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Aktuelle Urol 2018; 49(04): 319-327
DOI: 10.1055/a-0650-3700
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Nykturie beim Benignen Prostatasyndrom

Nocturia in men with benign prostatic hyperplasia
Matthias Oelke
Urologie, St. Antonius Hospital, Gronau
,
Bernhard Fangmeyer
Urologie, St. Antonius Hospital, Gronau
,
Jörg Zinke
Urologie, St. Antonius Hospital, Gronau
,
Jörn H. Witt
Urologie, St. Antonius Hospital, Gronau
› Author Affiliations
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Publication History

Publication Date:
07 August 2018 (online)

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Zusammenfassung

Nykturie, definiert als Miktion von mindestens 1 Mal pro Nacht, ist eines der am häufigsten vorkommenden Symptome bei Männern mit benignem Prostatasyndrom (BPS) und oft Ursache für Arztkonsultationen. Nykturie ist für den Betroffenen nicht nur lästig, sondern auch für eine erhöhte Morbidität und Mortalität verantwortlich. Nykturie kann durch eine vermehrte Flüssigkeitsaufnahme, gesteigerte Diurese oder verminderte Blasenkapazität verursacht werden. Häufig liegen beim einzelnen Mann mehrere Ursachen vor, die nur durch systematische Abklärung detektiert und differenziert werden können. Das Blasentagebuch für drei Tage ist ein essenzieller Bestandteil bei der Abklärung der zugrundeliegenden Pathophysiologie, die Grundlage für eine rationelle Therapie der Nykturie darstellt. Behandlungsziele sind die Reduktion der Miktion auf weniger als 2 Mal pro Nacht, die Verlängerung der ersten Schlafphase auf über 4 Stunden, die durch den Schlafmangel ausgelöste verminderte Lebensqualität wieder herzustellen und die mit Nykturie assoziierte Morbidität und Mortalität zu senken. Liegt beim Patienten mit BPS eine funktionell reduzierte Blasenkapazität durch Restharnbildung vor, können α-Blocker, 5α-Reduktasehemmer, Phosphodiesterase Typ 5-Inhibitoren, Pflanzenextrakte oder Prostataoperationen (z. B. TURP) die Nykturiefrequenz signifikant senken. Liegt jedoch eine nächtliche Polyurie vor, wie bei 80 % der BPS-Patienten mit Nykturie nachgewiesen wurde, sollte das therapeutische Ziel die Verminderung des nächtlichen Urinvolumens sein. Bei Mangel des antidiuretischen Hormons (Arginin-Vasopressin) ist die Einnahme von Desmopressin vor dem Schlafengehen die erste Therapiewahl. Eine neue galenische Zubereitung von Desmopressin reduziert die Wahrscheinlichkeit der Hyponatriämie und kann daher auch bei Männern über 65 Jahre sicher eingesetzt werden. Eine Medikamentenkombination könnte bei Männern mit mehreren Ursachen für die Nykturie sinnvoll sein.

Abstract

Nocturia, defined as nocturnal micturition with a frequency of at least once per night, is one of the most frequent lower urinary tract symptoms in men with benign prostatic hyperplasia (BPH) and often causes them to consult a physician. Nocturia is often bothersome and responsible for increased morbidity and mortality. Nocturia can be caused by increased fluid intake, increased diuresis or decreased bladder capacity, either alone or in combination. The underlying pathophysiology of nocturia can only be detected by methodical evaluation of the patient. Bladder diaries for 3 days are an essential part of the assessment. Treatment goals include reducing the nocturnal voiding frequency to less than 2 episodes per night, increasing the duration of undisturbed sleep to more than 4 hours, restoring quality of life, and reducing morbidity as well as mortality. In patients with reduced functional bladder capacity, α-blockers, 5α-reductase inhibitors, phosphodiesterase type-5 inhibitors, plant extracts or prostate operations (e. g. TURP) have shown to significantly reduce nocturnal voiding frequency. If nocturnal polyuria causes or contributes to nocturia, as shown in up to 80 % of BPH patients with nocturia, the treatment goal is to reduce urine production during the night. Low nocturnal serum concentration of the antidiuretic hormone can be treated with desmopressin to be taken at bedtime. The risk of hyponatremia is reduced with the new low-dose desmopressin formulation, which can be used even in men older than 65 years of age. Drug combinations may be useful in men with a mixed pathophysiology of nocturia.

Schlüsselwörter

Nykturie - benigne Prostatahyperplasie - Restharn - nächtliche Polyurie - Desmopressin

Keywords

nocturia - benign prostatic hyperplasia - nocturnal polyuria - desmopressin - post-void residual urine
 

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