Der Urologe

, Volume 56, Issue 12, pp 1532–1538 | Cite as

Überaktive Blase – wann welche Therapie?

Leitthema

Zusammenfassung

Die OAB (überaktive Blase/„overactive bladder“) stellt einen klinischen Symptomenkomplex dar. Die initiale Therapie sollte daher auf den klinischen Symptomen und einer Basisdiagnostik beruhen. Bei der Wahl der Ersttherapie spielt die Patientenpräferenz eine entscheidende Rolle. Neben verhaltenstherapeutischen Ansätzen stehen Elektrostimulation und medikamentöse Therapien zur Verfügung. Bei nicht ausreichendem Ansprechen sollte vor einer Therapieeskalation mit minimal-invasiven Behandlungen, wie Onabotulinumtoxin-Injektionen in den Detrusor oder sakrale Neuromodulation, eine erweiterte Diagnostik erfolgen. Chirurgische Maßnahmen wie z. B. Blasenaugmentation sind nur in Ausnahmefällen erforderlich.

Schlüsselwörter

Elektrostimulation Muskarinrezeptorantagonist Onabotulinumtoxin Neuromodulation, sakrale Nykturie 

Overactive bladder—which treatment when?

Abstract

The term OAB (overactive bladder) describes a symptom complex. Therefore, initial treatment should be based on clinical symptoms and the results of basic diagnostics. Patient preference is essential for the choice of the initial treatment. Behavioural therapy, electrostimulation and medical treatment are available treatment options. If these are not effective, extended diagnostic examinations should be performed prior to minimally invasive treatments, like onabotulinumtoxin injections in the detrusor or sacral neuromodulation. Surgical interventions like augmentation cystoplasty are rarely required today.

