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Überaktive Blase – aktuelle diagnostische und therapeutische Aspekte

Overactive bladder—Current diagnostic and therapeutic aspects

  • Leitthema
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Der Gynäkologe Aims and scope

Zusammenfassung

Die Prävalenz der überaktiven Blase beträgt bei Erwachsenen 16–17 %, ein Drittel der Betroffenen leidet zugleich unter einer Dranginkontinenz. Die Symptome der überaktiven Blase (Pollakisurie, Nykturie und imperativer Harndrang mit oder ohne Inkontinenz) treten ohne pathologische Veränderungen des Harntraktes auf. Die Basisdiagnostik umfasst: eine ausführliche Anamnese, eine klinische sowie urogynäkologische Untersuchung, eine Urinuntersuchung und das Führen eines Miktionstagebuchs. Zur weiterführenden Diagnostik gehören: die Urodynamik, die Urethrozystoskopie und die bildgebenden Verfahren. Neurologische und internistische Untersuchungen können differenzialdiagnostisch hilfreich sein. Die Therapie erfolgt individualisiert. Zusammengefasst stehen folgende konservative Behandlungsoptionen zur Verfügung: Lifestyle-Änderungen, Verhaltenstherapie, Beckenbodentraining und die medikamentöse Therapie. Bei therapierefraktärer Dranginkontinenz werden sowohl die Injektion von Onabotulinumtoxin A (100 Einheiten) als auch die sakrale Neuromodulation gleichrangig empfohlen. Die Patientenpräferenz und der Allgemeinzustand sind hierfür entscheidend. Die Blasenaugmentation stellt die Ultima Ratio der operativen Behandlung dar. Die Zufriedenheit mit der Behandlung korreliert mit den an die Therapie gestellten Erwartungen. Demzufolge sind die Aufklärung, die Motivation und die Begleitung der Patientinnen während der Therapie essenziell.

Abstract

The prevalence of overactive bladder in adults is 16–17% and one third of those affected also suffer from urge incontinence at the same time. The symptoms of overactive bladder (pollakiuria, nocturia and urgency with or without incontinence) occur without pathological changes of the urinary tract. The basic diagnostics include: detailed medical history, clinical and urogynecological examination, urinalysis and keeping a voiding diary. The further diagnostics comprise: urodynamics, urethrocystoscopy and imaging techniques. Neurological and medical examinations can be helpful in the differential diagnosis. The treatment is individualized. In summary, the following conservative treatment options are available: life style interventions, behavioral therapy, pelvic floor muscle training and pharmacological treatment. In patients with urge incontinence refractory to conservative treatment, onabotulinum toxin A injection (100 units) and sacral neuromodulation are equally recommended. Patient preference and general condition are decisive for the choice of treatment. Augmentation cystoplasty represents the last resort for operative treatment of patients. Satisfaction with the treatment correlates with the expectations of treatment. Consequently, education, motivation and accompaniment of patients during treatment are essential.

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  1. Universitäts-Frauenklinik, Eberhard Karls Universität, Calwerstraße 7, 72076, Tübingen, Deutschland

    Christl Reisenauer

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Reisenauer, C. Überaktive Blase – aktuelle diagnostische und therapeutische Aspekte. Gynäkologe 52, 188–194 (2019). https://doi.org/10.1007/s00129-019-4389-7

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