Harninkontinenz bei geriatrischen Patienten: Medikamentöse Therapie

Zusammenfassung

Einleitung 1/2019 wurde ein update der seit 2005 in AWMF eingestellten und fortlaufend aktualisierten Leitlinie „Harninkontinenz bei geriatrischen Patienten – Diagnostik und Therapie“ durch die interdisziplinäre Arbeitsgruppe „Harninkontinenz“ der Deutschen Gesellschaft für Geriatrie (DGG) publiziert. Aus dieser Leitlinie, die als offizielle Leitlinie DGG akkreditiert ist, stellt der vorliegende Artikel das Kapitel „Medikamentöse Therapie“ dar.

Methodik In einem strukturierten Bewertungsprozess identifizierte eine Literaturrecherche zunächst die vorhandene Literatur im Kontext des „geriatrischen Patienten“, wie er als zumeist über 70jährig und multimorbid oder über 80jährig durch die Fachgesellschaften definiert ist. Primäre Berücksichtigung fanden randomisierte, doppelblinde, plazebokontrollierte Studien sowie bereits vorhandene Leitlinien zum Thema. Wo keine solchen Untersuchungen vorlagen oder aus methodischen Gründen prinzipiell nicht durchführbar sind, wurden auch Publikationen anderen Designs (nicht randomisierte Untersuchungen, Fallkontrollstudien) zur Leitlinienerstellung herangezogen. Die daraus resultierenden Leitlinienempfehlungen wurden in einem strukturierten Abstimmungsprozess unterzogen; das Ergebnis ist in Prozent der zustimmenden Gruppenmitgliedern angegeben.

Ergebnisse Die medikamentöse Therapie der Überaktiven Blase, der Belastungsharninkontinenz und der Überlaufinkontinenz sowie die unspezifische medikamentöse Therapie mit Antidiuretika wurde vor dem besonderen Hintergrund des vulnerablen, potentiell kognitiv eingeschränkten und im Rahmen der Multimorbidität und Multimedikation durch Medikamenteninteraktionen besonders gefährdeten Patienten betrachtet. Dabei fand das relevante Nebenwirkungsprofil der eingesetzten Substanzen besondere Berücksichtigung.

Schlussfolgerungen Eine medikamentöse Therapie der Harninkontinenz bedarf bei den besonders vulnerablen, häufig multimedizierten Patienten eine besonders sorgfältige Indikationsstellung und Überwachung in Kenntnis des spezifischen Risiko- und Nebenwirkungsprofils der eingesetzten Substanzen.

Abstract

Introduction 1/2019 we presented an update of the AWMF guideline ‘urinary incontinence in frail elderly – diagnostics and therapy’. Since its introduction in 2015 the guideline has been under a continuous revision process by the working group ‘Incontinence’ of the German Society for Geriatrics (DGG). From this guideline which is accredited as an official guideline of the DGG we present here the chapter about pharmacological therapy.

Methods A profound literature search was done in a structured evaluation process in the context of a ‘frail elderly’. Most medical societies define a ‘frail elderly’ as someone older than 70 years and multimorbide or older than 80y. We focused on randomized, double blind, placebo controlled studies as well as already published guidelines in this field. In the case no studies were available or not feasible other publications such as not randomized studies or case reports were taken into consideration for our guideline. Recommendations resulted from a structured voting process and the results are stated as percentage of members who agreed.

Results Pharmacological therapy of OAB, stress incontinence and overflow incontinence as well as unspecific treatment with antidiuretics was evaluated with special focus on vulnerable, potentially cognitively impaired frail elderly. We took a closer look on special side effect profile of the above mentioned drugs with regard to the individual multimorbidity and multimedication.

Conclusion Pharmacological therapy of urinary incontinence in frail elderly needs strict indication. Knowledge about drug metabolization and substance interactions as well as close monitoring of possible side effects are indispensable in this vulnerable group of patients.

Schlüsselwörter

Antimuskarinika - Mirabegron - Botulinum Toxin - Duloxetin - Cholinesterasehemmer

Keywords

Antimuscarinics - Mirabegron - Botulinum Toxin - Duloxetin - Cholinesterase inhibitors

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