Skip to main content
SpringerLink
Log in

Intravesikale Therapie der überaktiven Blase

Intravesical therapy for overactive bladder

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Einleitung

Trotz deutlicher Fortschritte auf dem Gebiet der antimuskarinergen Medikation stellen weiterhin eine mögliche Ineffektivität und mangelnde Verträglichkeit Ursachen für einen Abbruch der Behandlung dar. Die Einführung des Botulinum-A-Toxins in die Behandlung der Detrusorüberaktivität stellte einen Meilenstein in der Therapie dar. Allerdings ist die Behandlung invasiv, die Wirkdauer ist limitiert und Langzeitergebnisse bei nicht-neurogener Blasendysfunktion sind noch nicht verfügbar. Daher sollen im Folgenden die therapeutischen Alternativen zur lokalen Behandlung der überaktiven Blase dargestellt werden.

Material und Methodik

52 Patienten erhielten eine intravesikale Instillation von Anticholinergika, bei 16 Patienten wurde eine Capsaicin-Instillation durchgeführt. 28 Patienten wurden mittels EMDA behandelt.

Ergebnisse

Der Therapieerfolg der intravesikalen Anticholinergika-Instillation betrug 86%; die Capsaicin-Instillation war in 47% erfolgreich. Der Erfolg der EMDA-Therapie betrug 78,6%. An signifikanten Nebenwirkungen traten 2 transitorisch-ischämische Attacken nach EMDA auf.

Schlussfolgerung

Bei Patienten mit überaktiver Blase, die von einer oralen medikamentösen Therapie nicht profitieren, stehen neben der Botulinum-A-Toxin-Injektion weitere effektive Therapiemaßnahmen zur Verfügung. Es sollte individuell unter Berücksichtigung der Invasivität und möglichen Komplikationen sorgfältig geprüft werden, welches Verfahren für den einzelnen Patienten am besten geeignet ist.

Abstract

Introduction

Despite recent advances in the field of anticholinergic drugs, lack of efficiency and side effects are still the main reasons for discontinuation of treatment. The introduction of botulinum A toxin was a milestone in the treatment of detrusor overactivity. The treatment, however, is invasive, the duration of the treatment effects is limited, and long-term results are not yet available. The following addresses therapeutic alternatives to local treatment of overactive bladder.

Materials and Methods

A total of 52 patients received intravesical oxybutynin. In 16 patients, capsaicin was instilled in the bladder and 28 patients were treated with EMDA.

Results

Intravesical oxybutynin was successful in 86%; the success rate of capsaicin instillation was 47%. EMDA was successful in 78%. Two transient ischemic attacks following EMDA were observed as significant side effects.

Conclusion

Besides botulinum A toxin, several effective treatment options are available for patients with detrusor overactivity refractory to oral anticholinergic treatment. Therefore, in each individual patient, possible risks and complications of the different treatment options should be considered thoroughly to find the optimal method in each case.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Buyse G, Verpoorten C, Vereecken, R, Casaer P (1998) Intravesical application of a stable oxybutinin solution improves therapeutic compliance and acceptance in children with neurogenic bladder dysfunction. J Urol 160: 1084–1087

    Article  PubMed  Google Scholar 

  2. Cruz F (2002) Vanilloid receptor and detrusor instability. Urology 59(Suppl 5A): 51–60

    Article  Google Scholar 

  3. De Séze M, Wiart L, de Séze MP et al. (2004) Intravesical capsaicin versus resiniferatoxin for the treatment of detrusor hyperreflexia in spinal cord injured patients: a double-blind, randomized, controlled study. J Urol 171: 251–255

    Article  PubMed  Google Scholar 

  4. Fontanella UA, Rossi CA, Stephen RL (1997) Bladder and urethral anestesia with electromotive drug administration (EMDA): a technique for invasive endoscopic procedures. Br J Urol 79: 4141–420

