Interstitielle Zystitis: Interventionelle und operative Therapie – mehr als eine Ultima Ratio

Zusammenfassung

Die interstitielle Zystitis ist eine häufig unterdiagnostizierte, chronisch-rezidivierend bis chronisch-progredient verlaufende Harnblasenerkrankung, deren Pathogenese und Ätiologie noch weitgehend unklar ist. Die Erkrankung selbst ist nicht heilbar, eine Therapie erfolgt symptomatisch. Neben konservativen und medikamentösen Therapieansätzen stehen den Patienten auch eine Vielzahl an interventionell-operativen Verfahren zur Verfügung. Dazu zählen neben intravesikalen Instillationen, transurethralen Verfahren wie Injektionen von Botulinum-Toxin A, Kortikosteroiden und Lokalanästhetika, Hydrodistension und Neuromodulation auch operative Eingriffe wie (Laser-) Fulguration, Resektion und Zystektomie. Obwohl operative Interventionen bei Vorliegen einer interstitiellen Zystitis meist sehr spät in Erwägung gezogen werden (sollen) und prinzipiell als Ultima ratio bezeichnet werden, weisen diese Eingriffe bei guten bis sehr guten Ansprechraten und meist überschaubaren Komplikationen ein günstiges Nutzen-Risikoverhältnis auf. Eine allgemeine Pauschalisierung der Intervention als Ultima ratio sollte daher vermieden werden und ihr Einsatz individuell abgestimmt auf den jeweiligen Patienten erfolgen.

Abstract

Interstitial cystitis is an underdiagnosed chronic-relapsing to chronic-progressive urinary bladder disease, whose pathogenesis and aetiology has not been fully elucidated. The disease itself cannot be cured and treatment is symptomatic. Treatment options comprise conservative and medicinal approaches as well as a large number of interventional/surgical procedures. These include intravesical instillation, transurethral procedures such as injections of botulinum toxin A, corticosteroids and local anaesthetics, hydrodistension and neuromodulation as well as (laser) fulguration, resection and cystectomy. Although surgical procedures are considered a late option and are often referred to as last-resort therapy, these interventional options often show good to very good response rates, manageable complications and a favourable risk-benefit evaluation. An overall generalisation of surgery as a last-resort treatment option should therefore be avoided and its use should be discussed based on the individual needs of each patient.

Schlüsselwörter

intravesikale Instillation - transurethrale Injektionen - Neuromodulation - Fulguration - Zystektomie

Keywords

intravesical instillation - transurethral injections - neuromodulation - fulguration - cystectomy

Publication History

Received: 03 September 2021

Accepted after revision: 11 October 2021

Article published online:
30 November 2021

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