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S2e-Leitlinie der Deutschen Urologen

Konservative und medikamentöse Therapie des benignen Prostatasyndroms

S2e guideline of the German urologists

Conservative and pharmacologic treatment of benign prostatic hyperplasia

  • Leitlinien der DGU und des BDU
  • Published:
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Zusammenfassung

Diese Übersicht fasst die relevanten Aspekte der S2e-Leitlinie der Deutschen Urologen zur konservativen und medikamentösen Therapie des benignen Prostatasyndroms (BPS) zusammen. Empfehlungen zu kontrolliertem Zuwarten, Verhaltenstherapie, Phytotherapie und medikamentöser Mono- und Kombinationstherapie werden gegeben. Die Arbeit stellt zudem detailliert den Einfluss der unterschiedlichen Therapieoptionen auf die Blasenauslassobstruktion (BOO) dar.

Abstract

This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the conservative and pharmacological treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding watchful waiting, behavioral therapy, phytotherapy and pharmacological mono- and combination therapy. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.

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Literatur

  1. Abrams P, Andersson KE (2007) Muscarinic receptor antagonists for overactive bladder. BJU Int 100:987–1006

    Article  CAS  PubMed  Google Scholar 

  2. Abrams P, Kaplan S, De Koning Gans HJ et al (2006) Safety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstruction. J Urol 175:999–1004

    Article  CAS  PubMed  Google Scholar 

  3. Abrams P, Schafer W, Tammela TL et al (1999) Improvement of pressure flow parameters with finasteride is greater in men with large prostates. Finasteride Urodynamics Study Group. J Urol 161:1513–1517

    Article  CAS  PubMed  Google Scholar 

  4. Abrams P, Speakman M, Stott M et al (1997) A dose-ranging study of the efficacy and safety of tamsulosin, the first prostate-selective alpha 1A-adrenoceptor antagonist, in patients with benign prostatic obstruction (symptomatic benign prostatic hyperplasia). Br J Urol 80:587–596

    Article  CAS  PubMed  Google Scholar 

  5. Abrams PH (1977) A double-blind trial of the effects of candicidin on patients with benign prostatic hypertrophy. Br J Urol 49:67–71

    Article  CAS  PubMed  Google Scholar 

  6. Agrawal MS, Yadav A, Yadav H et al (2009) A prospective randomized study comparing alfuzosin and tamsulosin in the management of patients suffering from acute urinary retention caused by benign prostatic hyperplasia. Indian J Urol 25:474–478

    Article  PubMed  PubMed Central  Google Scholar 

  7. Al-Shukri SH, Deschaseaux P, Kuzmin IV et al (2000) Early urodynamic effects of the lipido-sterolic extract of Serenoa repens (Permixon(R)) in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. Prostate Cancer Prostatic Dis 3:195–199

    Article  PubMed  Google Scholar 

  8. Anderson RU, Mobley D, Blank B et al (1999) Once daily controlled versus immediate release oxybutynin chloride for urge urinary incontinence. OROS Oxybutynin Study Group. J Urol 161:1809–1812

    Article  CAS  PubMed  Google Scholar 

  9. Andersson KE (2011) Antimuscarinic mechanisms and the overactive detrusor: an update. Eur Urol 59:377–386

    Article  CAS  PubMed  Google Scholar 

  10. Andriole GL, Bostwick DG, Brawley OW et al (2010) Effect of dutasteride on the risk of prostate cancer. N Engl J Med 362:1192–1202

    Article  CAS  PubMed  Google Scholar 

  11. Athanasopoulos A, Gyftopoulos K, Giannitsas K et al (2003) Combination treatment with an alpha-blocker plus an anticholinergic for bladder outlet obstruction: a prospective, randomized, controlled study. J Urol 169:2253–2256

    Article  CAS  PubMed  Google Scholar 

  12. Avins AL, Bent S, Staccone S et al (2008) A detailed safety assessment of a saw palmetto extract. Complement Ther Med 16:147–154

    Article  PubMed  PubMed Central  Google Scholar 

  13. AWMF (2014) AWMF-Register-Nummer 043-035, Aktualisierung 2014. Therapie benignes Prostatatasyndrom. AWMF, Düsseldorf. http://www.awmf.org/uploads/tx_szleitlinien/043-035m_S2e_Therapie_benignes_Prostatatasyndrom_2014_11.pdf

  14. AWMF (2014) AWMF, Düsseldorf. http://www.awmf.org/fileadmin/user_upload/Leitlinien/043_D_Ges_fuer_Urologie/043-035e1_S2e_Therapie_benignes_Prostatatasyndrom_2014_11.pdf

