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Palliative Harnblasenlangzeitdrainage: eine urogeriatrische Disputation

Palliative long-term urinary bladder drainage: the uro-geriatric point of view

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Zusammenfassung

Als Indikation zur Harnblasenlangzeitdrainage gilt die anders nicht behandelbare Blasenentleerungsstörung oder Harninkontinenz. Die Anlage eines transurethralen oder suprapubischen Katheters zur lebenslangen Harnblasendrainage stellt eine Maßnahme dar, die sowohl mit kurzfristigen, technischen Komplikationen verbunden ist, als auch langfristige Folgeerscheinungen nach sich zieht. So wird das Letalitätsrisiko der Anlage eines suprapubischen Blasenfistelkatheters mit rund 2 % angegeben. Neben den Folgen der Fehlpunktion bei der Anlage eines suprapubischen Katheters und der traumatischen Einlage eines transurethralen Katheters sind häufig Hämaturien, Infekte, Tenesmen, Steinbildungen, Obstruktionen, Katheterverluste und besonders bei kognitiv Eingeschränkten die Autodislokationstendenz Gründe für Notfallbehandlungen und Krankenhausaufenthalte. Weitere Problemfelder sind die Abhängigkeit von dem Pflegepersonal, das die erforderlichen Wechsel vornimmt, und Hautprobleme im Fistel-Stoma-Bereich. Inwieweit dies die Lebensqualität der Betroffenen beeinträchtigt, ist bisher unklar. Die „akuten“ Komplikationsmöglichkeiten und die langfristigen Folgen machen es notwendig, die Indikation zur lebenslangen Harnblasendrainage streng und erst dann zu stellen, wenn alle anderen Therapieoptionen nicht anwendbar oder nicht gewünscht sind.

Abstract

A serious voiding disorder or urinary incontinence represent indications for long-term catheterization of the urinary bladder. Treatment by a transurethral or suprapubic bladder catheter for life-long bladder drainage is accompanied by technical short-term complications and long-term sequelae. The mortality risk associated with inserting a suprapubic catheter is approximately 2% due to an incorrect bladder puncture. Long-term consequences of life-long bladder drainage are hematuria, infection, spasms, stone formation, obstruction, catheter loss, risk of falls and automanipulation especially in cognitively impaired persons. These constitute frequent reasons for emergency treatment or hospitalization. Further problem areas are dependency on caregivers to perform the catheter change and dermal problems in the area of the fistula stoma. To what extent this limits the quality of life of those affected remains unclear up to now. The acute complications and the long-term consequences of life-long bladder drainage make careful decision-making necessary after other therapeutic options have failed, are not appropriate or not desired.

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Author information

Authors and Affiliations

  1. Urologische Abteilung, Evangelisches Krankenhaus Witten, Pferdebachstr. 27, 58455, Witten, Deutschland

    A. Wiedemann

  2. Lehrstuhl für Geriatrie der Universität Witten/Herdecke, Witten, Deutschland

    A. Wiedemann &  H. J. Heppner

  3. Neuro-Urologie, Universitätsklinikum der Rheinischen Friedrich-Wilhelms Universität, Bonn, Deutschland

    R. Kirschner-Hermanns

  4. Neurologisches Rehabilitationszentrum der Godeshöhe, Bonn, Deutschland

    R. Kirschner-Hermanns

  5. Geriatrische Klinik und Tagesklinik, Helios-Klinikum, Schwelm, Deutschland

    H. J. Heppner

  6. Institut für Biomedizin des Alterns der FAU Erlangen-Nürnberg, Nürnberg, Deutschland

    H. J. Heppner

Authors
  1. A. Wiedemann
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  3. H. J. Heppner
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Correspondence to A. Wiedemann.

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Interessenkonflikt

A. Wiedemann: Beratungstätigkeit: Astellas Pharma, Dr. Pfleger, Pfizer Pharma; Vortragstätigkeit: Pharmallergan, AMS Deutschland, Aristo, Astellas Pharma, Berlin-Chemie, Boston Scientific, Ipsen, Jansen, Lilly Deutschland, Meda, Dr. Pfleger, Pfizer Pharma, Pohl-Boskamp; Forschungsunterstützung: AMS Deutschland, Dr. Pfleger. R. Kirschner-Hermanns: Beratungstätigkeit: Repha GmbH; Vortragstätigkeit: Repha GmbH. H. J. Heppner: Beratungstätigkeit: Astellas Pharma, Pfizer Pharma, Vortragshonorare: Pfizer Pharma, Bayer Health Care, Mundipharma, Astellas Pharma, MSD, BLÄK, AO Trauma Europa, Forschungsunterstützung: ThermoScience, Forschungskolleg Geriatrie der Robert-Bosch-Stiftung, Wissenschaftsforum Geriatrie, Infectopharm; GBA Innovationsfonds.

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Wiedemann, A., Kirschner-Hermanns, R. & Heppner, H.J. Palliative Harnblasenlangzeitdrainage: eine urogeriatrische Disputation. Urologe 58, 389–397 (2019). https://doi.org/10.1007/s00120-019-0883-8

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  • DOI: https://doi.org/10.1007/s00120-019-0883-8

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