Zusammenfassung
Die Belastungsinkontinenz des Mannes ist überwiegend iatrogen bedingt, wobei die radikale Prostatektomie mit einer persistierenden Inkontinenzrate von 10–25 % die häufigste Ursache ist. Die primäre Therapie der postoperativen Belastungsinkontinenz des Mannes ist die Physiotherapie, bei der das Beckenbodentraining eine zentrale Rolle einnimmt. Bei nicht ausreichender Besserung unter konservativer Therapie wird eine operative Therapie empfohlen. Für die operative Behandlung der Belastungsinkontinenz des Mannes stehen heute diverse Therapieoptionen zur Verfügung. Hierzu zählen der künstliche Schließmuskel, adjustierbare und funktionelle Schlingensysteme, Bulking-Agents und Ballon-Systeme.
Abstract
Stress urinary incontinence in men is predominantly iatrogenic whereby radical prostatectomy is the most common cause with persistent stress urinary incontinence rates varying between 10 % and 25 %. The first line therapy for postoperative male stress urinary incontinence is physiotherapy, especially pelvic floor muscle rehabilitation. If conservative treatment fails to show sufficient improvement, surgical therapy is recommended. Several treatment options are currently available for the surgical treatment of male stress urinary incontinence including artificial sphincters, adjustable and functional sling systems, bulking agents and implantable balloon systems.
Literatur
Markland AD, Vaughan CP, Johnson TM 2nd et al (2011) Incontinence. Med Clin North Am 95(3):539–554 (x–xi)
Tikkinen KA, Agarwal A, Griebling TL (2013) Epidemiology of male urinary incontinence. Curr Opin Urol 23(6):502–508
Penson DF, McLerran D, Feng Z et al (2005) 5-year urinary and sexual outcomes after radical prostatectomy: results from the prostate cancer outcomes study. J Urol 173(5):1701–1705
Stanford JL Feng Z, Hamilton AS et al (2000) Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA 283(3):354–360
Lucas MG, Bosch RJ, Burkhard FC et al (2012) EAU guidelines on assessment and nonsurgical management of urinary incontinence. Eur Urol 62(6):1130–1142
Tsakiris P, Oelke M, Michel MC (2008) Drug-induced urinary incontinence. Drugs Aging 25(7):541–549
Vaughan CP, Goode PS, Burgio KL, Markland AD (2011) Urinary incontinence in older adults. Mt Sinai J Med 78(4):558–570
Geraerts I, Van Poppel H, Devoogdt N et al (2013) Influence of preoperative and postoperative pelvic floor muscle training (PFMT) compared with postoperative PFMT on urinary incontinence after radical prostatectomy: a randomized controlled trial. Eur Urol 64(5):766–772
Berghmans B, Hendriks E, Bernards A et al (2013) Electrical stimulation with non-implanted electrodes for urinary incontinence in men. Cochrane Database Syst Rev 6:CD001202
Yokoyama T, Nishiguchi J, Watanabe T et al (2004) Comparative study of effects of extracorporeal magnetic innervation versus electrical stimulation for urinary incontinence after radical prostatectomy. Urology 63(2):264–267
Schlenker B, Gratzke C, Reich O et al (2006) Preliminary results on the off-label use of duloxetine for the treatment of stress incontinence after radical prostatectomy or cystectomy. Eur Urol 49(6):1075–1078
Cornu JN, Merlet B, Ciofu C et al (2011) Duloxetine for mild to moderate postprostatectomy incontinence: preliminary results of a randomised, placebo-controlled trial. Eur Urol 59(1):148–154
Tsakiris P, de la Rosette JJ, Michel MC, Oelke M (2008) Pharmacologic treatment of male stress urinary incontinence: systematic review of the literature and levels of evidence. Eur Urol 53(1):53–59
Bauer RM, Gozzi C, Hübner W et al (2011) Contemporary management of postprostatectomy incontinence. Eur Urol 59(6):985–996
