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Botulinumtoxin in der Urologie

Eine Bestandsaufnahme

Botulinum toxin in urology

An inventory

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Zusammenfassung

Botulinumtoxin (BTX) erweist sich als hochwirksam in der Behandlung neurogener und nicht-neurogener Blasenentleerungsstörungen. Erfahrungen im neurourologischen Bereich existieren seit nunmehr 15 Jahren—Anlass genug, die bisherigen Erkenntnisse zusammenzustellen und mögliche Indikationsempfehlungen im Rahmen eines Heilversuches daraus abzuleiten.

Die Pionierarbeit erfolgte durch Sphinkterinjektionen zur Behandlung der neurogenen Detrusor-Sphinkter-Dyssynergie. Mittlerweile wurde das Indikationsspektrum nicht nur auf die neurogene Detrusorhyperaktivität, sondern auch auf nicht-neurogene funktionelle Entleerungsstörungen und auf verschiedene Schmerzsyndrome im kleinen Becken ausgeweitet. Bei der Sphinkterinjektion scheinen sich die besten Erfolge in der Behandlung symptomatischen Restharns aufgrund eines insuffizienten Detrusormuskels einzustellen. Bei der Detrusorinjektion bietet sich zurzeit in erster Linie die medikamentös-therapierefraktäre neurogene Detrusorhyperaktivität an. Eine offizielle Zulassung existiert bisher für kein auf dem Markt befindliches Präparat und muss ein vordringliches Ziel der kommenden Jahre sein.

Abstract

Botulinum toxin (BTX) is highly potent in neurogenic and non-neurogenic voiding disorders. Experience with it in neurourology began 15 years ago in the treatment of neurogenic detrusor-sphincter dyssynergia. Indications were expanded not only to neurogenic detrusor hyperactivity but also to non-neurogenic detrusor hyperactivity, other forms of dysfunctional voiding, and some types of pelvic pain syndrome. Sphincter injections can be recommended for patients with symptomatic post-voiding residual urine due to insufficient detrusor contractility, and detrusor injections can be recommended for patients with neurogenic detrusor hyperactivity in which anticholinergic drugs are not sufficient. Because of the lack of evidence-based studies, botulinum toxin is not approved for urologic use, although there is a desperate need for it.

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  1. Urologische Abteilung, St. Hedwig Kliniken GmbH, Akademisches Lehrkrankenhaus der Universitätsmedizin Berlin, Campus Charité

    H. Schulte-Baukloh & H. H. Knispel

  2. Urologische Abteilung, St. Hedwig Kliniken, Große Hamburger Str. 5– 11, 10115, Berlin

    H. Schulte-Baukloh

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Schulte-Baukloh, H., Knispel, H.H. Botulinumtoxin in der Urologie. Urologe [A] 43, 963–975 (2004). https://doi.org/10.1007/s00120-004-0635-1

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