  15. Ball AJ, Feneley RC, Abrams PH (1981) The natural history of untreated „prostatism“. Br J Urol 53:613–616

    Article  CAS  PubMed  Google Scholar 

  16. Barendrecht MM, Abrams P, Schumacher H et al (2008) Do alpha1-adrenoceptor antagonists improve lower urinary tract symptoms by reducing bladder outlet resistance? Neurourol Urodyn 27:226–230

    Article  CAS  PubMed  Google Scholar 

  17. Bechara A, Romano S, Casabe A et al (2008) Comparative efficacy assessment of tamsulosin vs. tamsulosin plus tadalafil in the treatment of LUTS/BPH. Pilot study. J Sex Med 5:2170–2178

    Article  CAS  PubMed  Google Scholar 

  18. Bent S, Kane C, Shinohara K et al (2006) Saw palmetto for benign prostatic hyperplasia. N Engl J Med 354:557–566

    Article  CAS  PubMed  Google Scholar 

  19. Berges R, Dreikorn K, Hofner K et al (2009) Therapy of benign prostate syndrome (BPS): guidelines of the German Urologists (DGU). Urologe A 48:1503–1516

    Article  CAS  PubMed  Google Scholar 

  20. Berges R, Dreikorn K, Höfner K et al (2009) Diagnostik und Differenzialdiagnostik des benignen Prostatasyndroms (BPS): Leitlinien der Deutschen Urologen. Urologe A 48:1356–1360 (1362–1354)

    Article  CAS  PubMed  Google Scholar 

  21. Berges RR, Pientka L, Hofner K et al (2001) Male lower urinary tract symptoms and related health care seeking in Germany. Eur Urol 39:682–687

    Article  CAS  PubMed  Google Scholar 

  22. Bosch JL (1997) Urodynamic effects of various treatment modalities for benign prostatic hyperplasia. J Urol 158:2034–2044

    Article  CAS  PubMed  Google Scholar 

  23. Braverman AS, Doumanian LR, Ruggieri MR (2006) M2 and M3 muscarinic receptor activation of urinary bladder contractile signal transduction. II. Denervated rat bladder. J Pharmacol Exp Ther 316:875–880

    Article  CAS  PubMed  Google Scholar 

  24. Chang DF Campbell JR (2005) Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg 31:664–673

    Article  PubMed  Google Scholar 

  25. Chapple CR, Carter P, Christmas TJ et al (1994) A three month double-blind study of doxazosin as treatment for benign prostatic bladder outlet obstruction. Br J Urol 74:50–56

    Article  CAS  PubMed  Google Scholar 

  26. Chapple CR, Christmas TJ, Milroy EJ (1990) A twelve-week placebo-controlled study of prazosin in the treatment of prostatic obstruction. Urol Int 45(Suppl 1):47–55

    Article  PubMed  Google Scholar 

  27. Chapple CR, Montorsi F, Tammela TL et al (2011) Silodosin therapy for lower urinary tract symptoms in men with suspected benign prostatic hyperplasia: results of an international, randomized, double-blind, placebo- and active-controlled clinical trial performed in Europe. Eur Urol 59:342–352

    Article  CAS  PubMed  Google Scholar 

  28. Chapple CR, Roehrborn CG (2006) A shifted paradigm for the further understanding, evaluation, and treatment of lower urinary tract symptoms in men: focus on the bladder. Eur Urol 49:651–658

    Article  PubMed  Google Scholar 

  29. Chapple CR, Stott M, Abrams PH et al (1992) A 12-week placebo-controlled double-blind study of prazosin in the treatment of prostatic obstruction due to benign prostatic hyperplasia. Br J Urol 70:285–294

    Article  CAS  PubMed  Google Scholar 

  30. Chrubasik JE, Roufogalis BD, Wagner H et al (2007) A comprehensive review on the stinging nettle effect and efficacy profiles. Part II: urticae radix. Phytomedicine 14:568–579

    Article  CAS  PubMed  Google Scholar 

  31. Crawford ED, Wilson SS, McConnell JD et al (2006) Baseline factors as predictors of clinical progression of benign prostatic hyperplasia in men treated with placebo. J Urol 175:1422–1427

    Article  CAS  PubMed  Google Scholar 

  32. Debruyne FM, Jardin A, Colloi D et al (1998) Sustained-release alfuzosin, finasteride and the combination of both in the treatment of benign prostatic hyperplasia. European ALFIN Study Group. Eur Urol 34:169–175

