Belastungsinkontinenz nach operativer Therapie einer benignen Prostatahyperplasie: Konservative und operative Therapieoptionen

Zusammenfassung

Eine dauerhafte Belastungsinkontinenz nach operativer Therapie einer gutartigen Prostatavergrößerung (BPH) tritt mit einer Inzidenz von circa 2,2 % auf, wobei die Inzidenz zwischen den verschiedenen Therapieoptionen deutlich variiert. Die Evidenz zur konservativen sowie operativen Therapie der Belastungsinkontinenz basiert in der Regel auf Studien an Patienten mit einer Postprostatektomie-Inkontinenz (PPI) oder auf kleinen Subkohorten aus großen Patientenkollektiven. Studien, die sich auf Patienten mit Belastungsinkontinenz nach operativer Therapie einer BPH fokussieren, bilden die Ausnahme. Anhand der aktuellen Evidenz ist davon auszugehen, dass Beckenbodentraining, adjustierbare Schlingensysteme und artifizielle Sphinkter wirksame Therapieoptionen darstellen, während nach Implantation einer retrourethralen transobturatorischen Suspensionsschlinge mit niedrigeren Erfolgsraten gegenüber der PPI auszugehen ist.

Abstract

Persistent stress urinary incontinence following surgical treatment of bladder outlet obstruction based on benign prostate enlargement (BPE) occurs at an incidence of approximately 2.2 %, although incidence rates vary significantly between different surgical options. Current evidence on SUI treatment of BPE patients is usually based on postprostatectomy incontinence patient cohorts or small subgroup analyses of greater patient collectives. Studies that focus on SUI after surgical treatment of BPE are still rare. Based on the current low-level evidence, it can be assumed that pelvic floor muscle training, implantation of an adjustable male sling system and implantation of an artificial urinary sphincter may be equally effective in PPI and post-BPE patients. The implantation of a retrourethral transobturator male sling, however, seems to provide lower success rates compared to PPI patients.

Schlüsselwörter

Harninkontinenztherapie - gutartige Prostatavergrößerung - benigne Prostatahyperplasie - Beckenbodenmuskulaturtraining - adjustierbare Schlingensysteme

Keywords

benign prostate enlargement - benign prostate hyperplasia - pelvic floor muscle training - adjustable male sling - urinary incontinence treatment

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