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Der Urologe

, Volume 58, Issue 3, pp 238–247 | Cite as

Diagnostik und diagnostische Strategie beim benignen Prostatasyndrom

Ein Überblick
  • T. BschleipferEmail author
  • M. Oelke
  • M. Rieken
Leitthema
  • 72 Downloads

Zusammenfassung

Hintergrund

Das benigne Prostatasyndrom (BPS) ist die häufigste Erkrankung des unteren Harntrakts des Mannes. Eine evidenzbasierte Diagnostik ist die Grundlage einer bestmöglichen und effektiven Therapie.

Ziel der Arbeit (Fragestellung)

Es wird eine Übersicht der aktuellen Daten zum Stellenwert einzelner Verfahren in der Diagnostik des BPS gezeigt.

Material und Methoden

Ein deskriptiver Review der englischsprachigen Literatur zum Thema der Diagnostik des BPS.

Ergebnisse

Eine Anamnese, welche die Beschwerden sowie den Leidensdruck des Patienten erfasst, stellt die Basis der Diagnostik dar und wird durch standardisierte und validierte Symptomfragebögen wie den IPSS-Fragebogen (International Prostate Symptom Score) ergänzt. Eine körperliche Untersuchung inklusive digital-rektaler Untersuchung sowie die Sonographie des unteren und oberen Harntrakts sind ebenfalls fester Bestandteil der Basisdiagnostik. Die Größenbestimmung der Prostata erfolgt vorzugsweise mit transrektalem Ultraschall. Die PSA-Wert-Bestimmung (prostataspezifisches Antigen) dient dem Abschätzen des Prostatavolumens und des Progressionsrisikos. Sie kann ferner im Rahmen einer Prostatakarzinomvorsorge genutzt werden. Der Urinstatus wird im Rahmen der Erstuntersuchung erhoben und dient dem Ausschluss einer Infektion, Hämaturie oder Glucosurie. Die Uroflowmetrie misst die Harnstrahlstärke. Sie kann jedoch nicht eindeutig zwischen Blasenauslassobstruktion und anderen Ursachen der Harnstrahlabschwächung differenzieren. Ergänzend zur Basisdiagnostik stehen als fakultative Diagnostik das Miktionsprotokoll, die urodynamische Untersuchung, die sonographische Detrusordickenbestimmung und befundabhängig eine Zystoskopie bzw. eine röntgenologische Bildgebung des oberen Harntrakts zur Verfügung.

Schlussfolgerung

Die Diagnostik des BPS gliedert sich in Basisuntersuchungen und fakultative Untersuchungen und dient der Abschätzung des Progressionsrisikos, des Erkennens von Komplikationen sowie zur Planung der bestmöglichen Therapie.

Schlüsselwörter

Symptomatologie Urosonographie Urodynamik Progressionsrisiko Unterer Harntrakt 

Diagnostic procedures and diagnostic strategy for lower urinary tract symptoms/benign prostatic hyperplasia

An overview

Abstract

Background

Lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) is the most common condition affecting the lower urinary tract of men. Evidence-based assessment is the basis for an ideal treatment approach.

Objectives

To provide an overview of the current status of diagnostic measures for LUTS/BPH.

Materials and methods

Descriptive review of the literature on the diagnosis of LUTS/BPH.

Results

A medical history inquiring about LUTS/BPH symptoms and burden as well as a standardized and validated symptom questionnaire such as the International Prostate Symptom Score (IPSS) are the basis of the assessment. A physical examination including a rectal exam and the ultrasonography of the lower and upper urinary tract are also part of the basic diagnostic workup. Prostate size is ideally measured by transrectal ultrasound. Serum prostate-specific antigen measurement may help to estimate the prostate size and the risk fo progression. It can also be helpful in the detection of prostate cancer. Urine dipstick or sediment is used to exclude urinary tract infection, hematuria, or glucosuria. Voiding dysfunction can be detected by uroflowmetry. In addition to the aforementioned examinations, further tests such as frequency-voiding charts, multichannel urodynamic evaluation, measurement of detrusor wall thickness and X‑ray imaging of the upper urinary tract as well as a cystoscopy may be offered if needed.

Conclusions

Diagnostics of LUTS/BPH consist of basic exams as well as optional exams and can be used to assess the progression risk, to identify complications and to offer the ideal treatment.

Keywords

Benign prostatic syndrome Ultrasound Urodynamics Risk of progression Lower urinary tract 

Notes

Danksagung

Unser herzlicher Dank gilt Frau Dr. Isabell Karl für die hervorragende Unterstützung bei der Erstellung des Manuskripts.

Einhaltung ethischer Richtlinien

Interessenkonflikt

T. Bschleipfer, M. Oelke und M. Rieken geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik für Urologie, Andrologie und KinderurologieKlinikum Weiden/Kliniken Nordoberpfalz AGWeidenDeutschland
  2. 2.Klinik für Urologie, Kinderurologie & Urologische OnkologieSt. Antonius-HospitalGronauDeutschland
  3. 3.alta uro AGBaselSchweiz

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