Zusammenfassung
Angesichts der demographischen Entwicklungen in Industrieländern nimmt die Bedeutung altersabhängiger Erkrankungen wie Diabetes zu. Beschwerden des unteren Harntraktes („lower urinary tract symptoms“, LUTS) sind häufig Grund, sich in urologische Behandlung zu begeben. Der Zusammenhang zwischen LUTS und benigner Prostatahyperplasie bzw. neurologischen Erkrankungen ist akzeptiert, zum Zusammenhang mit Diabetes hingegen sind die Erkenntnisse trotz der hohen Wahrscheinlichkeit für Blasenfunktionsstörungen durch diabetesbedingte autonome Neuropathie begrenzt.
Die Wittener Diabeteserhebung umfasst Daten von 4071 Patienten mit Diabetes Typ 2 (mittleres Alter 67,4 Jahre, mittlere Erkrankungsdauer 8,8 Jahre). Die Inzidenz von LUTS steigt mit dem Alter, der Erkrankungsdauer und mit Komplikationen (z. B. erektile Dysfunktion). Insgesamt gaben 67,9% aller Befragten LUTS an, bei den Patienten in urologischer Behandlung war der Anteil höher als bei denen in hausärztlicher Behandlung (81,1 vs. 60,7%). Hinsichtlich der Beschwerdeintensität bestanden Unterschiede: Die von Patienten in urologischen Praxen angegebenen LUTS waren gravierender, die Anzahl der Inkontinenzepisoden beispielsweise lag bei 7,5/Woche (vs. 5,7/Woche bei den Patienten in hausärztlicher Behandlung). LUTS wurden bei Männern am häufigsten als OAB („overactive bladder“) eingeschätzt, bei Frauen am häufigsten als Mischinkontinenz. Unter den Patienten mit Diabeteskomplikationen gab es mit LUTS (79,8 vs. 49,9%), bei der Stratifizierung anhand der Komedikation dagegen ergab sich nur ein kleiner Unterschied (64% ohne vs. 72% mit Komedikation).
Die hohe Anzahl von Patienten mit LUTS in hausärztlichen und urologischen Praxen spricht für das Vorliegen eines unterschätzten Problems. Von Urologen wie von Hausärzten sollten Typ-2-Diabetespatienten auf LUTS so gescreent werden wie im Hinblick auf ophthalmologische Komplikationen, erektile Dysfunktion oder Kreislaufstörungen.
Abstract
Due to demographic developments in industrial nations, age-correlated diseases such as diabetes are becoming more important. In conclusion, lower urinary tract symptoms (LUTS) are a frequent reason for searching treatment by urologists. The association between LUTS and benign prostatic hyperplasia or neurologic diseases is accepted. In contrast there is limited knowledge about the connection of diabetes mellitus and LUTS although an autonomic neuropathy due to diabetes makes urinary bladder dysfunction likely.
The following survey covered data of 4071 patients with diabetes type 2 with a medium age of 67,4 years and a diabetes duration of 8,8 years. The incidence of LUTS in diabetic patients increases by increasing age, longer diabetes duration and concomitant diabetes complications e. G. erectile dysfunction. There was a difference in severity of LUTS in patients in urologic treatment or in treatment of a general practitioner: 81,1% of the patients in urologic treatment reported LUTS; in comparison 60,7% of patients being treated by general practitioners complained of LUTS. The LUTS being reported in urologic practice were more severe; e. G. the number of incontinence episodes per week of urologic patients was 7,5, the number of incontinence episodes in general practice 5,7. Lower urinary tract symptoms were most frequently classified as OAB in male patients and classified as mixed incontinence in females. The amount of patients with LUTS was higher in patients with diabetes complications (79,8% vs. 49,9%); there was only a small difference in the number of patients with LUTS stratified by co-medication (64% patients with LUTS without any co-medication; 72% patients with co-medication).
The high number of diabetic patients with LUTS in general and urologic practice indicates an underestimation of the problem. LUTS in patients with type-2-diabetes should be screened as eye complications, erectile dysfunction or circulatory disorders by urologists and general practitioners.
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Die Datenerhebung und statistische Auswertung fand mit Unterstützung der Fa. Dr. Pfleger (Bamberg) statt.
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Wiedemann, A., Füsgen, I. Der Diabetiker in der urologischen Praxis – eine besondere Risikogruppe für LUTS?. Urologe 49, 238–244 (2010). https://doi.org/10.1007/s00120-009-2176-0
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DOI: https://doi.org/10.1007/s00120-009-2176-0