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Neurogene oder idiopathische Detrusorüberaktivität nach erfolgloser antimuskarinerger Therapie

Klinische Wertigkeit der externen temporären Elektrostimulation

Neurogenic or idiopathic destrusor overactivity after failed antimuscarinic treatment

Clinical value of external temporary electrostimulation

Zusammenfassung

Standardbehandlung der symptomatischen Detrusorüberaktivität ist die antimuskarinerge Medikation. Unerwünschte Wirkungen und mangelnder Therapieerfolg führen mittelfristig bei mehr als der Hälfte der Patienten zum Therapieabbruch. Wir evaluierten den klinischen Nutzen der funktionellen externen Elektrostimulation (FES) als „Second-line-Therapie“ bei Patienten mit symptomatischer idiopathischer oder neurogener Detrusorüberaktivität.

In einer retrospektiven Studie wurden die Daten von 52 Patienten (38 Frauen, 14 Männer) bezüglich klinischem Erfolg der FES mindestens 1 Jahr nach Therapie ausgewertet. Als erfolgreich stuften die FES 18 Patienten (32,7%) ein, bei 34 Patienten (65,4%) trat keine Veränderung auf, eine Patientin berichtete über eine Verschlechterung. Der Therapieerfolg hielt 13,2 Monate an. Bei erfolgreich behandelten Patienten sank die Miktionsfrequenz signifikant von 13,3/24 h auf 6,1/24 h unter FES und auf 6,75/24 h zum Zeitpunkt der Befragung. Die FES stellt auch nach Versagen der medikamentösen Therapie eine gut tolerierte konservative Behandlungsoption bei neurogener oder idiopathischer Detrusorüberaktivität dar.

Abstract

Antimuscarinic drugs are regarded as the standard treatment of detrusor overactivity (DO). However, side effects and lack of efficacy cause patients to discontinue long-term therapy. We evaluated the clinical efficacy of functional external electrostimulation (FES) as “second-line” therapy in patients with symptomatic idiopathic or neurogenic DO.

In a retrospective study, 52 patients (38 women and 14 men) were evaluated at least 1 year after FES. Eighteen patients (32.7%) regarded FES as successful. No change occurred in 34 patients (65.4%) and 1 patient reported worsening of symptoms. Treatment success lasted for 13.2 months. In successfully treated patients, voiding frequency was significantly reduced from 13.3/24 h to 6.1/24 h under FES and to 6.75/24 h at follow-up. FES is a clinically useful, well-tolerated, conservative second-line treatment option after failed antimuscarinic treatment in patients with idiopathic or neurogenic DO.

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Literatur

  1. Schönberger B (2003) Die überaktive Blase. Welche Diagnostik ist vor Beginn der Primärtherapie notwendig? Urologe A 42:787–792

    Article  PubMed  Google Scholar 

  2. Kannan H, Radican L, Turpin RS, Bolge SC (2009) Burden of illness associated with lower urinary tract symptoms including overactive bladder/urinary incontinence. Urology (Epub ahead of print)

  3. Del Popolo G, Panariello G, Del Corso F et al (2008) Diagnosis and therapy for neurogenic bladder dysfunctions in multiple sclerosis patients. Neurol Sci 29(Suppl 4):S352–S355

    Article  Google Scholar 

  4. Novara G, Galfano A, Secco S et al (2008) A systematic review and meta-analysis of randomized controlled trials with antimuscarinic drugs for overactive bladder. Eur Urol 54:740–763

    Article  PubMed  CAS  Google Scholar 

  5. Basra RK, Wagg A, Chapple C et al (2008) A review of adherence to drug therapy in patients with overactive bladder. BJU Int 102:774–779

    Article  PubMed  Google Scholar 

  6. Burgio KL, Locher JL, Goode PS et al (1998) Behavioral vs. drug treatment for urge urinary incontinence in older women: a randomized controlled trial. JAMA 280:1995–2000

    Article  PubMed  CAS  Google Scholar 

  7. Wang AC, Chih SY, Chen MC (2006) Comparison of electric stimulation and oxybutynin chloride in management of overactive bladder with special reference to urinary urgency: a randomized placebo-controlled trial. Urology 68:999–1004

    Article  PubMed  Google Scholar 

  8. Suhel P (1976) Adjustable nonimplantable electrical stimulators for correction of urinary incontinence. Urol Int 31:115–123

    Article  PubMed  CAS  Google Scholar 

  9. Lindström S, Fall M, Carlsson CA, Erlandson BE (1983) The neurophysiological basis of bladder inhibition in response to intravaginal electrical stimulation. J Urol 129:405–410

    PubMed  Google Scholar 

  10. Kiss G (2004) Die Rolle der Elektrotherapie bei der Inkontinenz des Mannes. J Urol Urogynaekol 11:35–39

    Google Scholar 

  11. Aristizábal Agudelo JM, Salinas Casado J, Fuertes ME et al (1996) Urodynamic results of the treatment of urinary incontinence with peripheral electric stimulation. Arch Esp Urol 49:836–842

    Google Scholar 

  12. Perrigot M, Pichon B, Peskine A, Vassilev K (2008) Èlectrostimulation et rèèducation pèrinèale de l ‚incontinence urinaire et des troubles mictionnels non neurologiques. Ann Readapt Med Phys 51:479–490