    Google Scholar 

  5. Fowler CJ (2000) Intravesical treatment of overactive bladder. Urology 55(Suppl 5A): 60–64

    Article  PubMed  Google Scholar 

  6. Fröhlich G, Burmeister S, Wiedemann A, Bulitta M (1998) Intravesical instillation of trospium chloride, oxybutynin and verapamil for relaxation of the bladder detrusor muscle. A placebo controlled, randomized clinical test. Arzneimittelforschung 48: 486–491

    PubMed  Google Scholar 

  7. Geirssson G, Fall M, Sullivan L (1995) Clinical and urodynamic effects of intravesical capsaicin treatment in patients with chronic traumatic spinal detrusor hyperreflexia. J Urol 154: 1825–1829

    Article  PubMed  Google Scholar 

  8. Giannantoni A, Di Stasi S, Stephen RL, Navarra P, Scivoletto G, Mearini E, Porena M (2001) Intravesical capsaicin versus resiniferatoxin in patients with detrusor hyperreflexia: a prospective randomized trial. J Urol 167: 1710–1714

    Google Scholar 

  9. Giannantoni A, Di Stasi SM, Stephen RL (2004) Intravesical resiniferatoxin versus botulinum-A-toxin injections for neurogenic detrusor overactivity: a prospective randomized study. J Urol 172: 240–243

    Article  PubMed  Google Scholar 

  10. Gurpinar T, Truong LD, Wong HY, Griffith DP (1996) Electromotive drug administration to the urinary bladder: an animal model and prelinminary results. J Urol 156: 1496–1501

    Article  PubMed  Google Scholar 

  11. Haferkamp A, Schurch B, Reitz A et al. (2004) Lack of ultrastructural detrusor changes following endoscopic injection of botulinum toxin type a in overactive neurogenic bladder. Eur Urol 46: 784–791

    Article  PubMed  Google Scholar 

  12. Hampel C, Gillitzer R, Pahernik S, Melchior SW, Thüroff JW (2005) Medikamentöse Therapie der weiblichen Harninkontinenz. Urologe A 44: 244–255

    Article  PubMed  Google Scholar 

  13. Hinkel, A, Pannek J (2004) Transient ischemic attack after electromotive drug administration for chronic non-infectious cystitis: Report of two similar cases. Neurourol Urodyn 23: 180–182

    Article  PubMed  Google Scholar 

  14. Jankovic J (2004) Botulinum toxin in clinical practice. J Neurol Neurosurg Psychiatry 75: 951–957

    Google Scholar 

  15. Kuo HC (2003) Effectiveness of intravesical resiniferatoxin for anticholinergic treatment refractory detrusor overactivity due to nonspinal cord lesions. J Urol 170: 835–839

    Article  PubMed  Google Scholar 

  16. Loch A, Stein U (2004) Interstitielle Zystitis. Aktuelle Aspekte in der Diagnostik und Therapie. Urologe A 43: 1135–1146

    PubMed  Google Scholar 

  17. Lugnani F, Mazza G, Cerulli N, Rossi C, Stephen R (1993) Iontophoresis of drugs in the bladder wall: equipment and preliminary studies. Artif Org 17: 8–17

    Google Scholar 

  18. Madersbacher H, Knoll M (1995) Intravesical application of oxybutinine: mode of action in controlling detrusor hyperreflexia. Eur Urol 28: 240–244

    Google Scholar 

  19. Massad CA, Kogan BA, Trigo-Rocha FE (1992) The pharmacogenetics of intravesical and oral oxybutinin chloride. J Urol 148: 595–597

    PubMed  Google Scholar 

  20. Mejia NI, Dat Vuong K, Jankovic J (2005) Long term botulinum toxin efficacy, safety, and immunogenicity. Move Dis 20: 592–597

    Article  Google Scholar 

  21. Mohler JL (1990) Relaxation of intestinal bladders by intravesical oxybutinin chloride. Neurourol Urodynam 9: 179–187

    Google Scholar 

  22. Prasad KVR, Vaidyanathan S (1993) Intravesical oxybutinin chloride and clean intermittent catheterisation in patients with neurogenic vesical dysfunction and decreased bladder capacity. Br J Urol 72: 719–722

