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Neue Behandlungskonzepte von Symptomen des unteren Harntraktes beim Mann

New treatment strategies for male lower urinary tract symptoms

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Zusammenfassung

Als Goldstandard in der medikamentösen Therapie von Patienten mit Beschwerden des unteren Harntraktes („lower urinary tract symptoms“, LUTS) werden α1-Adrenozeptorblocker und 5α-Reduktaseinhibitoren sowie deren Kombination angesehen. Darüber hinaus kommen Anticholinergika bei Patienten mit überwiegenden Speicherstörungen zum Einsatz, während Phosphodiesterase-5-Hemmer ihr primäres Einsatzgebiet bei Patienten mit LUTS und erektiler Dysfunktion finden. In den letzten Jahren wurde die Suche nach neuen Therapieverfahren intensiviert. Vor allem intraprostatische Injektionstherapien (Botulinumtoxin A, NX-1207, PRX302) und innovative interventionelle Techniken (UroLift®) werden in Hinblick auf ihre Wirkung bei Patienten mit LUTS getestet und scheinen dabei wirksam und sicher zu sein. Besonderes Augenmerk sollte dabei auf den Zusammenhang von LUTS und sexuellen Funktionsstörungen gelegt werden.

Abstract

For patients with lower urinary tract symptoms (LUTS), α1-adrenoreceptor inhibitors and 5-alpha reductase inhibitors as well as their combination are considered the gold standard. In addition, anticholinergic agents are being introduced as monotherapy or in combination with α1-adrenocepetor inhibitors for patients with predominant storage disorders. Phosphodiesterase 5 (PDE5) inhibitors are often the best option for patients with LUTS who also suffer from erectile dysfunction. Recently, novel treatment options have been presented and intraprostatic injection of various agents, such as botulinum toxin A, NX-1207 and PRX302 has shown promising initial results. In addition, innovative minimally invasive treatment options, such as UroLift® appear to be efficacious and safe in this patient cohort. Particular emphasis should be laid on patients with LUTS and concomitant sexual disorders.

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Abbreviations

AUASS:

AUA-Syptom Score

onaBoNTA:

Onabotulinumtoxin A

IIEF:

International Index of Erectile Function

IPSS:

Internationaler Prostata Symptomen Score

MSHQ-EjD:

Male Sexual Health Questionnaire, Ejaculation Domaine

PUL:

Prostatic Urethral Lift

Qmax :

maximaler Harnfluss in ml/s

RCT:

Randomized Controlled Trial

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehung/en hin: Arenas da Silva: keine. Schönthaler: NeoTract Inc., Francisco: Astellas, Allergan, Recordati, Pfizer. Gratzke: Bayer Healthcare, Sanofi-Aventis, Rottapharm Madaus, Lilly, Astellas Pharma, Recordati und MSD. Zumbe: Lilly Pharma, Amend: AMS, Medtronic, Allergan, NeoTract. Stenzl: Ipsen Pharma, Novartis, Bayer AG. Sievert: NeoTract Inc., Medtronic, AMS, Allergan, Recordati.

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Authors and Affiliations

  1. Klinik für Urologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland

    L.F. Arenas da Silva, A. Stenzl, B. Amend &  K.-D. Sievert

  2. Abteilung Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland

    M. Schönthaler

  3. Department of Urology & IBMC, Hospital São João & Universidade Do Porto, Porto, Portugal

    F. Cruz

  4. Urologische Klinik und Poliklinik, LMU München, Campus Grosshadern, München, Deutschland

    C. Gratzke

  5. Klinik für Urologie, Klinikum Leverkusen, Leverkusen, Deutschland

    J. Zumbe

Authors
  1. L.F. Arenas da Silva
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  2. M. Schönthaler
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  3. F. Cruz
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  4. C. Gratzke
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  5. J. Zumbe
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  6. A. Stenzl
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  7. B. Amend
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  8. K.-D. Sievert
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Correspondence to K.-D. Sievert.

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Arenas da Silva, L., Schönthaler, M., Cruz, F. et al. Neue Behandlungskonzepte von Symptomen des unteren Harntraktes beim Mann. Urologe 51, 1697–1702 (2012). https://doi.org/10.1007/s00120-012-3032-1

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  • DOI: https://doi.org/10.1007/s00120-012-3032-1

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