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Botulinumtoxin in der Therapie der überaktiven Blase – ein Überblick

Botulinum toxin for the treatment of overactive bladder – an overview

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Zusammenfassung

Dieser Reviewartikel soll einen Überblick über den momentanen Stand in der Behandlung der neurogenen und idiopathischen Detrusorüberaktivität durch Botulinumtoxin-A-Injektionen in den Detrusor geben. Berücksichtigt wurden Originalarbeiten, die durch eine Online-Recherche unter PubMed bis Dezember 2006 ermittelt wurden, sowie auf internationalen Kongressen als Abstracts veröffentlichte Arbeiten, sofern sie wesentliche neue Informationen erbrachten. In Zusammenschau der Arbeiten ergab sich übereinstimmend, dass die überwiegende Mehrheit der Patienten mit einer traumatischen Querschnittslähmung nach der Botulinumtoxin-Injektion wieder eine vollständige Kontinenzsituation zwischen den intermittierenden Einmalkatheterismusereignissen zurückgewinnt, und dass bei Kindern mit einer Meningomyelozele ebenfalls eine signifikante Verbesserung der Kontinenzsituation resultiert. Aus der begleitenden Senkung des intravesikalen Druckes ergibt sich für diese Patienten eine Schonung des oberen Harntraktes. Auch bei der idiopathischen Detrusorüberaktivität stellte sich eine Verbesserung der Inkontinenz sowie eine Reduktion der täglichen Miktionsfrequenz ein.

Für beide Indikationen zeigte sich bei einer hohen Erfolgsrate eine durchschnittliche Wirkdauer von >6 Monaten. Wiederholte Injektionen in den Detrusor führten zu keiner Abschwächung der Wirkung. Die Nebenwirkungsrate war gering, systemische Nebenwirkungen waren auf Einzelfälle beschränkt, teilweise war für Patienten mit idiopathischer Detrusorüberaktivität ein kurzzeitiger Selbstkatheterismus erforderlich. Insgesamt scheint die Botulinumtoxin-Injektion in den Detrusor eine neue, wirksame und sichere Alternative zu den herkömmlichen Verfahren in der Therapie der neurogenen und idiopathischen Detrusorüberaktivität zu bieten.

Abstract

This article shall give a state-of-the-art review about the treatment of neurogenic and idiopathic detrusor overactivity with botulinum toxin injections into the detrusor muscle. We searched PubMed for original articles up to December 2006. Abstracts published at international congresses were also considered if they provided substantial new information. Based on this review it appears that a majority of patients with spinal cord injury regains continence after botulinum toxin A injection and that in children with myelomeningocele a significant improvement in continence can also be achieved. A concomitant reduction of intravesical pressure protects the upper urinary tract in these patients. In idiopathic detrusor overactivity, injection of botulinum toxin A also resulted in improvement of continence and reduction of daily micturition frequency.

For both indications a high success rate could be achieved with an average duration of the effect of 6 months. Repeated injections into the detrusor seem to have no adverse effects in terms of duration or strength of the effect. Side effects were marginal and systemic side effects were experienced only in individual cases; in some patients with idiopathic detrusor overactivity intermittent self-catheterization was required. Overall intradetrusor injections of botulinum toxin seem to be a new, highly effective, and safe alternative in the treatment of neurogenic and idiopathic detrusor overactivity.

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  1. Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 7, 24105, Kiel, Deutschland

    C. Seif, S. Boy, B. Wefer, R. Dmochowski, P.M. Braun & K.-P. Jünemann

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  1. C. Seif
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  2. S. Boy
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Seif, C., Boy, S., Wefer, B. et al. Botulinumtoxin in der Therapie der überaktiven Blase – ein Überblick. Urologe 47, 46–53 (2008). https://doi.org/10.1007/s00120-007-1592-2

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