    Article  CAS  PubMed  Google Scholar 

  33. Djavan B, Chapple C, Milani S et al (2004) State of the art on the efficacy and tolerability of alpha1-adrenoceptor antagonists in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Urology 64:1081–1088

    Article  PubMed  Google Scholar 

  34. Dmochowski R, Roehrborn C, Klise S et al (2010) Urodynamic effects of once daily tadalafil in men with lower urinary tract symptoms secondary to clinical benign prostatic hyperplasia: a randomized, placebo controlled 12-week clinical trial. J Urol 183:1092–1097

    Article  CAS  PubMed  Google Scholar 

  35. Drake MJ, Harvey IJ, Gillespie JI et al (2005) Localized contractions in the normal human bladder and in urinary urgency. BJU Int 95:1002–1005

    Article  PubMed  Google Scholar 

  36. Dreikorn K (2005) Complementary and alternative medicine in urology. BJU Int 96:1177–1184

    Article  CAS  PubMed  Google Scholar 

  37. Eri LM, Tveter KJ (1993) A prospective, placebo-controlled study of the antiandrogen Casodex as treatment for patients with benign prostatic hyperplasia. J Urol 150:90–94

    CAS  PubMed  Google Scholar 

  38. Eri LM, Tveter KJ (1993) A prospective, placebo-controlled study of the luteinizing hormone-releasing hormone agonist leuprolide as treatment for patients with benign prostatic hyperplasia. J Urol 150:359–364

    CAS  PubMed  Google Scholar 

  39. Franco G, De Nunzio C, Minardi V et al (2004) Patients with bladder outlet obstruction who refuse treatment show no clinical and urodynamic change after long-term follow-up. Arch Ital Urol Androl 76:6–10

    PubMed  Google Scholar 

  40. Gacci M, Corona G, Salvi M et al (2012) A systematic review and meta-analysis on the use of phosphodiesterase 5 inhibitors alone or in combination with alpha-blockers for lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol 61:994–1003

    Article  CAS  PubMed  Google Scholar 

  41. Gacci M, Vittori G, Tosi N et al (2012) A randomized, placebo-controlled study to assess safety and efficacy of vardenafil 10 mg and tamsulosin 0.4 mg vs. tamsulosin 0.4 mg alone in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Sex Med 9:1624–1633

    Article  CAS  PubMed  Google Scholar 

  42. Gerber GS, Contreras BA, Zagaja GP et al (1997) Doxazosin in men with lower urinary tract symptoms: urodynamic evaluation at 15 months. Urology 50:229–233

    Article  CAS  PubMed  Google Scholar 

  43. Gerber GS, Kim JH, Contreras BA et al (1996) An observational urodynamic evaluation of men with lower urinary tract symptoms treated with doxazosin. Urology 47:840–844

    Article  CAS  PubMed  Google Scholar 

  44. Gerber GS, Zagaja GP, Bales GT et al (1998) Saw palmetto (Serenoa repens) in men with lower urinary tract symptoms: effects on urodynamic parameters and voiding symptoms. Urology 51:1003–1007

    Article  CAS  PubMed  Google Scholar 

  45. Habib FK, Wyllie MG (2004) Not all brands are created equal: a comparison of selected components of different brands of Serenoa repens extract. Prostate Cancer Prostatic Dis 7:195–200

    Article  CAS  PubMed  Google Scholar 

  46. Harbour R, Miller J (2001) A new system for grading recommendations in evidence based guidelines. BMJ 323:334–336

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Hashim H, Elhilali M, Bjerklund Johansen TE et al (2007) The immediate and 6-mo reproducibility of pressure-flow studies in men with benign prostatic enlargement. Eur Urol 52:1186–1193

    Article  PubMed  Google Scholar 

  48. Hedlund H, Andersson KE (1988) Effects of prazosin and carbachol in patients with benign prostatic obstruction. Scand J Urol Nephrol 22:19–22

    Article  CAS  PubMed  Google Scholar 

  49. Hedlund H, Andersson KE, Ek A (1983) Effects of prazosin in patients with benign prostatic obstruction. J Urol 130:275–278

    CAS  PubMed  Google Scholar 

  50. Herschorn S, Jones JS, Oelke M et al (2010) Efficacy and tolerability of fesoterodine in men with overactive bladder: a pooled analysis of 2 phase III studies. Urology 75:1149–1155

