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Aktuelle Urol 2013; 44(2): 141-149
DOI: 10.1055/s-0032-1324997
Fortbildung
Georg Thieme Verlag KG Stuttgart · New York

Knochenmetastasen

Bone Metastases
C.-H. Ohlmann
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Publikationsverlauf

Publikationsdatum:
11. April 2013 (online)

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    Lizenzen und Reprints

Siehe auch:

KnochenmetastasenInnere Medizin up2date 2014; 2(03): 229-238
DOI: 10.1055/s-0034-1387250

Zusammenfassung

Die urologischen Tumorentitäten zählen zu den häufigsten Tumoren, die Knochenmetastasen entwickeln. In der Diagnostik stehen die bildgebenden Verfahren mit Nativröntgen, CT und MRT an vorderster Stelle. Die Differenzierung von benignen und malignen Veränderungen am Knochen kann dabei eine diagnostische Herausforderung sein und in seltenen Fällen auch eine invasive Diagnostik mittels perkutaner oder offener Knochenbiopsie notwendig machen. Mit dem Nachweis ossärer Metastasen sollte umgehend eine medikamentöse Prävention skeletaler Komplikationen mittels Bisphosphonaten oder Denosumab erfolgen. Die Therapieziele symptomatischer Knochenmetastasen liegen v. a. in der Reduktion tumorbedingter Schmerzen und Stabilisierung der Knochenstruktur. Pathologische Frakturen sind i. d. R. entweder durch minimalinvasive oder offen operative Verfahrung zur Stabilisierung des Knochenabschnitts zu versorgen. Bei Auftreten neurologischer Begleitsymptome ist eine notfallmäßige Dekompression der entsprechenden nervalen Strukturen notwendig, um bleibende neurologische Defizite zu vermeiden.

Abstract

Malignant urological tumours account for a relevant number of patients who develop bone metastasis throughout the course of their disease. Diagnosis of bone metastasis is mostly achieved by imaging studies including plain X-ray, computed tomography or magnetic resonance tomography. Differential diagnosis between benign and malignant processes in the bone can be sometimes challenging so that minimally or open operative biopsy of the bone becomes necessary in rare cases. After diagnosis of bone metastasis medical treatment using bisphosphonates or denosumab should be initiated in order to prevent skeletal complications. Therapeutic goals for symptomatic bone metastasis are the reduction of tumour associated pain and stabilization of the bone. Pathologic fractures are mostly being treated using either minimally invasive or open operative techniques for stabilizing the segment of the bone or spine. In case of accompanying neurologic symptoms immediate intervention and decompression of the neural structures is warranted in order to prevent irreversible neurologic deficits.

Key words

Knochenmetastasen - Bisphosphonate - Denosumab - Myelonkompression - Skeletale Komplikation

Key words

Bone metastasis - bisphosphonates - denosumab - spinal cord compression - skeletal related events
 

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