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Management von Harnleiterstrikturen und Harnstauung

Management of ureteral strictures and hydronephrosis

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Zusammenfassung

Neben kolikartigen Beschwerden eines akuten Harnstaus kann ein chronischer Verlauf unbemerkt bleiben. Harnleiterobstruktionen können verschiedene intrinsische und extrinsische Ursachen haben. Hierzu gehören u. a. Folgen nach Trauma und Bestrahlung, iatrogene Verletzungen, Urolithiasis, Malignome und angeborene Ursachen. Die Therapieplanung sollte neben der zugrunde liegenden Ursache den Allgemeinzustand sowie die Lebenserwartung des Patienten berücksichtigen. Bei tumorbedingten Ureterobstruktionen bieten segmentale Metallstents bei Vorteilen in der Lebensqualität eine Alternative zur Dauerversorgung mittels DJ-Stent. Die endoskopische Ballondilatation und die Endoureterotomie sind Optionen bei benignen Ureterstrikturen bis 2 cm Länge. Für längerstreckige Strikturen stehen verschiedene rekonstruktive Maßnahmen zur Verfügung, die an spezialisierten Zentren auch laparoskopisch bzw. roboterassistiert durchgeführt werden können.

Abstract

Patients who develop hydronephrosis due to an acute cause often have colic-like pain but hydronephrosis secondary to a chronic cause is often asymptomatic. Ureteral obstruction can be due to a variety of intrinsic and extrinsic causes, such as trauma, radiation, iatrogenic injury, urolithiasis, malignancies and congenital causes. Management planning is dictated by the underlying cause, patient comorbidity and life expectancy. Malignant ureteral obstructions can be managed with segmental metal stents with advantages in the quality of life and provide an alternative to long-term treatment with a DJ stent. Endoscopic balloon dilatation and endoureterotomy are options for benign ureteral strictures up to 2 cm in length. For longer benign strictures there are a number of reconstructive techniques, which can also be performed by laparoscopic or robot-assisted approaches at specialized centers.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. R. Ganzer, T. Franz, B.P. Rai, S. Siemer und J.-U. Stolzenburg geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland

    R. Ganzer FEBU, T. Franz, B.P. Rai & J.-U. Stolzenburg

  2. Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland

    S. Siemer

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  1. R. Ganzer FEBU
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  2. T. Franz
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  3. B.P. Rai
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  4. S. Siemer
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  5. J.-U. Stolzenburg
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Correspondence to R. Ganzer FEBU.

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Ganzer, R., Franz, T., Rai, B. et al. Management von Harnleiterstrikturen und Harnstauung. Urologe 54, 1147–1156 (2015). https://doi.org/10.1007/s00120-015-3870-8

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  • DOI: https://doi.org/10.1007/s00120-015-3870-8

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