    Article  PubMed  Google Scholar 

  51. Höfner K, Bach T, Berges R et al (2014) S2e Leitlinie, Therapie des Benignen Prostatasyndroms (BPS), Aktualisierung 2014. Arbeitskreis Benignes Prostatasyndrom (AK BPS) (Hrsg), Books on Demand, ISBN:978-3-95780-025-1

  52. Jacobsen SJ, Jacobson DJ, Girman CJ et al (1997) Natural history of prostatism: risk factors for acute urinary retention. J Urol 158:481–487

    Article  CAS  PubMed  Google Scholar 

  53. Jardin A, Bensadoun H, Delauche-Cavallier MC et al (1991) Alfuzosin for treatment of benign prostatic hypertrophy. The BPH-ALF Group. Lancet 337:1457–1461

    Article  CAS  PubMed  Google Scholar 

  54. Kadow C, Abrams PH (1986) A double-blind trial of the effect of beta-sitosteryl glucoside (WA184) in the treatment of benign prostatic hyperplasia. Eur Urol 12:187–189

    CAS  PubMed  Google Scholar 

  55. Kaplan SA, Gonzalez RR, Te AE (2007) Combination of alfuzosin and sildenafil is superior to monotherapy in treating lower urinary tract symptoms and erectile dysfunction. Eur Urol 51:1717–1723

    Article  CAS  PubMed  Google Scholar 

  56. Kaplan SA, He W, Koltun WD et al (2012) Solifenacin plus tamsulosin combination treatment in men with lower urinary tract symptoms and bladder outlet obstruction: a randomized controlled trial. Eur Urol 63:158–165

    Article  PubMed  CAS  Google Scholar 

  57. Kaplan SA, Roehrborn CG, Abrams P et al (2011) Antimuscarinics for treatment of storage lower urinary tract symptoms in men: a systematic review. Int J Clin Pract 65:487–507

    Article  CAS  PubMed  Google Scholar 

  58. Kaplan SA, Roehrborn CG, Rovner ES et al (2006) Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial. JAMA 296:2319–2328

    Article  CAS  PubMed  Google Scholar 

  59. Kaplan SA, Walmsley K, Te AE (2005) Tolterodine extended release attenuates lower urinary tract symptoms in men with benign prostatic hyperplasia. J Urol 174:2273–2276

    Article  PubMed  Google Scholar 

  60. Katz IR, Sands LP, Bilker W et al (1998) Identification of medications that cause cognitive impairment in older people: the case of oxybutynin chloride. J Am Geriatr Soc 46:8–13

    Article  CAS  PubMed  Google Scholar 

  61. Keast JR, Kawatani M, De Groat WC (1990) Sympathetic modulation of cholinergic transmission in cat vesical ganglia is mediated by alpha 1- and alpha 2-adrenoceptors. Am J Physiol 258:44–50

    Google Scholar 

  62. Kedia GT, Uckert S, Jonas U et al (2008) The nitric oxide pathway in the human prostate: clinical implications in men with lower urinary tract symptoms. World J Urol 26:603–609

    Article  CAS  PubMed  Google Scholar 

  63. Kirby RS, Roehrborn C, Boyle P et al (2003) Efficacy and tolerability of doxazosin and finasteride, alone or in combination, in treatment of symptomatic benign prostatic hyperplasia: the Prospective European Doxazosin and Combination Therapy (PREDICT) trial. Urology 61:119–126

    Article  PubMed  Google Scholar 

  64. Kortmann BBM, Floratos DL, Kiemeny LALM et al (2003) Urodyanmic effects of alpha-blockers: a review of clinical trials. Urology 62:1–9

    Article  PubMed  Google Scholar 

  65. Lee KSM, Choo MS, Kim DY et al (2005) Combination treatment with propiverine hydrochloride plus doxazosin controlled release gastrointestinal therapeutic system formulation for overactive bladder and coexisting benign prostatic obstruction: a prospective, randomized, controlled multicenter study. J Urol 174:1334–1338

    Article  CAS  PubMed  Google Scholar 

  66. Lepor H, Williford WO, Barry MJ et al (1996) The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group. N Engl J Med 335:533–539

    Article  CAS  PubMed  Google Scholar 

  67. Liguori G, Trombetta C, De Giorgi G et al (2009) Efficacy and safety of combined oral therapy with tadalafil and alfuzosin: an integrated approach to the management of patients with lower urinary tract symptoms and erectile dysfunction. Preliminary report. J Sex Med 6:544–552

