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Blasenüberaktivität im Alter

Overactive bladder in the elderly

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Zusammenfassung

Die überaktive Blase (OAB) ist ein Krankheitsbild des mittleren und höheren Alters, welches mit deutlichen Einschränkungen in der Lebensqualität verbunden ist. Wesentliche Ursache für ihr vermehrtes Auftreten im Alter sind altersbedingte Veränderungen der Blase und die Zunahme von Grunderkrankungen, die zur Pathogenese der OAB beitragen. Antimuskarinika sind auch im Alter die Therapie der ersten Wahl. Eingeschränkte Medikamentenverträglichkeit und Polypharmakotherapie limitieren jedoch ihren Einsatz beim ältern Patienten. Retardpräparate sind aufgrund höherer Einnahmesicherheit und reduzierter Nebenwirkungen zu bevorzugen. Neuere Wirkstoffe und quaternäre Ammoniumverbindungen zeigen gerade im Hinblick auf kognitive Einschränkungen deutliche Vorteile. Die medikamenteninduzierte Obstipation bleibt jedoch beim älteren Patienten eine ernstzunehmende Nebenwirkung. Die intravesikale BoNT/A-Injektion stellt eine Therapiealternative und -eskalation dar, ohne die Gefahr der Medikamentenwechselwirkung. Die Injektionstherapie zeigt auch im Alter kaum Nebenwirkungen, kann jedoch zu einer iatrogenen Hyperkontinenz mit Notwendigkeit einer artifiziellen Harnableitung führen.

Abstract

The prevalence of overactive bladder syndrome (OAB) increases with age and is associated with a clear reduction in patient quality of life. Age-related alterations of the urinary bladder as well as increased occurrence of neurological and non-neurological diseases with age contribute to the onset of OAB. Antimuscarinic drugs are the medication of choice; however, restricted tolerability and polypharmacotherapy limit administration in the elderly. Extended release preparations are to be favored as constant intake of medication is more feasible and adverse effects occur less often compared to immediate release formulations. With respect to cognitive impairment newly introduced substances and quaternary amines seem to be advantageous. However, constipation remains a notable side effect in older patients. Intravesical botulinum toxin type A (BoNT/A) injections are an alternative and a therapeutic escalation in patients suffering from OAB. Adverse events are very rare and drug interactions are unknown; however, injections can result in hypercontinence causing the necessity for artificial urine drainage.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: T. Bschleipfer: Vorträge/Beraterfunktion für die Firmen Astellas Pharma GmbH, Pfizer Pharma GmbH, Bayer Health Care/Bayer Vital GmbH, Dr. R. Pfleger GmbH. F.M. Wagenlehner: Vorträge/Beraterfunktion für die Firmen Astellas Pharma GmbH, AstraZeneca, Bayer Health Care/Bayer Vital GmbH, Bionorica, Calixa, Cerexa, Elli Lilly, MerLion, OM-Pharma, Janssen-Cilag, Johnson und Johnson, Pharmacia, Pierre Fabre, Rosen-Pharma, Sanofi-Aventis, Zambon, Serag Wiessner. G. Lüdecke: Vorträge/Beraterfunktion für die Firmen Ipsen Pharma GmbH, Bayer Health Care/Bayer Vital GmbH, Pfizer Pharma GmbH, Novartis Pharma GmbH, Janssen-Cilag GmbH, GE-Healthcare, Medical Enterprises, Alere GmbH, Concile GmbH, Sanofi-Aventis. A. Pilatz: keine; W. Weidner: keine.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Justus-Liebig-Universität Gießen, Rudolf-Buchheim-Straße 7, 35385, Gießen, Deutschland

    T. Bschleipfer FEBU, F.M. Wagenlehner, G. Lüdecke, A. Pilatz & W. Weidner

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  1. T. Bschleipfer FEBU
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  2. F.M. Wagenlehner
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  3. G. Lüdecke
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  4. A. Pilatz
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  5. W. Weidner
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Correspondence to T. Bschleipfer FEBU.

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Bschleipfer, T., Wagenlehner, F., Lüdecke, G. et al. Blasenüberaktivität im Alter. Urologe 52, 800–804 (2013). https://doi.org/10.1007/s00120-013-3153-1

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  • DOI: https://doi.org/10.1007/s00120-013-3153-1

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