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Harninkontinenz bei Frau und Mann

Diagnostik und Konservative Therapie

Urinary incontinence in men and women

Diagnostics and conservative therapy

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Zusammenfassung

Harninkontinenz kann beide Geschlechter gleichermaßen betreffen. Es werden die Formen Belastungsinkontinenz (Urinverlust bei körperlicher Belastung, Niesen, Husten) und Dranginkontinenz (imperativer Harndrang mit Urinverlust) von Mischharninkontinenz und Sonderformen unterschieden. Während sich Frauen und Männer die Pathophysiologie der drangassoziierten Harninkontinenz teilen, steht der multifaktoriell bedingten, weiblichen Belastungsharninkontinenz, die zumeist exklusiv durch Prostatektomie bedingte Inkontinenz des Mannes (post Prostatektomie) gegenüber. Die Basisdiagnostik der Harninkontinenz ist weitgehend non-invasiv. Spezielle diagnostische Maßnahmen bleiben dem Rezidiv respektive der Vorbereitung operativer Maßnahmen vorbehalten. Die Therapie orientiert sich am Leidensdruck sowie an der Compliance des Patienten und umfasst in erster Linie konservative Maßnahmen (Lebensstiländerung; Blasen-, Kontinenztraining). Duloxetin ist für die medikamentöse Therapie der weiblichen Belastungsharninkontinenz zugelassen. Die Behandlung drangassoziierter Inkontinenzformen erfolgt primär anticholinerg. Alternativ können Verfahren zur Neuromodulation, ein Betamimetikum sowie die Injektionstherapie mit Botulinumtoxin zukünftig angewendet werden.

Abstract

Urinary incontinence can affect men and women to the same degree. A differentiation is made between stress incontinence (i.e. urine discharge as a result of physical activities, sneezing or coughing), urge incontinence (i.e. strong urge to void with involuntary discharge of urine), mixed urinary incontinence and special forms. While men and women share the pathophysiology of urge-associated urinary incontinence, the multifactorial female urinary stress incontinence is in contrast to the stress incontinence in men which is almost exclusively caused by prostatectomy (postprostatectomy). The basic diagnostic procedure for urinary incontinence is largely non-invasive. Special diagnostic procedures are reserved for recurrences and preparation for operative measures. Therapy is oriented to the degree of suffering and patient compliance and incorporates conservative measures as first line therapy (e.g. lifestyle changes, bladder and continence training). Duloxetin is approved for the medicinal therapy of female urinary stress incontinence. The treatment of urge-associated urinary incontinence is primarily with anticholinergic agents. Alternatively, procedures for neuromodulation, a beta mimetic or injection therapy with botulinum toxin can be used in the future.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M.F. Hamann, K.P. Jünemann und C.M. Naumann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Urologie und Kinderurologie, Unversitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 7, 24105, Kiel, Deutschland

    M.F. Hamann, K.P. Jünemann & C.M. Naumann

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  1. M.F. Hamann
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  2. K.P. Jünemann
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  3. C.M. Naumann
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Correspondence to M.F. Hamann.

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Hamann, M., Jünemann, K. & Naumann, C. Harninkontinenz bei Frau und Mann. Urologe 53, 1073–1086 (2014). https://doi.org/10.1007/s00120-014-3439-y

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