    Article  CAS  PubMed  Google Scholar 

  68. MacDiarmid SA, Peters KM, Chen A et al (2008) Efficacy and safety of extended-release oxybutynin in combination with tamsulosin for treatment of lower urinary tract symptoms in men: randomized, double-blind, placebo-controlled study. Mayo Clin Proc 83:1002–1010

    Article  CAS  PubMed  Google Scholar 

  69. MacDonald R, Tacklind JW, Rutks I et al (2012) Serenoa repens monotherapy for benign prostatic hyperplasia (BPH): an updated Cochrane systematic review. BJU Int 109:1756–1761

    Article  PubMed  PubMed Central  Google Scholar 

  70. Madersbacher S, Marszalek M, Lackner J et al (2007) The long-term outcome of medical therapy for BPH. Eur Urol 51:1522–1533

    Article  CAS  PubMed  Google Scholar 

  71. Malloy BJ, Price DT, Price RR et al (1998) Alpha1-adrenergic receptor subtypes in human detrusor. J Urol 160:937–943

    Article  CAS  PubMed  Google Scholar 

  72. Marks LS, Gittelman MC, Hill LA et al (2009) Silodosin in the treatment of the signs and symptoms of benign prostatic hyperplasia: a 9-month, open-label extension study. Urology 74:1318–1322

    Article  PubMed  Google Scholar 

  73. Martorana G, Giberti C, Di Silverio F et al (1997) Effects of short-term treatment with the alpha 1-blocker alfuzosin on urodynamic pressure/flow parameters in patients with benign prostatic hyperplasia. Eur Urol 32:47–53

    CAS  PubMed  Google Scholar 

  74. McConnell JD, Bruskewitz R, Walsh P et al (1998) The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N Engl J Med 338:557–563

    Article  CAS  PubMed  Google Scholar 

  75. McConnell JD, Roehrborn CG, Bautista OM et al (2003) The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 349:2387–2398

    Article  CAS  PubMed  Google Scholar 

  76. McNeill SA, Daruwala PD (1999) Sustained-release alfuzosin and trial without catheter after acute urinary retention: a prospective, placebo-controlled. BJU Int 84:622–627

    Article  CAS  PubMed  Google Scholar 

  77. McNicholas T, Kirby R (2011) Benign prostatic hyperplasia and male lower urinary tract symptoms (LUTS). BMJ Clin Evid (Online) pii: 1801

    Google Scholar 

  78. McVary KT, Monnig W, Camps JL Jr et al (2007) Sildenafil citrate improves erectile function and urinary symptoms in men with erectile dysfunction and lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized, double-blind trial. J Urol 177:1071–1077

    Article  CAS  PubMed  Google Scholar 

  79. McVary KT, Roehrborn CG, Avins AL et al (2011) Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 185:1793–1803

    Article  PubMed  Google Scholar 

  80. Meigs JB, Barry MJ, Giovannucci E et al (1999) Incidence rates and risk factors for acute urinary retention: the health professionals followup study. J Urol 162:376–382

    Article  CAS  PubMed  Google Scholar 

  81. Mey C de (1998) Cardiovascular effects of alpha-blockers for the treatment of symptomatic BPH. Eur Urol 34:18–28

    Article  Google Scholar 

  82. Michel MC, Bressel HU (1998) Tamsulosin: real life clinical experience in 19,365 patients. Eur Urol 34:37–45

    Article  CAS  PubMed  Google Scholar 

  83. Michel MC, Berges R, Dreikorn K et al (2007) Konservative Behandlung des benignen Prostatasyndroms. Dtsch Ärztebl 104:2354–2358

    Google Scholar 

  84. Michel MC, Mehlburger L, Bressel HU et al (1998) Comparison of tamsulosin efficacy in subgroups of patients with lower urinary tract symptoms. Prostate Cancer Prostatic Dis 1:332–335

    Article  CAS  PubMed  Google Scholar 

  85. Michel MC, Pfeiffer N, Höfner K (2006) Was bedeutet das „intraoperative floppy iris“ Syndrom für den Urologen? Urologe A 45:1547–1548

    Article  CAS  PubMed  Google Scholar 

  86. Naslund MJ, Miner M (2007) A review of the clinical efficacy and safety of 5alpha-reductase inhibitors for the enlarged prostate. Clin Ther 29:17–25

    Article  CAS  PubMed  Google Scholar 

  87. Nawrocki JD, Bell TJ, Lawrence WT et al (1997) A randomized controlled trial of transurethral microwave thermotherapy. Br J Urol 79:389–393

    Article  CAS  PubMed  Google Scholar 

  88. NICE (2010) The management of lower urinary tract symptoms in men & Appendices A – H. National Institute for Health and Clinical Excellence, London. http://www.nice.org.uk