Keywords

Electrostimulation Muscarin receptor antagonists Onabotulinumtoxin Sacral neuromodulation Nocturia 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. Pannek gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A, Standardisation Sub-committee of the International Continence Society (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 21:167–178CrossRefPubMedGoogle Scholar
  2. 2.
    Azuri J, Kafri R, Ziv-Baran T, Stav K (2017) Outcomes of different protocols of pelvic floor physical therapy and anti-cholinergics in women with wet over-active bladder: a 4‑year follow-up. Neurourol Urodyn 36:755–758CrossRefPubMedGoogle Scholar
  3. 3.
    Biers SM, Venn SN, Greenwell TJ (2012) The past, present and future of augmentation cystoplasty. BJU Int 109:1280–1293CrossRefPubMedGoogle Scholar
  4. 4.
    Burgio KL, Goode PS, Locher JL, Umlauf MG, Roth DL, Richter HE, Varner RE, Lloyd LK (2002) Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. JAMA 288:2293–2299CrossRefPubMedGoogle Scholar
  5. 5.
    Burgio KL, Goode PS, Johnson TM, Hammontree L, Ouslander JG, Markland AD, Colli J, Vaughan CP, Redden DT (2011) Behavioral versus drug treatment for overactive bladder in men: the Male Overactive Bladder Treatment in Veterans (MOTIVE) trial. J Am Geriatr Soc 59:2209–2216CrossRefPubMedGoogle Scholar
  6. 6.
    Buser N, Ivic S, Kessler TM, Kessels AG, Bachmann LM (2012) Efficacy and adverse events of antimuscarinics for treating overactive bladder: network meta-analyses. Eur Urol 62:1040–1060CrossRefPubMedGoogle Scholar
  7. 7.
    Charach G, Greenstein A, Rabinovich P, Groskopf I, Weintraub M (2001) Alleviating constipation in the elderly improves lower urinary tract symptoms. Gerontology 47:72–76CrossRefPubMedGoogle Scholar
  8. 8.
    Chen H, Wang F, Yu Z, Zhang Y, Liu C, Dai S, Chen B, Lv J (2017) Efficacy of daily low-dose tadalafil for treating overactive bladder: results of a randomized, double-blind, placebo-controlled trial. Urology 100:59–64CrossRefPubMedGoogle Scholar
  9. 9.
    Cheng CL, Li JR, Lin CH, de Groat WC (2016) Positive association of female overactive bladder symptoms and estrogen deprivation: a nationwide population-based cohort study in Taiwan. Medicine (Baltimore) 95:e4107CrossRefGoogle Scholar
  10. 10.
    Chua ME, See MC 4th, Esmeňa EB, Balingit JC, Morales ML Jr (2017) Efficacy and safety of Gabapentin in comparison to solifenacin succinate in adult overactive bladder treatment. Low Urin Tract Symptoms.  https://doi.org/10.1111/luts.12152 PubMedGoogle Scholar
  11. 11.
    Cui Y, Zong H, Yang C, Yan H, Zhang Y (2014) The efficacy and safety of mirabegron in treating OAB: a systematic review and meta-analysis of phase III trials. Int Urol Nephrol 46:275–284CrossRefPubMedGoogle Scholar
  12. 12.
    Del Río-Gonzalez S, Aragon IM, Castillo E, Milla-España F, Galacho A, Machuca J, Lara MF, Herrera-Imbroda B (2017) Percutaneous tibial nerve stimulation therapy for overactive bladder syndrome: clinical effectiveness, urodynamic and durability evaluation. Urology.  https://doi.org/10.1016/j.urology.2017.04.059 Google Scholar
  13. 13.
    Drake MJ, Nitti VW, Ginsberg DA, Brucker BM, Hepp Z, McCool R, Glanville JM, Fleetwood K, James D, Chapple CR (2017) Comparative assessment of efficacy of onabotulinumtoxin A and oral therapies (anticholinergics and mirabegron) for overactive bladder: a systematic review and network meta-analysis. BJU Int.  https://doi.org/10.1111/bju.13945 Google Scholar
  14. 14.
    Eldred-Evans D, Sahai A (2017) Medium- to long-term outcomes of botulinum toxin A for idiopathic overactive bladder. Ther Adv Urol 9:3–10CrossRefPubMedGoogle Scholar
  15. 15.
    Forde JC, Davila JL, Marks BK, Epstein M, Tsui JF, Weiss JP, Blaivas JG (2017) Urogynecological conditions associated with overactive bladder symptoms in women. Can Urol Assoc J 11:E83–E87CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Herdman M, Nazir J, Hakimi Z, Siddiqui E, Huang M, Pavesi M, MacDiarmid S, Drake MJ, Devlin N (2017) Assessing preference-based outcome measures for overactive bladder: an evaluation of patient-reported outcome data from the BESIDE clinical trial. Patient.  https://doi.org/10.1007/s40271-017-0262-8 PubMedGoogle Scholar
  17. 17.
    Homma Y (2008) Lower urinary tract symptomatology: its definition and confusion. Int J Urol 15:35–43CrossRefPubMedGoogle Scholar
  18. 18.
    Kaufmann A, Kirschner-Hermanns R (2016) Therapie der weiblichen OAB. Aktuelle Urol 47:305–309CrossRefPubMedGoogle Scholar
  19. 19.