    PubMed  CAS  Google Scholar 

  13. Trontelj JV, Janko M, Godec C et al (1974) Proceedings: Electrical stimulation for urinary incontinence: a neurophysiological study. Urol Int 29:213–220

    Article  PubMed  CAS  Google Scholar 

  14. Bower WF, Moore KH, Adams RD, Shepherd R (1998) A urodynamic study of surface neuromodulation versus sham in detrusor instability and sensory urgency. J Urol 160:2133–2136

    Article  PubMed  CAS  Google Scholar 

  15. Zöllner-Nielsen M, Samuelsson SM (1992) Maximal electrical stimulation of patients with frequency, urgency and urge incontinence. Report of 38 cases. Acta Obstet Gynecol Scand 71:629–631

    Article  PubMed  Google Scholar 

  16. Brubaker L, Benson JT, Bent A et al (1997) Transvaginal electrical stimulation for female urinary incontinence. Am J Obstet Gynecol 177:536–540

    Article  PubMed  CAS  Google Scholar 

  17. Amaro JL, Gameiro MO, Kawano PR, Padovani CR (2006) Intravaginal electrical stimulation: a randomized, double-blind study on the treatment of mixed urinary incontinence. Acta Obstet Gynecol Scand 85:619–622

    Article  PubMed  Google Scholar 

  18. Kulseng-Hanssen S, Kristoffersen M, Larsen E (1998) Evaluation of the subjective and objective effect of maximal electrical stimulation in patients complaining of urge incontinence. Acta Obstet Gynecol Scand 168(Suppl):12–15

    CAS  Google Scholar 

  19. Caputo RM, Benson JT, McClellan E (1993) Intravaginal maximal electrical stimulation in the treatment of urinary incontinence. J Reprod Med 38:667–671

    PubMed  CAS  Google Scholar 

  20. Yamanishi T, Yasuda K, Sakakibara R et al (2000) Randomized, double-blind study of electrical stimulation for urinary incontinence due to detrusor overactivity. Urology 55:353–357

    Article  PubMed  CAS  Google Scholar 

  21. Bratt H, Salvesen KA, Eriksen BC, Kulseng-Hanssen S (1998) Long-term effects ten years after maximal electrostimulation of the pelvic floor in women with unstable detrusor and urge incontinence. Acta Obstet Gynecol Scand 168(Suppl):22–24

    CAS  Google Scholar 

  22. Primus G (1992) Maximal electrical stimulation in neurogenic detrusor hyperactivity: experiences in multiple sclerosis. Eur J Med 1:80–82

    PubMed  CAS  Google Scholar 

  23. Primus G, Kramer G (1996) Maximal external electrical stimulation for treatment of neurogenic or non-neurogenic urgency and/or urge incontinence. Neurourol Urodyn 15:187–194

    Article  PubMed  CAS  Google Scholar 

  24. Berghmans LC, Hendriks HJ, De Bie RA et al (2000) Conservative treatment of urge urinary incontinence in women: a systematic review of randomized clinical trials. BJU Int 85:254–263

    Article  PubMed  CAS  Google Scholar 

  25. Brubaker L (2000) Electrical stimulation in overactive bladder. Urology 55(5A Suppl):17–23

    Article  PubMed  CAS  Google Scholar 

  26. Arruda RM, Castro RA, Sousa GC et al (2008) Prospective randomized comparison of oxybutynin, functional electrostimulation and pelvic floor training for treatment of Detrusor overactivity in women. Int Urogynecol J Pelvic Floor Dysfunct 19:1055–1061

    Article  PubMed  Google Scholar 

  27. Bower WF, Moore KH, Adams RD, Shepherd R (1998) A urodynamic study of surface neuromodulation versus sham in detrusor instability and sensory urgency. J Urol 160:2133–2136

    Article  PubMed  CAS  Google Scholar 

  28. Burgio KL, Goode PS, Locher JL et al (2002) Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. JAMA 288:2293–2299

    Article  PubMed  Google Scholar 

  29. Klarskov P, Heely E, Nyholdt I et al (1994) Biofeedback treatment of bladder dysfunction in multiple sclerosis. A randomized trial. Scand J Urol Nephrol 157(Suppl):61–65

    CAS  Google Scholar 

  30. Suzuki T, Yasuda K, Yamanishi T et al (2007) Randomized, double-blind, sham-controlled evaluation of the effect of functional continuous magnetic stimulation in patients with urgency incontinence. Neurourol Urodyn 26:767–772

    Article  PubMed  Google Scholar 

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Pannek, J., Janek, S. & Noldus, J. Neurogene oder idiopathische Detrusorüberaktivität nach erfolgloser antimuskarinerger Therapie. Urologe 49, 530–535 (2010). https://doi.org/10.1007/s00120-009-2179-x

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  • DOI: https://doi.org/10.1007/s00120-009-2179-x

Schlüsselwörter

  • Neurogene Blasenfunktionsstörung
  • Überaktive Blase
  • Elektrostimulation
  • Detrusorüberaktivität
  • Dranginkontinenz

Keywords

  • Neurogenic bladder dysfunction
  • Overactive bladder
  • Electrostimulation
  • Detrusor overactivity
  • Urge incontinence