  89. Nickel JC, Gilling P, Tammela TL et al (2011) Comparison of dutasteride and finasteride for treating benign prostatic hyperplasia: the Enlarged Prostate International Comparator Study (EPICS). BJU Int 108:388–394

    Article  CAS  PubMed  Google Scholar 

  90. Nickel JC, Shoskes D, Roehrborn C et al (2008) Nutraceuticals in prostate disease: the urologist’s role. Rev Urol 10:192–206

    Google Scholar 

  91. Nielsen KK, Kromann-Andersen B, Poulsen AL et al (1994) Subjective and objective evaluation of patients with prostatism and infravesical obstruction treated with both intraprostatic spiral and transurethral prostatectomy. Neurourol Urodyn 13:13–19

    Article  CAS  PubMed  Google Scholar 

  92. Nishino Y, Masue T, Miwa K et al (2006) Comparison of two alpha1-adrenoceptor antagonists, naftopidil and tamsulosin hydrochloride, in the treatment of lower urinary tract symptoms with benign prostatic hyperplasia: a randomized crossover study. BJU Int 97:747–751

    Article  CAS  PubMed  Google Scholar 

  93. Nunzio C de, Franco G, Rocchegiani A et al (2003) The evolution of detrusor overactivity after watchful waiting, medical therapy and surgery in patients with bladder outlet obstruction. J Urol 169:535–539

    Article  PubMed  Google Scholar 

  94. Oelke M, Bachmann A, Descazeaud A et al (2013) EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 64:118–140

    Article  PubMed  Google Scholar 

  95. Oelke M, Bachmann A, Descazeaud A et al (2012) Guidelines on management of male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO). In: Office Members of the European Association of Urology (EAU) Guidelines (Hrsg) EAU Guidelines, edition presented at the 27th EAU Annual Congress, Paris

  96. Oelke M, Giuliano F, Mirone V et al (2012) Monotherapy with tadalafil or tamsulosin similarly improved lower urinary tract symptoms suggestive of benign prostatic hyperplasia in an international, randomised, parallel, placebo-controlled clinical trial. Eur Urol 61:917–925

    Article  CAS  PubMed  Google Scholar 

  97. Özbey I, Aksoy Y, Polat O et al (1999) Effects of doxazosin in men with benign prostatic hyperplasia: urodynamic assessment. Int Urol Nephrol 31:471–479

    Article  PubMed  Google Scholar 

  98. Risi O, Blefari F, Ghilardi M et al (1995) Urodynamic and echographic effects of finasteride and terazosin in the treatment of benign prostatic hyperplasia. Urodinamica 5:184

    Google Scholar 

  99. Roehrborn CG (2005) Acute urinary retention: risks and management. Rev Urol 7(Suppl 4):31–41

    Google Scholar 

  100. Roehrborn CG, Barkin J, Siami P et al (2011) Clinical outcomes after combined therapy with dutasteride plus tamsulosin or either monotherapy in men with benign prostatic hyperplasia (BPH) by baseline characteristics: 4-year results from the randomized, double-blind Combination of Avodart and Tamsulosin (CombAT) trial. BJU Int 107:946–954

    Article  CAS  PubMed  Google Scholar 

  101. Roehrborn CG, Kaplan SA, Kraus SR et al (2008) Effects of serum PSA on efficacy of tolterodine extended release with or without tamsulosin in men with LUTS, including OAB. Urology 72:1061–1067

    Article  PubMed  Google Scholar 

  102. Roehrborn CG, McVary KT, Elion-Mboussa A et al (2008) Tadalafil administered once daily for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a dose finding study. J Urol 180:1228–1234

    Article  CAS  PubMed  Google Scholar 

  103. Roehrborn CG, Siami P, Barkin J et al (2010) The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol 57:123–131

    Article  PubMed  Google Scholar 

  104. Scaglione F, Lucini V, Pannacci M et al (2008) Comparison of the potency of different brands of Serenoa repens extract on 5alpha-reductase types I and II in prostatic co-cultured epithelial and fibroblast cells. Pharmacology 82:270–275

    Article  CAS  PubMed  Google Scholar 

  105. Schäfer W, Tammela TL, Barrett DM et al (1999) Continued improvement in pressure-flow parameters in men receiving finasteride for 2 years Finasteride Urodynamics Study Group. Urology 54:278–283

