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Benignes Prostatasyndrom

Neues und Praxisrelevantes aus den DGU-Leitlinien

Benign prostatic hyperplasia

New and treatment-relevant aspects from the DGU guidelines

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Zusammenfassung

Die Diagnostik und Therapie des benignen Prostatasyndroms (BPS) nimmt einen wesentlichen Stellenwert in der täglichen urologischen Praxis ein. Hierbei ist ein zielgerichtetes und ressourcenschonendes Vorgehen unerlässlich. Eine rationale Basisdiagnostik liefert die notwendigen Informationen zur Diagnosestellung und muss nur in Einzelfällen erweitert werden. Neben der medikamentösen Therapie darf die Modifikation der Lebensführung und die Möglichkeit des kontrollierten Zuwartens nicht unterschätzt werden. Durch einfache Maßnahmen wie eine zeitlich abgestimmte Flüssigkeitszufuhr, Doppelmiktion bei Restharnbildung aber auch Blasenrekonditionierung kann die Lebensqualität der Patienten signifikant verbessert werden. In der interventionellen Therapie haben Laserverfahren in vielen Kliniken Einzug gehalten und sich in der täglichen Routine als Referenzverfahren neben der transurethralen Resektion der Prostata (TURP) und der offenen Adenomenukleation etabliert. Neue minimal-invasive Verfahren – wie die Prostataarterien Embolisation (PAE), das Rezum™- (Boston Scientific, Malborough, MA, USA) oder das AquaBeam®-Verfahren (Procept, Redwood City, CA, USA), aber auch nicht-ablative Verfahren wie iTIND© (TIND, Medi-Tate, Or Akiva, Israel) oder Urolift® (Neotract Inc., Pleasanton, CA, USA) eröffnen den Betroffenen neue Therapieoptionen mit dem Potenzial, v. a. die Sexualfunktion der Patienten zu erhalten. Dadurch wird eine individuelle Risikoabschätzung und Beratung über die Vor- und Nachteile aller zur Verfügung stehenden Therapieoptionen – noch mehr als heute schon – wichtiger Bestandteil der Therapie des BPS sein und eine individuelle Therapie, ähnlich wie bei der Therapie onkologischer Krankheitsbilder, wird auch bei der Behandlung des BPS zum Standard werden.

Abstract

The diagnosis and treatment of lower urinary tract symptoms (LUTS) due to benign prostatic enlargement plays an important role in daily urological practice. Therefore, a targeted and resource-saving approach is essential. A rational base-line work-up of our patients provides the necessary information for obtaining the diagnosis and only needs to be expanded in individual cases. In addition to drug therapy, the modification of lifestyle and the possibility of watchful waiting must not be underestimated. Simple measures such as a timed fluid intake, double micturition in the case of residual urine development, but also bladder reconditioning can significantly improve the quality of life of our patients. Regarding surgical treatment, laser procedures have found their way into many departments and have established themselves in daily routine as a reference procedure in addition to transurethral resection of the prostate (TUR-P) and simple open prostatectomy. New, minimally invasive procedures—such as prostatic artery embolization (PAE), the Rezum™- (NxThera Inc., Maple-Grove, MN, USA) or the Aquabeam® (Procept, Redwood City, CA, USA) procedure, but also nonablative procedures such as iTind© (TIND, Medi-Tate, Or Akiva, Israel) or Urolift® (Neotract Inc., Pleasanton, CA, USA)—offer new treatment options to those affected, with the potential to maintain patient’s sexual function. As a result, individual risk assessment and advice on the advantages and disadvantages of all available treatment options—even more than today—will be an important part of LUTS treatment. An individual approach, similar to that used in the treatment of oncological disease, will become standard also in the treatment of benign prostatic syndrome.

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Authors and Affiliations

  1. Klinik für Urologie, Asklepios Westklinikum Rissen, Suurheid 20, 22559, Hamburg, Deutschland

    T. Bach

  2. Urologische Praxisgemeinschaft, Hamburg-Blankenese, Hamburg, Deutschland

    M. Heitz & T. Bruns

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  1. T. Bach
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  3. T. Bruns
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Correspondence to T. Bach.

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Interessenkonflikt

T. Bach, M. Heitz und T. Bruns geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Bach, T., Heitz, M. & Bruns, T. Benignes Prostatasyndrom. Urologe 59, 544–549 (2020). https://doi.org/10.1007/s00120-020-01184-y

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  • DOI: https://doi.org/10.1007/s00120-020-01184-y

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