Baard J, Wijkstra H et al (2008) Age and bladder outlet obstruction are independently associated with detrusor overactivity in patients with benign prostatic hyperplasia. Eur Urol 54:419–426

    Article  PubMed  Google Scholar 

  19. Peters TJ, Donovan JL, Kay HE et al (1997) The International Continence Society „Benign Prostatic Hyperplasia“ Study: the bothersomeness of urinary symptoms. J Urol 157:885–889

    Article  PubMed  Google Scholar 

  20. Roehrborn CG, Siami P, Barkin J et al (2008) The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the ComBAT study. J Urol 179:616–621

    Article  PubMed  Google Scholar 

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  1. Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    M. Oelke, M.A. Kuczyk & T.R.W. Herrmann

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  1. M. Oelke
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  2. M.A. Kuczyk
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  3. T.R.W. Herrmann
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Correspondence to M. Oelke.

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Oelke, M., Kuczyk, M. & Herrmann, T. Medikamentöse Therapie der benignen Prostatahyperplasie. Urologe 48, 1365–1377 (2009). https://doi.org/10.1007/s00120-009-2141-y

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  • DOI: https://doi.org/10.1007/s00120-009-2141-y

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