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Diagnostik und Therapie von Blasenfunktionsstörungen bei Personen mit Diabetes mellitus

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Diagnosis and therapy of functional disorders of the bladder in persons with diabetes mellitus

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Zusammenfassung

Obwohl Diabetes mellitus weltweit eine der am meisten verbreiteten Krankheiten ist, existieren nur wenige Studien zur Diagnostik und Therapie von Komplikationen dieser Erkrankung am unteren Harntrakt. Neben der klassischen „diabetischen Zystopathie“ (reduzierte Blasenwahrnehmung, verminderte Detrusorkontraktilität, erhöhter Restharn) können 30–50% der Patienten Symptome der überaktiven Blase (OAB) entwickeln. Die Basisdiagnostik sollte Anamnese, Miktionstagebuch, Restharnbestimmung und Urinanalyse umfassen. Zur spezifischen Diagnostik können Uroflow, Symptomenscores und ggf. die Urodynamik gehören.

Die Evidenz aller Therapieoptionen bei Diabetes mellitus ist gering. Während bei Restharn Verhaltensstrategien, Metoclopramid, Alphablocker und intermittierender Katheterismus möglich sind, besteht keine Evidenz für Parasympathomimetika. Bei der OAB können Verhaltenstraining, Biofeedback, Elektrostimulation oder Antimuskarinika eingesetzt werden.

Zur adäquaten Positionierung der Urologen bei der Betreuung von Sekundärkomplikationen des Diabetes mellitus ist neben einer Kooperation mit Kollegen anderer Fachgruppen eine intensivere Forschung erforderlich, um zukünftig über evidenzbasierte Konzepte zur Versorgung von Patienten mit urologischen Folgen der häufigsten Stoffwechselstörung unserer Bevölkerung zu verfügen.

Abstract

Although diabetes mellitus is one of the most common diseases worldwide, only few studies evaluating diagnosis and treatment of lower urinary tract complications of this disorder exist. In addition to diabetic cystopathy (impaired sensation, reduced detrusor muscle contractility, elevated residual urine), 30-50% of patients can develop an overactive bladder. Basic diagnostics should include patient history, bladder diary, post-void residual and urinalysis. Advanced diagnostics include uroflowmetry, symptom scores and urodynamics.

The evidence for all treatment options in patients with diabetes mellitus is low. Residual urine may be treated with coping strategies, Metoclopramid, alpha blockers and intermittent catheterization, but there is no evidence for parasympathomimetic medication. Overactive bladders can be treated by behavioral therapy, biofeedback, electrostimulation or antimuscarinics.

In addition to cooperation with colleagues from other specialties, intensive urologic research is required for the development of evidence-based strategies for long-term urologic care of patients with diabetes mellitus.

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Danksagung

Wesentliche Teile des Textes sind in intensiver konstruktiver interdisziplinärer Diskussion mit den Mitgliedern des Programms „Nationale Versorgungsleitlinie Typ 2 Diabetes – Neuropathie“ entstanden. Dafür danke ich folgenden Kolleginnen und Kollegen: Ellger, Björn (Münster; Deutsche Gesellschaft für Anästhesiologie und operative Intensivmedizin); Haslbeck, Manfred (München; Deutsche Diabetes Gesellschaft); Hübner, Peter (Bad Neuenahr; Deutsche Gesellschaft für Rehabilitationswissenschaften); Keller, Jutta (Hamburg; Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten); Kopp, Ina (Marburg; AWMF); Maier, Christoph (Bochum; Deutsche Gesellschaft zum Studium des Schmerzes); Marx, Nikolaus (Ulm; Deutsche Gesellschaft für Kardiologie); Neundörfer, Bernhard (Erlangen; Deutsche Gesellschaft für Neuropathie); Ollenschläger, Günter (Berlin; Ärztliches Zentrums für Qualität in der Medizin); Prange, Hilmar (Göttingen; Arzneimittelkommission der deutschen Ärzteschaft); Weinbrenner, Susanne (Berlin; Ärztliches Zentrums für Qualität in der Medizin); Wilm, Stefan (Witten; Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin); Ziegler, Dan (Düsseldorf; Deutsche Diabetes Gesellschaft).

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  1. Neuro-Urologie, Schweizer Paraplegiker-Zentrum, Guido A. Zäch-Straße 1, CH-6207, Nottwil, Schweiz

    J. Pannek

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Pannek, J. Diagnostik und Therapie von Blasenfunktionsstörungen bei Personen mit Diabetes mellitus. Urologe 49, 381–386 (2010). https://doi.org/10.1007/s00120-009-2170-6

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