Lucas MG, Bosch RJ, Burkhard FC et al (2012) EAU guidelines on surgical treatment of urinary incontinence. Eur Urol 62(6):1118–1129
Van der Aa F, Drake MJ, Kasyan GR et al (2013) The artificial urinary sphincter after a quarter of a century: a critical systematic review of its use in male non-neurogenic incontinence. Eur Urol 63(4):681–689
Wilson S, Delk J 2nd, Henry GD, Siegel AL (2003) New surgical technique for sphincter urinary control system using upper transverse scrotal incision. J Urol 169(1):261–264
Henry GD, Graham SM, Cornell RJ et al (2009) A multicenter study on the perineal versus penoscrotal approach for implantation of an artificial urinary sphincter: cuff size and control of male stress urinary incontinence. J Urol 182(5):2404–2409
O’Connor RC, Nanigian DK, Patel BN et al (2007) Artificial urinary sphincter placement in elderly men. Urology 69(1):126–128
Raj GV, Peterson AC, Toh KL, Webster GD (2005) Outcomes following revisions and secondary implantation of the artificial urinary sphincter. J Urol 173(4):1242–1245
Gomha MA, Boone TB (2002) Artificial urinary sphincter for post-prostatectomy incontinence in men who had prior radiotherapy: a risk and outcome analysis. J Urol 167(2 Pt 1):591–596
Clemens JQ, Schuster TG, Konnak JW et al (2001) Revision rate after artificial urinary sphincter implantation for incontinence after radical prostatectomy: actuarial analysis. J Urol 166(4):1372–1375
Gousse AE, Madjar S, Lambert MM, Fishman IJ (2001) Artificial urinary sphincter for post-radical prostatectomy urinary incontinence: long-term subjective results. J Urol 166(5):1755–1758
O’Connor RC, Lyon MB, Guralnick ML, Bales GT (2008) Long-term follow-up of single versus double cuff artificial urinary sphincter insertion for the treatment of severe postprostatectomy stress urinary incontinence. Urology 71(1):90–93
Staerman F, G-Llorens C, Leon P, Leclerc Y (2013) ZSI 375 artificial urinary sphincter for male urinary incontinence: a preliminary study. BJU Int 111(4 Pt B):E202–E206
Romano SV, Metrebian SE, Vaz F et al (2009) Long-term results of a phase III multicentre trial of the adjustable male sling for treating urinary incontinence after prostatectomy: minimum 3 years. Actas Urol Esp 33(3):309–314
Hubner WA, Gallistl H, Rutkowski M, Huber ER (2011) Adjustable bulbourethral male sling: experience after 101 cases of moderate-to-severe male stress urinary incontinence. BJU Int 107(5):777–782
Bauer RM, Rutkowski M, Kretschmer A et al (2015) Efficacy and complications of the adjustable sling system argust for male incontinence: results of a prospective 2-center study. Urology 85(2):316–320
Hoda MR, Primus G, Fischereder K et al (2012) Early results of a European multicentre experience with a new self-anchoring adjustable transobturator system for treatment of stress urinary incontinence in men. BJU Int 111(2):296–303
Seweryn J, Bauer W, Ponholzer A, Schramek P (2012) Initial experience and results with a new adjustable transobturator male system for the treatment of stress urinary incontinence. J Urol 187(3):956–961
Campos-fernandes JL, Timsit MO, Paparel P et al (2006) REMEEX: a possible treatment option in selected cases of sphincter incompetence. Prog Urol 16(2):184–191
Sousa-Escandon A, Cabrera J, Mantovani F et al (2007) Adjustable suburethral sling (male remeex system) in the treatment of male stress urinary incontinence: a multicentric European study. Eur Urol 52(5):1473–1479
Rehder P, Gozzi C (2007) Transobturator sling suspension for male urinary incontinence including post-radical prostatectomy. Eur Urol 52(3):860–866
