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Kombinationstherapie bei benignem Prostatasyndrom/unterer Harntraktsymptomatik

Combination therapy of benign prostate syndrome/lower urinary tract symptoms

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Zusammenfassung

Die Pathophysiologie der unteren Harntraktsymptomatik ist multifaktoriell. Da keines der heute eingesetzten Präparate an mehr als einem Pathomechanismus angreift, bietet sich die Kombinationstherapie an. Die Kombination aus α-Blocker und 5α-Reduktaseinhibitor gilt als leitlinienkonforme Erstlinientherapie für Männer mit mäßigen/ausgeprägten Miktionsbeschwerden und höherem Progressionsrisiko. Die Wirksamkeit dieses Ansatzes ist in randomisierten Studien bis 4 Jahre gut belegt. Die Kombination aus α-Blocker und Anticholinergikum ist als Add-on-Strategie bei persistierenden Drangsymptomen unter α-Blockade ebenfalls gut belegt, das Risiko für eine akute Harnverhaltung ist bei sorgfältig selektionierten Patienten gering, Langzeitstudien fehlen allerdings. Für alle anderen denkbaren Kombinationen kann – basierend auf der derzeit relativ dünnen Datenlage – keine Empfehlung gegeben werden.

Abstract

The pathophysiology of lower urinary tract symptoms (LUTS) is multifactorial. The fact that none of the available drugs impacts on more than one of these pathomechanisms, provides the rationale for combined medical treatment strategies. The combination of α-blocker and a 5-reductase inhibitor is recommended by all major benign prostate hyperplasia (BPH/LUTS) guidelines as a first line approach for men with moderate to severe LUTS and a higher risk for disease progression. The efficacy of this approach has been proven in prospective randomized trials for up to 4 years. The combination of α-blocker and antimuscarinics has been tested in several randomized trials as a primary approach or as add on therapy but the maximum study duration was only 3 months. The add on approach is suitable in particular for men with persisting storage symptoms under α-blockade. The risk for acute retention in appropriately selected men is low. The scientific basis for all other combinations is not solid enough to recommend the use outside clinical trials.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: GSK, Lilly, Boehringer, Astellas, Austroplant.

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Correspondence to S. Madersbacher.

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Madersbacher, S. Kombinationstherapie bei benignem Prostatasyndrom/unterer Harntraktsymptomatik. Urologe 52, 212–218 (2013). https://doi.org/10.1007/s00120-012-3055-7

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  • DOI: https://doi.org/10.1007/s00120-012-3055-7

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