    Article  PubMed  Google Scholar 

  106. Sivkov AV, Egorov AA, Romikh VV et al (2002) Urodynamic criteria of predicting efficacy of therapy with alpha1-adrenergic blockaders in patients with benign prostatic hyperplasia. Urologiia 13–22

  107. Slawin KM, Kattan MW, Roehrborn CG et al (2006) Development of nomogram to predict acute urinary retention or surgical intervention, with or without dutasteride therapy, in men with benign prostatic hyperplasia. Urology 67:84–88

    Article  PubMed  Google Scholar 

  108. Sonke GS, Kortmann BB, Verbeek AL et al (2000) Variability of pressure-flow studies in men with lower urinary tract symptoms. Neurourol Urodyn 19:637–651

    Article  CAS  PubMed  Google Scholar 

  109. Stief CG, Porst H, Neuser D et al (2008) A randomised, placebo-controlled study to assess the efficacy of twice-daily vardenafil in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Eur Urol 53:1236–1244

    Article  CAS  PubMed  Google Scholar 

  110. Stott MA, Abrams P (1991) Indoramin in the treatment of prostatic bladder outflow obstruction. Br J Urol 67:499–501

    Article  CAS  PubMed  Google Scholar 

  111. Tacklind J, Fink HA, Macdonald R et al (2010) Finasteride for benign prostatic hyperplasia. Cochrane Database Syst Rev 10:CD006015

    PubMed  Google Scholar 

  112. Tammela TL, Kontturi MJ (1993) Urodynamic effects of finasteride in the treatment of bladder outlet obstruction due to benign prostatic hyperplasia. J Urol 149:342–344

    CAS  PubMed  Google Scholar 

  113. Thomas AW, Cannon A, Bartlett E et al (2005) The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic follow-up of untreated bladder outlet obstruction. BJU Int 96:1301–1306

    Article  PubMed  Google Scholar 

  114. Thomas AW, Cannon A, Bartlett E et al (2005) The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic follow-up of untreated detrusor underactivity. BJU Int 96:1295–1300

    Article  PubMed  Google Scholar 

  115. Thompson IM, Goodman PJ, Tangen CM et al (2003) The influence of finasteride on the development of prostate cancer. N Engl J Med 349:215–224

    Article  CAS  PubMed  Google Scholar 

  116. Tiong HY, Tibung MJ, Macalalag M et al (2009) Alfuzosin 10 mg once daily increases the chances of successful trial without catheter after acute urinary retention secondary to benign prostate hyperplasia. Urol Int 83:44–48

    Article  CAS  PubMed  Google Scholar 

  117. Tuncel A, Nalcacioglu V, Ener K et al (2010) Sildenafil citrate and tamsulosin combination is not superior to monotherapy in treating lower urinary tract symptoms and erectile dysfunction. World J Urol 28:17–22

    Article  CAS  PubMed  Google Scholar 

  118. Wildt MJ de, Witjes WP, Rosier PF et al (1995) A urodynamic view on watchful waiting in patients with benign prostatic hyperplasia. Neurourol Urodyn 14:566

    Google Scholar 

  119. Witjes WP, Wildt MJ de, Rosier PF et al (1996) Variability of clinical and pressure-flow study variables after 6 months of watchful waiting in patients with lower urinary tract symptoms and benign prostatic enlargement. J Urol 156:1026–1034

    Article  CAS  PubMed  Google Scholar 

  120. Witjes WP, Rosier FW, Wildt MJ de et al (1996) Urodynamic and clinical effects of terazosin therapy in patients with symptomatic benign prostatic hyperplasia. J Urol 155:1317–1323

    Article  CAS  PubMed  Google Scholar 

  121. Witjes WPJ, Robertson A, Rosier PF et al (1997) Urodynamic and clinical effects of noninvasive and minimally invasive treatments in elderly men with lower urinary tract symptoms stratified according to the grade of obstruction. Urology 50:55–61

    Article  CAS  PubMed  Google Scholar 

  122. Yamanishi T, Mizuno T, Tatsumiya K et al (2010) Urodynamic effects of silodosin, a new alpha 1A-adrenoceptor selective antagonist, for the treatment of benign prostatic hyperplasia. Neurourol Urodyn 29:558–562

    CAS  PubMed  Google Scholar 

  123. Yamanishi T, Yasuda K, Kamai T et al (2004) Single-blind, randomized controlled study of the clinical and urodynamic effects of an alpha-blocker (naftopidil) and phytotherapy (eviprostat) in the treatment of benign prostatic hyperplasia. Int J Urol 11:501–509