Rehder P, Freiin von Gleissenthall G, Pichler R, Glodny B (2009) The treatment of postprostatectomy incontinence with the retroluminal transobturator repositioning sling (Advance): lessons learnt from accumulative experience. Arch Esp Urol 62(10):860–870
Bauer RM, Gozzi C, Roosen A et al (2013) Impact of the ‚repositioning test‘ on postoperative outcome of retroluminar transobturator male sling implantation. Urol Int 90(3):334–338
Bauer RM, Mayer ME, Gratzke C et al (2009) Prospective evaluation of the functional sling suspension for male postprostatectomy stress urinary incontinence: results after 1 year. Eur Urol 56(6):928–933
Cornu JN, Sèbe P, Ciofu C et al (2009) The AdVance transobturator male sling for postprostatectomy incontinence: clinical results of a prospective evaluation after a minimum follow-up of 6 months. Eur Urol 56(6):923–927
Bauer RM, Mayer ME, May F et al (2010) Complications of the AdVance transobturator male sling in the treatment of male stress urinary incontinence. Urology 75(6):1494–1498
Rehder P, Haab F, Cornu JN et al (2012) Treatment of postprostatectomy male urinary incontinence with the transobturator retroluminal repositioning sling suspension: 3-year follow-up. Eur Urol 62(1):140–145
Bauer RM, Soljanik I, Füllhase C et al (2011) Results of the AdVance transobturator male sling after radical prostatectomy and adjuvant radiotherapy. Urology 77(2):474–479
Collado Serra A, Resel Folkersma L, Domínguez-Escrig JL et al (2013) AdVance/AdVance XP transobturator male slings: preoperative degree of incontinence as predictor of surgical outcome. Urology 81(5):1034–1039
Drai J, Caremel R, Riou J, Grise P (2013) The two-year outcome of the I-Stop TOMS transobturator sling in the treatment of male stress urinary incontinence in a single centre and prediction of outcome. Prog Urol 23(17):1494–1499
Comiter CV, Rhee EY, Tu LM et al (2014) The virtue sling – a new quadratic sling for postprostatectomy incontinence – results of a multinational clinical trial. Urology 84(2):433–438
Grise P, Vautherin R, Njinou-Ngninkeu B et al (2012) I-STOP TOMS transobturator male sling, a minimally invasive treatment for post-prostatectomy incontinence: continence improvement and tolerability. Urology 79(2):458–463
Gilling PJ, Bell DF, Wilson LC et al (2008) An adjustable continence therapy device for treating incontinence after prostatectomy: a minimum 2-year follow-up. BJU Int 102(10):1426–1430
Hubner WA, Schlarp OM (2007) Adjustable continence therapy (ProACT): evolution of the surgical technique and comparison of the original 50 patients with the most recent 50 patients at a single centre. Eur Urol 52(3):680–686
Trigo Rocha F, Gomes CM, Mitre AI et al (2008) A prospective study evaluating the efficacy of the artificial sphincter AMS 800 for the treatment of postradical prostatectomy urinary incontinence and the correlation between preoperative urodynamic and surgical outcomes. Urology 71(1):85–89
Einhaltung ethischer Richtlinien
Interessenkonflikt. Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin:
R.M. Bauer: Studien, beratende Tätigkeit und Referententätigkeit für AMS und Promedon.
M. Grabbert: keine.
R. Anding: keine.
R. Kirschner-Hermanns: keine.
M. Oelke: Referent, Berater und/oder Studienteilnehmer für: Allergan, Apogepha, Astellas, Bayer, Eli Lilly, GT-Urological und Pfizer.
W. Hübner: Referent und Berater für Promedon, Referent für AMS.
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Bauer, R., Oelke, M., Hübner, W. et al. Harninkontinenz des Mannes. Urologe 54, 887–900 (2015). https://doi.org/10.1007/s00120-015-3826-z
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DOI: https://doi.org/10.1007/s00120-015-3826-z