    Kim A, Lee KS, Kim TB, Kim HJ, Yoo ES, Yun JH, Kim DY, Jung SG, Lee JT, Kim JM, Oh CK, Shin JH, Jeon SH, Lee SH, Han CH, Lee DH, Cho HJ, Choo MS (2017) Incidence and risk factors of recurrence of overactive bladder symptoms after discontinuation of successful medical treatment. Investig Clin Urol 58:42–47CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Lua LL, Pathak P, Dandolu V (2017) Comparing anticholinergic persistence and adherence profiles in overactive bladder patients based on gender, obesity, and major anticholinergic agents. Neurourol Urodyn.  https://doi.org/10.1002/nau.23256 PubMedGoogle Scholar
  21. 21.
    Madhu C, Enki D, Drake MJ, Hashim H (2015) The functional effects of cigarette smoking in women on the lower urinary tract. Urol Int 95:478–482CrossRefPubMedGoogle Scholar
  22. 22.
    Marcelissen TA, Rahnama’i MS, Snijkers A, Schurch B, De Vries P (2017) Long-term follow-up of intravesical botulinum toxin-A injections in women with idiopathic overactive bladder symptoms. World J Urol 35:307–311CrossRefPubMedGoogle Scholar
  23. 23.
    Pannek J, Janek S, Noldus J (2010) Neurogene oder idiopathische Detrusorüberaktivität nach erfolgloser antimuskarinerger Therapie. Klinische Wertigkeit der externen temporären Elektrostimulation. Urologe A 49:530–535CrossRefPubMedGoogle Scholar
  24. 24.
    Robinson D, Hanna-Mitchell A, Rantell A, Thiagamoorthy G, Cardozo L (2017) Are we justified in suggesting change to caffeine, alcohol, and carbonated drink intake in lower urinary tract disease? Report from the ICI-RS 2015. Neurourol Urodyn 36:876–881CrossRefPubMedGoogle Scholar
  25. 25.
    Rovner ES, Raymond K, Andruczyk E, Juul KV (2017) Low-dose Desmopressin and Tolterodine combination therapy for treating nocturia in women with overactive bladder: a double-blind, randomized, controlled study. Low Urin Tract Symptoms.  https://doi.org/10.1111/luts.12169 PubMedGoogle Scholar
  26. 26.
    Shafik A, Shafik IA (2003) Overactive bladder inhibition in response to pelvic floor muscle exercises. World J Urol 20:374–377PubMedGoogle Scholar
  27. 27.
    Shin JH, Kim A, Choo MS (2017) Additional low-dose antimuscarinics can improve overactive bladder symptoms in patients with suboptimal response to beta 3 agonist monotherapy. Investig Clin Urol 58:261–266CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Siegel S, Noblett K, Mangel J, Bennett J, Griebling TL, Sutherland SE, Bird ET, Comiter C, Culkin D, Zylstra S, Kan F, Berg KC (2017) Five year follow-up results of a prospective, multicenter study in overactive bladder subjects treated with sacral neuromodulation. J Urol 5347(17):77099–77091.  https://doi.org/10.1016/j.juro.2017.07.010 Google Scholar
  29. 29.
    Staskin D, Herschorn S, Fialkov J, Tu LM, Walsh T, Schermer CR (2017) A prospective, double-blind, randomized, two-period crossover, multicenter study to evaluate tolerability and patient preference between mirabegron and tolterodine in patients with overactive bladder (PREFER study). Int Urogynecol J.  https://doi.org/10.1007/s00192-017-3377-5 PubMedPubMedCentralGoogle Scholar
  30. 30.
    Stewart F, Gameiro LF, El Dib R, Gameiro MO, Kapoor A, Amaro JL (2016) Electrical stimulation with non-implanted electrodes for overactive bladder in adults. Cochrane Database Syst Rev 12:CD10098PubMedGoogle Scholar
  31. 31.
    Sukhu T, Kennelly MJ, Kurpad R (2016) Sacral neuromodulation in overactive bladder: a review and current perspectives. Res Rep Urol 8:193–199PubMedPubMedCentralGoogle Scholar
  32. 32.
    Tyagi P, Kashyap M, Yoshimura N, Chancellor M, Chermansky CJ (2017) Past, present and future of chemodenervation with botulinum toxin in the treatment of overactive bladder. J Urol 197:982–990CrossRefPubMedGoogle Scholar
  33. 33.
    Vijverberg MA, Stortelder E, de Kort LM, Kok ET, de Jong TP (2011) Long-term follow-up of incontinence and urge complaints after intensive urotherapy in childhood (75 patients followed up for 16.2–21.8 years). Urology 78:1391–1396CrossRefPubMedGoogle Scholar
  34. 34.
    Wolz-Beck M, Reisenauer C, Kolenic GE, Hahn S, Brucker SY, Huebner M (2017) Physiotherapy and behavior therapy for the treatment of overactive bladder syndrome: a prospective cohort study. Arch Gynecol Obstet 295:1211–1217CrossRefPubMedGoogle Scholar
  35. 35.
    Wyman JF, Klutke C, Burgio K, Guan Z, Sun F, Berriman S, Bavendam T (2010) Effects of combined behavioral intervention and tolterodine on patient-reported outcomes. Can J Urol 17:5283–5290PubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  1. 1.Neuro-UrologieSchweizer Paraplegiker-ZentrumNottwilSchweiz

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