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Botulinumtoxin bei nichtneurogenen Blasenfunktionsstörungen

Botulinum toxin in nonneurogenic bladder dysfunction

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Zusammenfassung

Die nichtneurogene überaktive Harnblase mit oder ohne Detrusorüberaktivität und/oder Inkontinenz ist ein belastendes Symptom für viele Menschen, das bis vor wenigen Jahren nur mit anticholinergen Medikamenten oder operativ behandelt werden konnte. Intradetrusorinjektionen mit Botulinumtoxin Typ A stellen eine minimal-invasive Alternative für Patienten dar, die auf Anticholinergika nicht ansprechen oder diese nicht vertragen. Dieser Übersichtsartikel fasst die relevanten Arbeiten der letzten 6 Jahre zu diesem Thema zusammen und gibt Auskunft über die Wirksamkeit, die Nebenwirkungen, die verwendeten Dosierungen und Injektionstechniken. Insgesamt zeigte sich eine gute initiale Wirksamkeit, die etwa ab dem 4. Tag nach Injektion beginnt und durchschnittlich bis zu 31 Wochen anhalten kann. Es ist allerdings je nach Dosis mit einer Erhöhung der Restharnmengen zu rechnen, die auch die Anwendung von intermittierendem Selbstkatheterismus notwendig machen können. Die Anwendung von Botulinumtoxin in der Harnblase ist noch immer keine offiziell zugelassene Therapie.

Abstract

Nonneurogenic overactive bladder with or without detrusor overactivity and/or incontinence is a bothersome symptom for many people. Until a few years ago, it could be treated only with anticholinergic drugs or invasive surgery. Intradetrusor injection with botulinum toxin type A is a minimally invasive alternative therapy option for patients who do not respond to or tolerate anticholinergic treatment. This literature overview summarises the relevant articles on this topic over the last 6 years and provides information on the efficacy, adverse events, currently used dosages, and injection techniques. Overall, a favourable initial efficacy has been observed starting around day 4 after injection and can last up to approximately 31 weeks. Depending on the dose, however, elevated postvoid residual volumes should be anticipated and might require clean intermittent self-catheterisation. The use of botulinum toxin in the urinary bladder is still considered off-label.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Die Autorin Prof. Dr. Schurch hat Beraterverträge mit Allergan (CH; USA), Astellas (CH) and Pfizer (CH; UK). Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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  1. Neurourologie, Spinal Cord Injury Center, Uniklinik Balgrist, Forchstraße 340, CH-8008, Zürich, Schweiz

    U. Mehnert &  B. Schurch

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  1. U. Mehnert
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  2. B. Schurch
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Correspondence to B. Schurch.

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Mehnert, U., Schurch, B. Botulinumtoxin bei nichtneurogenen Blasenfunktionsstörungen. Urologe 48, 233–244 (2009). https://doi.org/10.1007/s00120-008-1918-8

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  • DOI: https://doi.org/10.1007/s00120-008-1918-8

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