Minimal-invasive Therapie: Wie ist der Stand im Jahre 2021 – was kommt, was geht

Zusammenfassung

Die Volkskrankheit „benignes Prostatasyndrom“ erfordert mit der Vielzahl an betroffenen Männern und einer variablen klinischen Präsentation individuelle Therapieoptionen, die auf die jeweiligen klinischen Charakteristika und Wünsche des Patienten zugeschnitten werden. Ist eine operative Therapie indiziert, steht ein großes Spektrum an invasiven Verfahren zur Verfügung. Als Goldstandard galten lange Zeit die transurethrale Resektion der Prostata und die offene Adenomenukleation, die jedoch mit erhöhter Morbidität und Einschränkungen der Sexualfunktion einhergehen. Daher wird zunehmend nach minimal-invasiven Therapieoptionen gefordert, die eine effektive und sichere Therapie im ambulanten Setting ermöglichen sollen. Über die letzten Jahre wurde eine Vielzahl an Technologien und Verfahren entwickelt und getestet, von denen nur wenige in der klinischen Praxis etabliert werden konnten, meist aufgrund unzureichender funktioneller Ergebnisse. Nicht mehr empfohlen werden daher die transurethrale Nadelablation, transurethrale Mikrowellentherapie, intraprostatische Botulinumtoxin-A- oder PRX302-Injektionen und prostatische Stents. Demgegenüber spricht die Europäische Gesellschaft für Urologie derzeit Empfehlungen für den UroLift, die Aquablation und die Prostataarterienembolisation aus, die langfristig signifikante Verbesserungen der funktionellen Parameter erreichen und dabei mit einem guten Sicherheitsprofil und erhaltener Sexualfunktion überzeugen. Vielversprechende Daten liegen auch für das temporär implantierte Nitinoldevice (iTIND), Rezūm, intraprostatische Injektionen von Fexapotid-Triflurtat und die transperineale Laserablation der Prostata vor, deren Effektivität und Sicherheit jedoch noch in weiteren Studien bestätigt werden müssen.

Abstract

Due to the large number of men affected and a variable clinical presentation, the widespread disease “benign prostatic syndrome” requires individual treatment options tailored to the patient’s specific clinical characteristics and wishes. If surgical treatment is indicated, there is a wide range of invasive procedures available. For a long time, transurethral resection of the prostate and simple prostatectomy were considered the gold standard, but these procedures are associated with increased morbidity and limitations in sexual function. Therefore, there is now an increasing call for minimally invasive treatment options that will provide effective and safe treatment in the outpatient setting. Over the past years, a variety of technologies and procedures have been developed and tested, but only a few of them have found their way into clinical practice, mostly due to insufficient functional results. For instance, transurethral needle ablation, transurethral microwave thermotherapy, intraprostatic botulinum toxin A or PRX302 injections as well as prostatic stents are no longer recommended. In contrast, the European Association of Urology is currently recommending UroLift, Aquablation and prostatic artery embolisation, which achieve significant long-term improvements in functional parameters while providing a good safety profile and preserved sexual function. Promising data are also available for the temporarily implanted nitinol device (iTIND), Rezūm, intraprostatic injection of fexapotide triflutate and transperineal laser ablation of the prostate, but the efficacy and safety of these procedures need to be confirmed in further studies.

Schlüsselwörter

Benignes Prostatasyndrom - Benigne Prostatahyperplasie - Minimal-invasive Therapie - LUTS - Prostata

Keywords

benign prostatic hyperplasia - benign prostatic syndrome - minimally invasive treatment - lower urinary tract symptoms - prostate

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