    Article  CAS  PubMed  Google Scholar 

  124. Zong HT, Peng XX, Yang CC et al (2011) A systematic review of the effects and mechanisms of preoperative 5alpha-reductase inhibitors on intraoperative haemorrhage during surgery for benign prostatic hyperplasia. Asian J Androl 13:812–818

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. K. Höfner: Referent und Berater für: Aristo, Astellas, GlaxoSmithKline, Lilly. T. Bach: Referent, Berater und/oder Studienteilnehmer für: Cook, Boston Scientific, GlaxoSmithKline, Richard Wolf, Rowa Pharma. R. Berges: Referent, Berater und/oder Studienteilnehmer für: Astellas, Ferring, GlaxoSmithKline, Neotract, Recordati. K. Dreikorn: Referent für: TAD-Pharma GmbH. C. Gratzke: Referent, Berater und/oder Studienteilnehmer für: American Medical Systems, Astellas, Bayer Healthcare, GlaxoSmithKline, Lilly, Madaus, Merck Sharp & Dome, Pfizer, Recordati, Rottapharm. S. Madersbacher: Referent, Berater und/oder Studienteilnehmer für: Allergan, Astellas, Austroplant, Bayer Healthcare, Boehringer, GlaxoSmithKline, Lilly, Madaus, Merck Sharp & Dome, Takeda, Pfizer, Sandoz. M.-S. Michel: Beteiligung bei onkologischen Arzneimittelstudien und Vortragshonorare ohne Relevanz für BPS. R. Muschter: Referent für: Amgen, American Medical Systems, Ferring, GlaxoSmithKline, Ibsen, Lilly, StarmedTec, Takeda. M. Oelke: Referent, Berater und/oder Studienteilnehmer für: Apogepha Arzneimittel GmbH, Allergan, Astellas, Bayer Healthcare, Biocompatibles, Ferring, GlaxoSmithKline, Lilly, Mundipharma, Pfizer, Recordati, Dr. Schwabe GmbH, TAD-Pharma GmbH. O. Reich: Referent und Berater für: American Medical Systems. C. Tschuschke: Referent, Berater, Studienteilnehmer und/oder Beteiligungen: Astellas, Ferring, Fresenius, GlaxoSmithKline, Lilly, Novartis, Dr. Pfleger GmbH, TAD-Pharma GmbH, Roche, Takeda. T. Bschleipfer: Referent, Berater und/oder Studienteilnehmer für: Allergan, Astellas, Bayer Healthcare, Bionorica, GlaxoSmithKline, Pfizer, Serag Wiessner, Speciality European Pharma GmbH.

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Authors and Affiliations

  1. Klinik für Urologie, Evangelisches Krankenhaus Oberhausen, Virchowstraße 20, 46047, Oberhausen, Deutschland

    K. Höfner

  2. Abteilung für Urologie, Asklepios Klinikum Harburg, Hamburg, Deutschland

    T. Bach

  3. Gemeinschaftspraxis Urologische und Andrologische Diagnose und Therapie, PAN-Klinik, Köln, Deutschland

    R. Berges

  4. Ärztezentrum Horn, Bremen, Deutschland

    K. Dreikorn

  5. Urologische Klinik und Poliklinik, Klinikum der LMU München, München, Deutschland

    C. Gratzke

  6. Abteilung für Urologie, Kaiser-Franz-Josef-Spital, Wien, Österreich

    S. Madersbacher

  7. Klinik für Urologie, Universitätsmedizin Mannheim, Mannheim, Deutschland

    M.-S. Michel

  8. Klinik für Urologie und Kinderurologie, Agaplesion Diakonieklinikum Rotenburg gemeinnützige GmbH, Rotenburg (Wümme), Deutschland

    R. Muschter

  9. Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Hannover, Deutschland

    M. Oelke

  10. Klinik für Urologie, Klinikum Harlaching; Städtisches Klinikum München, München, Deutschland

    O. Reich

  11. Urologische Gemeinschaftspraxis, Münster, Deutschland

    C. Tschuschke

  12. Klinik für Urologie, Andrologie und Kinderurologie, Klinikum Weiden/Kliniken Nordoberpfalz AG, Weiden, Deutschland

    T. Bschleipfer

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  1. K. Höfner
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  2. T. Bach
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  3. R. Berges
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  9. M. Oelke
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Correspondence to K. Höfner.

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Höfner, K., Bach, T., Berges, R. et al. S2e-Leitlinie der Deutschen Urologen. Urologe 55, 184–194 (2016). https://doi.org/10.1007/s00120-015-3984-z

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