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Kombinationstherapie bei LUTS: Wann Pillen und wann nicht?

Medical combination therapy in LUTS suggestive of BPH

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Zusammenfassung

Auf der Suche nach Optimierung der medikamentösen Therapie des BPS werden zunehmend Kombinationen von α1-Blockern mit 5α-Reduktasehemmern (5ARI), α1-Blockern mit Muskarinrezeptorantagonisten und α1-Blockern mit Phosphodiesterase-5- (PDE-5-)Hemmern getestet. Die umfangreichsten Daten sind für die Kombination von α1-Blockern mit 5ARI publiziert worden. Eine Kombinationsbehandlung mit einem α1-Blocker und 5α-Reduktasehemmer ist zur alleinigen Symptomreduktion nicht indiziert, allerdings zur Progressionshemmung des BPS geeignet und hierbei der Monotherapie überlegen. Die routinemäßige Kombinationstherapie aus α1-Blocker und Muskarinrezeptorantagonisten zur Behandlung der Symptome des BPS kann zurzeit aufgrund der unzureichenden Datenlage nicht empfohlen werden, auch wenn erste viel versprechende Ergebnisse vorliegen. Für die Kombinationstherapie aus α1-Blockern und Phosphodiesterase-5-Hemmern existieren nur erste vorläufige Daten, die überzeugende Vorteile gegenüber anderen Kombinationen bisher nicht erkennen lassen.

Abstract

To improve the efficacy of medical treatment of patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH), studies on combination treatment with α1-blockers and 5α-reductase inhibitors, α1-blockers and muscarinic receptor antagonists, and α1-blockers and 5-phosphodiesterase inhibitors are increasingly performed. The most substantial data are available on the combination of α1-blockers and 5α-reductase inhibitors. This combination is not suitable for symptom improvement alone but for inhibition of progression. A combination therapy of α1-blockers and muscarinic receptor antagonists cannot be recommended as routine because of the still limited, although promising, data. Only preliminary data are available for the combination of α1-blockers and 5-phosphodiesterase inhibitors, which do not show convincing advantages over other combinations.

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Der korrespondierende Autor weist auf folgende Beziehung hin: Mitglied in Advisory Boards bei Pfizer und GlaxoSmithKline. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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Authors and Affiliations

  1. Klinik für Urologie, Evangelisches Krankenhaus, Virchowstraße 20, 46047, Oberhausen, Deutschland

    K. Höfner

  2. Klinik und Poliklinik für Urologie, Medizinische Hochschule, Hannover, Deutschland

    M. Oelke

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  1. K. Höfner
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  2. M. Oelke
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Correspondence to K. Höfner.

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Höfner, K., Oelke, M. Kombinationstherapie bei LUTS: Wann Pillen und wann nicht?. Urologe 48, 250–256 (2009). https://doi.org/10.1007/s00120-008-1919-7

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  • DOI: https://doi.org/10.1007/s00120-008-1919-7

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