Die medikamentöse Therapie des BPS

Zusammenfassung

Die medikamentöse Therapie des BPS ist oftmals das erstes Therapieregime bei symptomatischen BPS-Patienten, die unter zuwartendem Verhalten signifikant beschwerdeprogredient werden. Ziel der medikamentösen Therapie ist eine schnelle Verbesserung der „lower urinary tract symptoms“ (LUTS), die Verbesserung des Harnstrahls sowie die Verminderung der Restharnmenge. Unerwünschte Nebenwirkungen sollten möglichst niedrig sein.

Die häufig primär eingesetzten α1-Adrenorezeptorblocker überzeugen bei guter Verträglichkeit durch schnelle Wirksamkeit und signifikante Verbesserung von LUTS, Qmax und Restharnmengen.

Bei LUTS auf Grund von größeren Prostatavolumina zeigen 5α-Reduktase-Hemmer nach längerer Einnahme signifikante Verbesserung hinsichtlich Qmax, LUTS und Restharn. Zudem wirken sie als einziges Medikament relevant der Krankheitsprogression entgegen.

Bei ausgeprägten irritativen Beschwerden zeigen umfangreiche Studien gute Ergebnisse unter Therapie mit Muskarinrezeptorantagonisten und den seit kurzem zur BPS-Therapie erneut in Deutschland erhältlichen Beta-3-Agonisten. Beide bewirken Verbesserung der LUTS, ein günstigeres Nebenwirkungsprofil zeigt sich unter Therapie mit Beta-3-Agonisten.

Vorrangig als Therapie erektiler Dysfunktion (ED) genutzte PDE-5-Hemmer zeigen ebenfalls eine signifikante Verbesserung von LUTS und Restharnmengen und eignen sich gut für Patienten mit LUTS in Kombination mit ED.

Die zunehmend äußerst beliebten Phytopharmaka bestechen durch geringe Nebenwirkungen, werden jedoch auf Grund fraglicher Wirksamkeit durch keine akute Leitlinie empfohlen.

Neue Substanzgruppen, aber auch neue Therapieansätze mit bewährten Substanzen ergänzen laufend das wachsende Spektrum der medikamentösen Therapie des BPS. So ermöglichen neue Therapie-Algorithmen die individuelle Anpassung der Therapie an das Risikoprofil des Patienten unter Berücksichtigung unerwünschter Nebenwirkungen.

Abstract

Pharmacological treatment of BPS is often considered the first therapeutic approach for patients who experience progression in lower urinary tract symptoms (LUTS).

α1-adrenoceptor antagonists are often chosen as the first line pharmacological treatment, due to their rapid onset of action, as well as their significant impact on LUTS and Qmax and post-void residual. Adverse effects appear to be low.

With larger prostate volume and LUTS, long term treatment with 5α-reductase inhibitors (5ARIs) significantly improves LUTS and post-void residual. In addition, 5ARIs have a significant impact on the reduction in disease progression.

Patients with LUTS who mainly suffer from bladder storage symptoms appear to respond to treatment with muscarinic receptor antagonists and beta-3 agonists. Both of these drug classes significantly improve LUTS, but beta-3 agonists seem to be superior with respect to adverse effects.

Treatment with phosphodiesterase-5 inhibitors, which are well established in the treatment of erectile dysfunction (ED) gives significant improvement in LUTS and post-void residual and can therefore be recommended for patients with LUTS and ED.

Phytotherapies have low rates of adverse effects, which has made them increasingly popular, but effects on LUTS, Qmax and post-void residual remain to be proven.

New substances and therapeutic approaches are continuously expanding the options for pharmacological treatment of BPS. As regards adverse effects, therapeutic schemes can increasingly be customised to a patient profile.

Schlüsselwörter

benignes Prostatasyndrom - benigne Prostatahyperplasie - medikamentöse Therapie

Keywords

lower urinary tract symptoms - benign prostatic hyperplasia - medical treatment

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