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Botulinumtoxin in der Urologie

Indikationen und Ergebnisse

Botulinum toxin in urology

Indications and results

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Zusammenfassung

Das Botulinumtoxin blockiert den neuromuskulären Übergang, wo das Toxin die Ausschüttung von Acetylcholin aus der präsynaptischen Nervenendigung und so die Erregungsübertragung vom Nerven auf das Zielorgan verhindert. Es resultiert eine Chemodenervation des Muskels oder der Drüse, die je nach Zielgewebe einige Wochen bis Monate anhalten kann.

Die Anwendung von Botulinumtoxin eröffnet für eine Reihe urologischer Krankheitsbilder neue therapeutische Optionen. Randomisierte und kontrollierte Studien liegen für die Behandlung der Detrusor-Sphinkter-Dyssynergie, der neurogenen Detrusorübererregbarkeit und der benignen Prostatahyperplasie vor. In den letzten Jahren konnte das Spektrum möglicher Indikationen schrittweise erweitert werden, vielversprechende Ergebnisse wurden bei Kindern mit neurogener Blasenstörung, bei überaktiver Blase nichtneurogener Genese, chronischer Harnretention und chronischem Beckenschmerz berichtet. Effektivität und Sicherheit bedürfen einer weiteren Überprüfung in kontrollierten Studien. Dosis, Dilution und Anzahl der Injektionsorte basieren weitgehend auf Erfahrungen, weitere Grundlagenstudien sind daher notwendig.

Abstract

Botulinum toxin is a presynaptic neuromuscular blocking agent inducing selective and reversible muscle weakness for up to several months when injected intramuscularly. In urology, indications for botulinum A toxin injections have been reported in detrusor-sphincter dyssynergia, neurogenic detrusor over activity and benign prostatic hyperplasia. Randomized controlled studies are available for these indications. During the last few years, the indications have been expanded to include chronic retention, chronic pelvic pain, and motor and sensory urinary urge incontinence. However, further research is needed on the efficacy and safety as well as the dilution, dose and number of injection sites.

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Authors and Affiliations

  1. Neuro-Urologie, Schweizer Paraplegikerzentrum, Universitätsklinik Balgrist, Zürich

    B. Schurch & A. Reitz

  2. Neuro-Urologie, Schweizer Paraplegikerzentrum, Universitätsklinik Balgrist, Forchstrasse 340, 8008, Zürich, Schweiz

    B. Schurch

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  2. A. Reitz
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Correspondence to B. Schurch.

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Schurch, B., Reitz, A. Botulinumtoxin in der Urologie. Urologe [A] 43, 1410–1415 (2004). https://doi.org/10.1007/s00120-004-0652-0

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