Skip to main content
Log in

Überaktive Blase – wann welche Therapie?

Overactive bladder—which treatment when?

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

An Erratum to this article was published on 09 February 2018

This article has been updated

Zusammenfassung

Die OAB (überaktive Blase/„overactive bladder“) stellt einen klinischen Symptomenkomplex dar. Die initiale Therapie sollte daher auf den klinischen Symptomen und einer Basisdiagnostik beruhen. Bei der Wahl der Ersttherapie spielt die Patientenpräferenz eine entscheidende Rolle. Neben verhaltenstherapeutischen Ansätzen stehen Elektrostimulation und medikamentöse Therapien zur Verfügung. Bei nicht ausreichendem Ansprechen sollte vor einer Therapieeskalation mit minimal-invasiven Behandlungen, wie Onabotulinumtoxin-Injektionen in den Detrusor oder sakrale Neuromodulation, eine erweiterte Diagnostik erfolgen. Chirurgische Maßnahmen wie z. B. Blasenaugmentation sind nur in Ausnahmefällen erforderlich.

Abstract

The term OAB (overactive bladder) describes a symptom complex. Therefore, initial treatment should be based on clinical symptoms and the results of basic diagnostics. Patient preference is essential for the choice of the initial treatment. Behavioural therapy, electrostimulation and medical treatment are available treatment options. If these are not effective, extended diagnostic examinations should be performed prior to minimally invasive treatments, like onabotulinumtoxin injections in the detrusor or sacral neuromodulation. Surgical interventions like augmentation cystoplasty are rarely required today.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Change history

  • 09 February 2018

    Erratum zu:

Literatur

  1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A, Standardisation Sub-committee of the International Continence Society (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 

  2. Azuri J, Kafri R, Ziv-Baran T, Stav K (2017) Outcomes of different protocols of pelvic floor physical therapy and anti-cholinergics in women with wet over-active bladder: a 4‑year follow-up. Neurourol Urodyn 36:755–758

    Article  CAS  PubMed  Google Scholar 

  3. Biers SM, Venn SN, Greenwell TJ (2012) The past, present and future of augmentation cystoplasty. BJU Int 109:1280–1293

    Article  PubMed  Google Scholar 

  4. Burgio KL, Goode PS, Locher JL, Umlauf MG, Roth DL, Richter HE, Varner RE, Lloyd LK (2002) Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. JAMA 288:2293–2299

    Article  PubMed  Google Scholar 

  5. Burgio KL, Goode PS, Johnson TM, Hammontree L, Ouslander JG, Markland AD, Colli J, Vaughan CP, Redden DT (2011) Behavioral versus drug treatment for overactive bladder in men: the Male Overactive Bladder Treatment in Veterans (MOTIVE) trial. J Am Geriatr Soc 59:2209–2216

    Article  PubMed  Google Scholar 

  6. 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 62:1040–1060

    Article  CAS  PubMed  Google Scholar 

  7. Charach G, Greenstein A, Rabinovich P, Groskopf I, Weintraub M (2001) Alleviating constipation in the elderly improves lower urinary tract symptoms. Gerontology 47:72–76

    Article  CAS  PubMed  Google Scholar 

  8. Chen H, Wang F, Yu Z, Zhang Y, Liu C, Dai S, Chen B, Lv J (2017) Efficacy of daily low-dose tadalafil for treating overactive bladder: results of a randomized, double-blind, placebo-controlled trial. Urology 100:59–64

    Article  PubMed  Google Scholar 

  9. Cheng CL, Li JR, Lin CH, de Groat WC (2016) Positive association of female overactive bladder symptoms and estrogen deprivation: a nationwide population-based cohort study in Taiwan. Medicine (Baltimore) 95:e4107

    Article  CAS  Google Scholar 

  10. Chua ME, See MC 4th, Esmeňa EB, Balingit JC, Morales ML Jr (2017) Efficacy and safety of Gabapentin in comparison to solifenacin succinate in adult overactive bladder treatment. Low Urin Tract Symptoms. https://doi.org/10.1111/luts.12152

