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Transurethrale Eingriffe des unteren Harntraktes

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Komplikationen in der Urologie

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Zusammenfassung

Dargestellt werden Häufigkeit, Ursache, Behandlung und Vorbeugung der typischen Komplikationen bei transurethralen Eingriffen an Harnröhre und Prostata. Vor dem Hintergrund des in einigen Ländern aktuell sehr zurückhaltenden Einsatzes suburethraler Bänder zur Therapie der weiblichen Belastungsinkontinenz, rücken alternative Verfahren wie „bulking agents“ vermehrt in den Fokus. Bulking agents unterscheiden sich aufgrund ihrer Wirkprofile in ihren Erfolgs- und Komplikationsraten deutlich voneinander, derzeit liegen allerdings nur wenige direkte Head-to-Head-Vergleiche vor. Bei der Urethrotomia interna liegt das Augenmerk auf der Beachtung der richtigen Indikation und der Kontraindikationen, sowie auf den intraoperativen Komplikationen, wie einer Via falsa urethrae durch Harnröhrenperforation mit konsekutiver Urinextravasation mit Penis- oder Skrotalödem, ausgedehnten intra- oder postoperativen Blutungen aus der Harnröhre mit Penis- oder Skrotalhämatom, und den postoperativen Komplikationen wie Harnröhrendivertikel, Harnröhrenfistel, Harnwegsinfektion (Urethritis, Prostatitis, Epididymitis und Kavernitis), Belastungsinkontinenz durch Sphinkterläsion, erektile Dysfunktion und Rezidivstriktur. Bei der transurethralen Prostataresektion werden neben korrekter Indikation und Beachtung der Kontraindikationen die intraoperativen Komplikationen Spülflüssigkeitseinschwemmung/TUR-Syndrom, Blutung und subtrigonale Blasenunterfahrung beleuchtet. Bei den postoperativen Komplikationen wird das Augenmerk insbesondere auf Harnwegsinfektion/Epididymitis, Nachblutung, Verletzung der Ureterostien, Belastungsinkontinenz, Harnröhrenstriktur, Blasenhalsstenose, retrograde Ejakulation und erektile Dysfunktion gerichtet. Die transurethrale Resektion von Blasentumoren (TURB) stellt den zentralen diagnostischen und beim nicht-muskelinvasiven Harnblasenkarzinom (NMIBC) auch therapeutischen Schritt in der Behandlung des Urothelkarzinoms der Harnblase dar. Ziel ist die Resektion aller visuell sichtbaren Befunde. Die allgemeine Komplikationsrate liegt bei ca. 5–6 %, wobei Blutungen, Blasenperforationen, Verletzungen der Harnleiterostien oder der Harnröhre am häufigsten auftreten. In der Regel können Komplikationen konservativ oder mittels erneuter zystoskopischer Intervention erfolgreich behandelt werden. Selten ist bei ausgeprägter intraperitonealer Perforation eine operative (offen oder laparoskopisch) Revision erforderlich.

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Authors and Affiliations

  1. Urologie und Kinderurologie, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Deutschland

    Herbert Leyh

  2. Klinik für Urologie, Caritas-Krankenhaus St. Josef, Regensburg, Deutschland

    Johannes Breyer

  3. Klinik für Urologie, Caritas-Krankenhaus St. Josef, Regensburg, Deutschland

    Maximilian Burger

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  1. Johannes Breyer
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  2. Maximilian Burger
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  3. Herbert Leyh
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Correspondence to Herbert Leyh .

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Editors and Affiliations

  1. Klinik für Urologie und Kinderurologie, St.-Antonius Hospital gGmbH, Eschweiler, Nordrhein-Westfalen, Deutschland

    Jennifer Kranz

  2. Klinik für Urologie, Asklepios Klinik Wandsbek, Hamburg, Deutschland

    Petra Anheuser

  3. Klinik für Urologie und Kinderurologie, St.-Antonius Hospital gGmbH, Eschweiler, Nordrhein-Westfalen, Deutschland

    Joachim A. Steffens

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Breyer, J., Burger, M., Leyh, H. (2021). Transurethrale Eingriffe des unteren Harntraktes. In: Kranz, J., Anheuser, P., Steffens, J.A. (eds) Komplikationen in der Urologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-60625-4_13

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  • DOI: https://doi.org/10.1007/978-3-662-60625-4_13

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