Medikamentöse Therapie des benignen Prostatasyndroms

Medicinal therapy of benign prostate syndrome

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Zusammenfassung

Die medikamentöse Behandlung eines Patienten mit benignem Prostatasyndrom (BPS) ist nach Ausschluss strenger Operationsindikationen bei mäßigen bis schweren Symptomen des unteren Harntrakts indiziert. Die Differenzierung von Speicher- und Entleerungsstörungen dient der Wahl der einzelnen Wirkstoffe, die an das individuelle Risikoprofil des Patienten angepasst werden sollte. Primäre Ziele sind die Verbesserung der subjektiven Beschwerden sowie eine Reduktion des Progressionsrisikos. Damit sollen die Lebensqualität gebessert und Komplikationen, wie das Eintreten eines akuten Harnverhalts, oder BPS-bedingte Operationen verhindert werden. Als Goldstandard werden α1-Adrenozeptor-Blocker und 5α-Reduktase-Inhibitoren sowie deren Kombination angesehen. Außerdem kommen bei Patienten mit vorwiegenden Speicherstörungen zunehmend Anticholinergika als Monotherapie oder in Kombination mit α-Blockern zum Einsatz, während Phosphodiesterase-5-Hemmer ihr primäres Einsatzgebiet wohl bei Patienten mit BPS und erektiler Dysfunktion finden werden.

Abstract

Male lower urinary tract symptoms (LUTS) include storage and voiding disorders and should be carefully evaluated before the start of any treatment. Medical therapy is directed at improving symptoms and reducing the risk of progression in order to improve quality of life and prevent complications, such as acute urinary retention, or the need for surgical intervention. Careful assessment of the individual complaints helps to identify the best drug which should be adapted to each individual patient’s risk profile. At present, α1-adrenoreceptor inhibitors and 5-alpha reductase inhibitors and their combination form the gold standard for pharmacological treatment. In addition, anticholinergic agents are increasingly being used as monotherapy or in combination with α1-adrenocepetor inhibitors for patients with predominant storage disorders while phosphodiesterase 5 (PDE5) inhibitors may be suitable for patients suffering from LUTS and concomitant erectile dysfunction.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: CG war tätig für Bayer Healthcare, Sanofi-Aventis, Rottapharm Madaus, Lilly, Recordati und MSD; SM war tätig für Bayer, Madaus, Lilly, MDS, Pfizer und GSK.

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Correspondence to Dr. F. Strittmatter.

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Strittmatter, F., Madersbacher, S., Stief, C. et al. Medikamentöse Therapie des benignen Prostatasyndroms. Urologe 51, 1125–1136 (2012). https://doi.org/10.1007/s00120-012-2943-1

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Schlüsselwörter

  • Symptome des unteren Harntrakts
  • Benigne Prostatahyperplasie
  • α1-Blocker
  • 5α-Reduktase-Inhibitoren
  • Anticholinergika
  • Phytotherapie

Keywords

  • Lower urinary tract symptoms
  • Benign prostatic hyperplasia
  • α1 blocker
  • 5α reductase inhibitors
  • Cholinergic antagonists
  • Phytotherapy