    PubMed  Google Scholar 

  11. Cui Y, Zong H, Yang C, Yan H, Zhang Y (2014) The efficacy and safety of mirabegron in treating OAB: a systematic review and meta-analysis of phase III trials. Int Urol Nephrol 46:275–284

    Article  CAS  PubMed  Google Scholar 

  12. Del Río-Gonzalez S, Aragon IM, Castillo E, Milla-España F, Galacho A, Machuca J, Lara MF, Herrera-Imbroda B (2017) Percutaneous tibial nerve stimulation therapy for overactive bladder syndrome: clinical effectiveness, urodynamic and durability evaluation. Urology. https://doi.org/10.1016/j.urology.2017.04.059

    Google Scholar 

  13. Drake MJ, Nitti VW, Ginsberg DA, Brucker BM, Hepp Z, McCool R, Glanville JM, Fleetwood K, James D, Chapple CR (2017) Comparative assessment of efficacy of onabotulinumtoxin A and oral therapies (anticholinergics and mirabegron) for overactive bladder: a systematic review and network meta-analysis. BJU Int. https://doi.org/10.1111/bju.13945

    Google Scholar 

  14. Eldred-Evans D, Sahai A (2017) Medium- to long-term outcomes of botulinum toxin A for idiopathic overactive bladder. Ther Adv Urol 9:3–10

    Article  CAS  PubMed  Google Scholar 

  15. Forde JC, Davila JL, Marks BK, Epstein M, Tsui JF, Weiss JP, Blaivas JG (2017) Urogynecological conditions associated with overactive bladder symptoms in women. Can Urol Assoc J 11:E83–E87

    Article  PubMed  PubMed Central  Google Scholar 

  16. Herdman M, Nazir J, Hakimi Z, Siddiqui E, Huang M, Pavesi M, MacDiarmid S, Drake MJ, Devlin N (2017) Assessing preference-based outcome measures for overactive bladder: an evaluation of patient-reported outcome data from the BESIDE clinical trial. Patient. https://doi.org/10.1007/s40271-017-0262-8

    PubMed  Google Scholar 

  17. Homma Y (2008) Lower urinary tract symptomatology: its definition and confusion. Int J Urol 15:35–43

    Article  PubMed  Google Scholar 

  18. Kaufmann A, Kirschner-Hermanns R (2016) Therapie der weiblichen OAB. Aktuelle Urol 47:305–309

    Article  CAS  PubMed  Google Scholar 

  19. Kim A, Lee KS, Kim TB, Kim HJ, Yoo ES, Yun JH, Kim DY, Jung SG, Lee JT, Kim JM, Oh CK, Shin JH, Jeon SH, Lee SH, Han CH, Lee DH, Cho HJ, Choo MS (2017) Incidence and risk factors of recurrence of overactive bladder symptoms after discontinuation of successful medical treatment. Investig Clin Urol 58:42–47

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lua LL, Pathak P, Dandolu V (2017) Comparing anticholinergic persistence and adherence profiles in overactive bladder patients based on gender, obesity, and major anticholinergic agents. Neurourol Urodyn. https://doi.org/10.1002/nau.23256

    PubMed  Google Scholar 

  21. Madhu C, Enki D, Drake MJ, Hashim H (2015) The functional effects of cigarette smoking in women on the lower urinary tract. Urol Int 95:478–482

    Article  PubMed  Google Scholar 

  22. Marcelissen TA, Rahnama’i MS, Snijkers A, Schurch B, De Vries P (2017) Long-term follow-up of intravesical botulinum toxin-A injections in women with idiopathic overactive bladder symptoms. World J Urol 35:307–311

    Article  CAS  PubMed  Google Scholar 

  23. Pannek J, Janek S, Noldus J (2010) Neurogene oder idiopathische Detrusorüberaktivität nach erfolgloser antimuskarinerger Therapie. Klinische Wertigkeit der externen temporären Elektrostimulation. Urologe A 49:530–535

