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Behandlung von Miktionsstörungen bei BPS

Wann Pillen und wann nicht?

Treatment of LUTS in BPS

When and when not to administer pills

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Zusammenfassung

Das benigne Prostatahyperplasiesyndrom (BPS) ist eine Ausschlussdiagnose und verlangt eine dezidierte Diagnostik. Der Ausschluss einer signifikanten Obstruktion gehört zum wichtigsten Baustein dieser Diagnostik vor jeder Medikation. Charakteristika der einzelnen BPS-Medikamente und die multifaktorielle Genese von Symptomen bei BPS implizieren ein individualisiertes Therapieschema. LUTS (lower urinary tract symptoms) bei kleiner Prostata und vorwiegende Speichersymptome sind Domäne der α1-Rezeptorenblocker. Bei führender OAB-Syptomatik ist eine Kombination mit Muskarinrezeptorantagonisten möglich.

Ist eine BPS-Therapie langfristig ausgerichtet und soll eine Progression verhindert werden, kann die Kombination von α1-Rezeptorenblockern mit einem 5α-Reduktasehemmer sinnvoll sein, vorausgesetzt, das Prostatavolumen ist ausreichend groß. Alter, stark ausgeprägte Basalsymptome und große Prostata bzw. hoher PSA-Wert sind Risiken für die klinische Progression. Generell gilt, eine Kombinationstherapie verstärkt Nebenwirkungen – eine Nutzen-Risiko-Abschätzung ist daher notwendig. Das Potential aller BPS-Medikamente zur Behandlung der Obstruktion ist gering. Ist Deobstruktion ein vordringliches Therapieziel, eignen sich Medikamente oder Kombinationen aus Medikamenten eher nicht.

Abstract

Benign prostatic syndrome (BPS) is considered a diagnosis of exclusion and needs a thorough work-up. One of the pitfalls for a tailored medical treatment scheme is the objective evaluation of benign prostatic obstruction. Characteristics of the various medical therapy options and the multifactorial origin of LUTS in BPH patients imply an individualized approach. LUTS involving mostly urine storage disorders and a small prostate are suitably managed with α1-receptor antagonists, which may be combined with antimuscarinics if OAB symptoms predominate.

Long-term treatment addressing clinical progression may favor combination therapy of α1-receptor antagonists with 5α-reductase inhibitors if prostate size is sufficient. Age, symptom severity at baseline, a large prostate volume, or a high PSA value are indicative of progression. However, combination therapy aggravates side effects, and thus a risk-benefit analysis is essential. The potential of any medication for BPS to treat obstruction is rather low. If deobstruction is the main aim of therapy, medical treatment is not suitable.

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    R. Berges

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Berges, R. Behandlung von Miktionsstörungen bei BPS. Urologe 48, 257–263 (2009). https://doi.org/10.1007/s00120-009-1980-x

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