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Hartnäckige Mythen zum Thema BPS – und was davon wirklich stimmt!

Fake News BPH – what is really true!

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Zusammenfassung

Hintergrund

Das benigne Prostatasyndrom (BPS) ist die vierthäufigste und fünfteuerste Erkrankung von Männern ≥50 Jahre. Obwohl die meisten Urologen zahlreiche Patienten mit BPS behandeln und evidenzbasierte Leitlinien zur Diagnostik und Therapie des BPS vorliegen, halten sich noch zahlreiche Mythen hartnäckig in der Urologie, insbesondere zur Pathophysiologie.

Ziel der Arbeit

Nennung gängiger BPS-Mythen und Darstellung der korrekten Terminologie sowie evidenzbasierten Pathophysiologie.

Material und Methoden

Kritische Betrachtung von 12 ausgewählten BPS-Mythen und Darstellung der korrekten Terminologie sowie Pathophysiologie anhand einer Literaturrecherche (PubMed).

Ergebnisse

Das durchschnittliche Prostatagewicht eines jungen, gesunden, erwachsenen Mannes beträgt zwar 20 g, variiert aber zwischen 8 und 40 g. Das BPS verläuft nicht in Stadien, weshalb die Stadieneinteilungen nach Alken oder Vahlensieck nicht mehr verwendet werden sollten. Es besteht keine feste Beziehung zwischen Blasenauslassobstruktion (BOO) und Prostatagröße, Divertikel/Pseudodivertikel, Restharn, Harnwegsinfektionen, Harnverhalt oder Nierenfunktionsstörung. Die Urethro-Zystoskopie eignet sich nicht zur BOO-Diagnostik. Kein BPS-Medikament kann die BOO relevant reduzieren. Es bestehen keine stichhaltigen Beweise, dass die Prostataresektion vollständig bis zur chirurgischen Kapsel erfolgen muss.

Diskussion

Die Ursachen für die hartnäckige Verwendung überholter Begriffe, alter oder falscher Terminologie sowie falscher pathophysiologischer Zusammenhänge beim BPS sind vielfältig. Ein Grund ist die mangelnde Umsetzung evidenzbasierter Inhalte von Leitlinien bedingt durch mangelndes Wissen, individuelle Überzeugungen, Kosten, Verfügbarkeit und Erstattungspolitik. Ein weiterer Grund ist die zunehmende Fokussierung der Urologie auf onkologische Themen verbunden mit einer unterrepräsentierten Aus- und Weiterbildung zum Thema BPS.

Abstract

Background

Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) is the fourth most common and the fifth most costly disease in men aged 50 years or older. Despite the high prevalence of LUTS/BPH in clinical practice and evidence-based guideline recommendations, there are still plenty of misconceptions on the terminology and pathophysiology of the disease, leading to false assumptions and malpractice.

Objectives

Listing of commonly used false assumptions and clarification of the correct terminology and pathophysiology.

Materials and Methods

Critical reflection of 12 selected fake news based on PubMed search.

Results

Average prostate weight in healthy men is 20 g but varies between 8–40 g. The BPH-disease does not progress in stages; therefore, the BPH-classifications according Alken or Vahlensieck should not be used anymore. There is only a weak and inconsistent relationship between bladder outlet obstruction (BOO) and prostate size, diverticula/pseudo-diverticula, postvoid residual, urinary retention or renal insufficiency, which is too unreliable for BOO-diagnosis in the individual patient. Urethro-cystoscopy with grading of the degrees of occlusion of the prostatic urethra and bladder trabeculation is insufficient for BOO-diagnosis. There is no clinically relevant reduction of BOO with licensed BPH-drugs and no convincing data that prostate resection (TURP) has to be complete until the surgical capsule in order to obtain optimal results.

Conclusions

The reasons for the persistent use of wrong terminology and pathophysiology are diverse. One reason is lack of implementation of evidence-based guidelines into clinical practice due to lack of knowledge, individual beliefs, costs, availability and reimbursement policies. Another reason is the increasing focus on oncology, coupled with underrepresented education and training on BPH.

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Authors and Affiliations

  1. Klinik für Urologie, Kinderurologie und Urologische Onkologie, Prostatazentrum Nordwest, St. Antonius-Hospital, Möllenweg 22, 48599, Gronau, Deutschland

    M. Oelke

  2. Klinik für Urologie, Andrologie und Kinderurologie, Kliniken Nordoberpfalz, Weiden, Deutschland

    T. Bschleipfer

  3. Klinik für Urologie, Evangelisches Krankenhaus Oberhausen, Oberhausen, Deutschland

    K. Höfner

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M. Oelke, T. Bschleipfer und K. Höfner geben an, dass kein Interessenkonflikt besteht.

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Oelke, M., Bschleipfer, T. & Höfner, K. Hartnäckige Mythen zum Thema BPS – und was davon wirklich stimmt!. Urologe 58, 271–283 (2019). https://doi.org/10.1007/s00120-019-0885-6

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