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Therapie des benignen Prostatasyndroms beim geriatrischen Patienten – Anwendung und Limitation medizinischer Leitlinien

Treatment of benign prostatic hyperplasia in geriatric patients—use and limitations of existing guidelines

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Zusammenfassung

Der demographische Wandel und die daraus resultierende Zunahme hochbetagter Patienten in der urologischen Praxis stellt eine Herausforderung an die Neukonzeption von Leitlinien und klinischen Studien dar. Während in der inneren Medizin mit der Fachrichtung Geriatrie bereits eine Subspezialisierung mit dem Fokus auf der Behandlung älterer und multimorbider Patienten existiert, besteht in der Urologie bisher noch kaum eine spezielle Orientierung auf die Probleme hochbetagter Patienten. Am folgenden Fallbeispiel sollen daher die Therapieentscheidungen beim benignen Prostatasyndrom bei geriatrischen Patienten exemplarisch dargestellt und die verfügbaren Evidenzgrundlagen aus Literatur und Leitlinien dargelegt werden, um Hilfe für die tägliche Routineversorgung zur Verfügung zu stellen, sowie potenzielle Anwendungsfelder und Limitationen der vorhanden Leitlinien kritisch zu diskutieren. Der Fall behandelt dabei sowohl die Herausforderungen bei der Wahl einer medikamentösen Therapie als auch bei der Entscheidung, welche der Vielzahl von chirurgischen Therapiemethoden eingesetzt werden sollte.

Abstract

The demographic developments of western society and the resulting increase in the number of very old patients in urology represents a challenge for the design of clinical studies and, consequently, recommendations of guidelines. While in internal medicine there is already a subspecialization with a focus on the treatment of elderly and multimorbid patients, in urology there is hardly any subspecialization into the problems of geriatric patients. Thus, using a case study as an example, the treatment decisions for benign prostatic hyperplasia (BPH) in geriatric patients are discussed. In addition the available evidence from the literature and guidelines are presented in order to assiste in daily management of geriatric patients with lower urinary tract symptoms and to critically discuss potential fields of application and limitations of the existing guidelines. In this context, we also examine the challenges when choosing a drug therapy and in deciding which of the many surgical options should be used.

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Authors and Affiliations

  1. Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland

    D. S. Schoeb,  K. Wilhelm,  C. Gratzke &  A. Miernik

  2. Urologische und Kinderurologische Klinik, Universitätsklinikum Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland

    B. Wullich

  3. Medizinische Fakultät, Klinik für Kardiologie und Angiologie, Universitäts-Herzzentrum Freiburg – Bad Krozingen, Hugstetterstr. 55, 79106, Freiburg, Deutschland

    D. Dürschmied

  4. Medizinische Fakultät, Zentrum für Geriatrie und Gerontologie Freiburg, Universitätsklinikum Freiburg, Lehener Straße 88, 79106, Freiburg, Deutschland

    B. Heimbach &  M. Heupel-Reuter

  5. Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland

    A. J. Gross

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  1. D. S. Schoeb
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Correspondence to D. S. Schoeb.

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D.S. Schoeb, B. Wullich, D. Dürschmied, B. Heimbach, M. Heupel-Reuter, A.J. Gross, K. Wilhelm, C. Gratzke und A. Miernik geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Schoeb, D.S., Wullich, B., Dürschmied, D. et al. Therapie des benignen Prostatasyndroms beim geriatrischen Patienten – Anwendung und Limitation medizinischer Leitlinien. Urologe 58, 1029–1038 (2019). https://doi.org/10.1007/s00120-019-0988-0

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