Stellenwert der α1-Adrenozeptorblocker und 5α-Reduktaseinhibitoren

Monotherapie bei der Behandlung des benignen Prostatasyndroms

Importance of adrenoceptor blockers and alpha reductase inhibitors

Monotherapy for treatment of benign prostate syndrome

Zusammenfassung

Bei Patienten mit moderaten bis schweren Symptomen des unteren Harntraktes (LUTS) stellt die medikamentöse Therapie die primäre konservative Therapieoption dar. Die zur Verfügung stehenden α1-Blocker sind bei Patienten mit moderaten bis schweren LUTS indiziert und können wegen ihres schnellen Wirkeintritts bei Patienten mit geringem Progressionsrisiko als Monotherapie eingesetzt werden. Trotz der Symptomverbesserung kann eine Krankheitsprogression nicht vermieden werden. 5α-Reduktaseinhibitoren (5ARI) eignen sich wegen ihres verzögerten Wirkeintritts primär nicht zur initialen Monotherapie. Mittel bis langfristig führen 5ARI zu einer Verbesserung der Symptome und der maximalen Harnflussrate und haben darüber hinaus – als einzige Substanzgruppe – einen positiven Effekt auf die Krankheitsprogression. Der Einsatz von 5ARI im Sinne einer BPS-Prävention ist zwar wissenschaftlich gut belegt jedoch ist dieser Ansatz nicht leitlinienkonform.

Abstract

Medicinal treatment is the primary conservative treatment option for patients with moderate to severe lower urinary tract symptoms (LUTS). Monotherapy with alpha-blockers may be a suitable option for patients with a low risk of progression and with moderate to severe LUTS due to the rapid onset of action. However, alpha-blockers do not have any impact on disease progression and 5-alpha-reductase inhibitors (5-ARIs) are not recommended as initial monotherapy due to a slow onset of action. In the medium and long term 5-ARIs have been shown to have a positive effect on symptoms and the maximum flow rate and are also the only substance group to have a positive effect on disease progression. The positive effects of 5-ARIs on prevention of benign prostate syndrome are based on scientific findings but the use is not yet recommended in any guidelines.

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Interessenskonflikt

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

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Correspondence to Dr. F. Strittmatter.

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Strittmatter, F., Madersbacher, S., Stief, C. et al. Stellenwert der α1-Adrenozeptorblocker und 5α-Reduktaseinhibitoren. Urologe 52, 197–203 (2013). https://doi.org/10.1007/s00120-012-3086-0

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Schlüsselwörter

  • Prostatahyperplasie, benigne
  • Harntrakt, unterer
  • Harnflussrate
  • Postmiktionsphase
  • Blasenauslassobstruktion

Keywords

  • Prostatic hyperplasia, benign
  • Urinary tract symptoms
  • Urine flow rate
  • Postmiction phase
  • Bladder outflow obstruction