Harninkontinenz bei geriatrischen Patienten, Diagnostik und Therapie

1 Vorwort zum Leitlinienupdate 2019

Die Leitlinie „Harninkontinenz“ der Deutschen Gesellschaft für Geriatrie wurde erstmals 2005 und 2008 publiziert und 2009 bei der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften eingestellt (Leitlinien-Nr. 84-001). Nach einem Update 2014 liegt nun ein erneutes Update nach Ablauf der Gültigkeit 2019 vor. Mit Ausnahme der Kapitel „operative Therapie“, „Duloxetin“, „Parasympathomimetika“ (hier keine aktuellen Entwicklungen) wurden alle Kapitel überarbeitet. Das Kapitel „psychosomatische Aspekte“ wurde wegen der mangelnden Expertise der momentanen Mitglieder der Leitliniengruppe aus dem Update 2019 herausgenommen. Mit dem Kapitel „instrumentelle Harnblasenlangzeitdrainage“ wurde ein neues, relevantes Kapitel eingefügt.

1.1 Literaturrecherche

Primäre Berücksichtigung fanden randomisierte, doppelblinde, placebokontrollierte Studien sowie bereits vorhandene Leitlinien zum Thema. Wo keine randomisierten, placebokontrollierten Untersuchungen vorlagen oder aus methodischen Gründen prinzipiell nicht durchführbar sind, wurden auch Publikationen anderen Designs (nicht randomisierte Untersuchungen, Fallkontrollstudien) zur Leitlinienerstellung heran-gezogen.

Die verwendeten Suchbegriffe und die Anzahl der Treffer sind jedem Kapitel des Leitlinienupdates vorangestellt, die verwendeten Untersuchungen im Text benannt bzw. zitiert.

Wissenschaftliche Arbeiten zu geriatrischen Patienten im Sinne des hochbetagten und multimorbiden Patienten lagen selten vor, sodass auch auf Untersuchungen über andere Patienten zurückgegriffen wurde. Wenn spezielle Literatur zu geriatrischen Patienten oder zu älteren Patienten herangezogen werden konnte, fand diese besondere Erwähnung im Text.

1.2 Ausschlusskriterien

Nicht berücksichtigt wurden Kasuistiken und Untersuchungen, die nicht in englischer oder deutscher Sprache verfasst wurden. Ferner fanden keine experimentellen Untersuchungen aus der Grundlagenforschung, tierexperimentelle Studien und solche ohne Patientenkollektive Berücksichtigung.

In einem Gruppenprozess wurde die vorhandene und so extrahierte Literatur auf ihre Relevanz für die Leitlinie überprüft und gemeinsam nach ihrer Qualität bewertet (randomisierte Untersuchung? Placebokontrollierte Studie? Durchschnittsalter der Patienten? Geriatrische Patienten? Stichprobengröße? Studiendauer?). Verwendet wurde dazu die Klassifikation der Agency for Healthcare Research and Quality (https://www.ahrg.gov, s. Vorwort Gesamtleitlinie, Tabelle 2).

Vorhandene Leitlinien wurden bei der Formulierung der Leitlinie für den geriatrischen Patienten vergleichend hinzugezogen. Hierzu zählen die der Deutschen Gesellschaft für Urologie bzw. Gynäkologie https://www.awmf.org/uploads/tx_szleitlinien/015-007l_S2k_Ueberaktive_Blase_2010-abgelaufen.pdf; http://www.awmf.org/uploads/tx_szleitlinien/043.

Deren Bewertung erfolgte unter dem besonderen Blickwinkel des multimorbiden, multimedizierten, vulnerablen und von Chronifizierung sowie Autonomieverlust bedrohten geriatrischen Patienten. Dies erklärt eine u. U. andere Gewichtung der getroffenen Aussagen bzw. auch andere Schlussfolgerungen für den geriatrischen Patienten.

Nach Erstellung des Leitlinientexters wurden alle Leitlinienempfehlungen nach dem Überprüfungs- und Bewertungsprozess in der Gruppe in einem anonymisierten Prozess zur schriftlichen Einzelabstimmung gebracht. Das Ergebnis findet sich mit dem Anteil der zustimmenden Mitglieder der Arbeitsgruppe angegeben in Prozent hinter jeder Empfehlung. Die aktuellen Mitglieder der Arbeitsgruppe Harninkontinenz der Deutschen Gesellschaft für Geriatrie sind in [Tab. 1] in alphabetischer Reihenfolge aufgeführt.

Tab. 1 Mitglieder der AG Inkontinenz der DGG (Stand: Dezember 2018).

Dr. Klaus Becher	Helios Hanseklinikum Stralsund Klinik für Geriatrie und Frührehabilitation Rostocker Chaussee 70 18437 Stralsund [e-mail]
Dr. Barbara Bojack	Ärztin für Urologie Eichgartenallee 14 35394 Gießen [e-mail]
Dr. Sigrid Ege	Robert-Bosch-Krankenhaus Geriatrische Abteilung Auerbachstr. 110 70376 Stuttgart [e-mail]
Prof. Dr. Ruth Kirschner-Hermanns	Universitätsklinikum Bonn Neuro-Urologie im Chirurgischen Zentrum Sigmund-Freud-Str. 25 53105 Bonn Neuro-Urologie, Neurologisches Rehabilitationszentrum Godeshöhe e.V. Waldstr. 2 – 10 53177 Bonn [e-mail]
Dr. Silke von der Heide	Praxis für Physikalische und Rehabilitative Medizin Kasseler Landstraße 25 b 37081 Göttingen [e-mail]
Prof. Dr. Andreas Wiedemann	Lehrstuhl für Geriatrie der Universität Witten/Herdecke Evangelisches Krankenhaus Witten gGmbH Urologische Klinik Pferdebachstr. 27 58455 Witten [e-mail]

Die Leitlinie wurde von den Mitgliedern der AG Inkontinenz neutral, unabhängig und ohne Finanzierung oder Aufwandsentschädigung von dritter Seite im Auftrag der Deutschen Gesellschaft für Geriatrie in personam des Präsidenten erstellt.

Publication History

Article published online:
28 February 2019

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