    Article  CAS  PubMed  Google Scholar 

  24. Robinson D, Hanna-Mitchell A, Rantell A, Thiagamoorthy G, Cardozo L (2017) Are we justified in suggesting change to caffeine, alcohol, and carbonated drink intake in lower urinary tract disease? Report from the ICI-RS 2015. Neurourol Urodyn 36:876–881

    Article  PubMed  Google Scholar 

  25. Rovner ES, Raymond K, Andruczyk E, Juul KV (2017) Low-dose Desmopressin and Tolterodine combination therapy for treating nocturia in women with overactive bladder: a double-blind, randomized, controlled study. Low Urin Tract Symptoms. https://doi.org/10.1111/luts.12169

    PubMed  Google Scholar 

  26. Shafik A, Shafik IA (2003) Overactive bladder inhibition in response to pelvic floor muscle exercises. World J Urol 20:374–377

    PubMed  Google Scholar 

  27. Shin JH, Kim A, Choo MS (2017) Additional low-dose antimuscarinics can improve overactive bladder symptoms in patients with suboptimal response to beta 3 agonist monotherapy. Investig Clin Urol 58:261–266

    Article  PubMed  PubMed Central  Google Scholar 

  28. Siegel S, Noblett K, Mangel J, Bennett J, Griebling TL, Sutherland SE, Bird ET, Comiter C, Culkin D, Zylstra S, Kan F, Berg KC (2017) Five year follow-up results of a prospective, multicenter study in overactive bladder subjects treated with sacral neuromodulation. J Urol 5347(17):77099–77091. https://doi.org/10.1016/j.juro.2017.07.010

    Google Scholar 

  29. Staskin D, Herschorn S, Fialkov J, Tu LM, Walsh T, Schermer CR (2017) A prospective, double-blind, randomized, two-period crossover, multicenter study to evaluate tolerability and patient preference between mirabegron and tolterodine in patients with overactive bladder (PREFER study). Int Urogynecol J. https://doi.org/10.1007/s00192-017-3377-5

    PubMed  PubMed Central  Google Scholar 

  30. Stewart F, Gameiro LF, El Dib R, Gameiro MO, Kapoor A, Amaro JL (2016) Electrical stimulation with non-implanted electrodes for overactive bladder in adults. Cochrane Database Syst Rev 12:CD10098

    PubMed  Google Scholar 

  31. Sukhu T, Kennelly MJ, Kurpad R (2016) Sacral neuromodulation in overactive bladder: a review and current perspectives. Res Rep Urol 8:193–199

    PubMed  PubMed Central  Google Scholar 

  32. Tyagi P, Kashyap M, Yoshimura N, Chancellor M, Chermansky CJ (2017) Past, present and future of chemodenervation with botulinum toxin in the treatment of overactive bladder. J Urol 197:982–990

    Article  CAS  PubMed  Google Scholar 

  33. Vijverberg MA, Stortelder E, de Kort LM, Kok ET, de Jong TP (2011) Long-term follow-up of incontinence and urge complaints after intensive urotherapy in childhood (75 patients followed up for 16.2–21.8 years). Urology 78:1391–1396

    Article  PubMed  Google Scholar 

  34. Wolz-Beck M, Reisenauer C, Kolenic GE, Hahn S, Brucker SY, Huebner M (2017) Physiotherapy and behavior therapy for the treatment of overactive bladder syndrome: a prospective cohort study. Arch Gynecol Obstet 295:1211–1217

    Article  PubMed  Google Scholar 

  35. Wyman JF, Klutke C, Burgio K, Guan Z, Sun F, Berriman S, Bavendam T (2010) Effects of combined behavioral intervention and tolterodine on patient-reported outcomes. Can J Urol 17:5283–5290

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J. Pannek.

Ethics declarations

Interessenkonflikt

J. Pannek gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Ein Erratum zu diesem Beitrag ist unter https://doi.org/10.1007/s00120-018-0590-x zu finden.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pannek, J. Überaktive Blase – wann welche Therapie?. Urologe 56, 1532–1538 (2017). https://doi.org/10.1007/s00120-017-0522-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-017-0522-1

Schlüsselwörter

Keywords

Navigation