    PubMed  Google Scholar 

  23. Reitz A, Stöhrer M, Kramer G et al. (2004) European xperience of 200 cases treated with Botulinum-A Toxin Injections into the detrusor muscle for urinary incontinence due to neurogenic detrusor overactivity. Eur Urol 45: 510–515

    Article  PubMed  Google Scholar 

  24. Riedl CR, Knoll M, Plas E, Pfluger H (1998) Intravesical electromotive drug administration technique: preliminary results and side effects. J Urol 159: 1851–1856

    Article  PubMed  Google Scholar 

  25. Rosamilia A, Dwyer PL, Gibson J (1997) Electromotive drug administration of lidocaine and dexomethasone followed by cytodistention in women with interstitial cystitis. Int Urogynecol J Pelvic Floor Dysfunct 8(3): 142–145

    PubMed  Google Scholar 

  26. Rose AE, Payne CK, Azevedo K (2005) Pilot study of the feasibility of in-office bladder distension using electromotive drug administration (EMDA). Neurourol Urodyn 24: 254–260

    Article  PubMed  Google Scholar 

  27. Schurch B, Stöhrer M, Kramer G, Schmid DM, Gaul G, Hauri D (2000) Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol 164: 692–697

    Article  PubMed  Google Scholar 

  28. Schurch B, Reitz A (2004) Botulinumtoxin in der Urologie. Indikationen und Ergebnisse. Urologe A 43: 1410–1415

    Article  PubMed  Google Scholar 

  29. Schurch B, Reitz A, Tenti G (2004) Electromotive drug administration of lidocaine to anesthetize the bladder before botulinum-A toxin injections into the detrusor. Spinal Cord 42: 338–341

    Article  PubMed  Google Scholar 

  30. Schultz-Lampel, D, Weißhaar I, Lampel A (2002) EMDA-Therapie bei interstitieller Zystitis, therapierefraktärem Urge- und pelvic pain Syndrom. Urologe A 41(Suppl 1): 30

    Google Scholar 

  31. Schultz-Lampel (2003) Konservative Primärtherapie vor allem bei IC. Urologische Nachrichten 19.11.2003

  32. Silva C, Ribeiro MJ, Cruz F (2002) The effect of intravesical resiniferatoxin in patients with idiopathic detrusor instability suggests that involuntary detrusor contractions are triggered by C-fiber input. J Urol 168: 575–579

    Article  PubMed  Google Scholar 

  33. Szallasi A, Blumberg PM (1999) Vanilloid (capsaicin) receptors and mechanisms. Pharmacol Rev 51: 159–212

    PubMed  Google Scholar 

  34. Walter P, Grosse J, Bihr AM, Kramer G, Schulz HU, Schwantes U, Stöhrer M (1999) Bioavailability of trospium chloride after intravesical instillation in patients with neurogenic lower urinary tract dysfunction: A pilot study. Neurourol Urodyn 18: 447–453

    Article  PubMed  Google Scholar 

  35. Weese DL, Roskamp DA, Leach GE, Zimmern, PE (1993) Intravesical oxybutynin chloride: experience with 42 patients. Urology 41: 527–530

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt:

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Schwerpunkt Neuro-Urologie, Urologische und Neuro-Urologische Klinik, Ruhr-Universität Bochum, Marienhospital, Herne

    J. Pannek & U. Grigoleit

  2. Klinik für Urologie und Kinderurologie, Klinikum, Niederberg Velbert

    R. Wormland & M. Goepel

  3. Schwerpunkt Neuro-Urologie, Urologische und Neuro-Urologische Klinik, Ruhr-Universität Bochum, Marienhospital, Widumer Straße 8, 44627, Herne

    J. Pannek

Authors
  1. J. Pannek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. U. Grigoleit
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Wormland
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Goepel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Pannek.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pannek, J., Grigoleit, U., Wormland, R. et al. Intravesikale Therapie der überaktiven Blase. Urologe 45, 167–174 (2006). https://doi.org/10.1007/s00120-006-1000-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-006-1000-3

Schlüsselwörter

Keywords

Search

Navigation