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Diagnostik des benignen Prostatasyndroms

Die deutsche S2e-Leitlinie 2023 Teil 1

Diagnostic work-up of benign prostatic hyperplasia

The German S2e-guideline 2023 part 1

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Zusammenfassung

Hintergrund

Das benigne Prostatasyndrom (BPS) ist die häufigste urologische Erkrankung erwachsener Männer und kann zur erheblichen Beeinträchtigung der Lebensqualität beim Betroffenen führen. Das BPS besteht aus den individuell variabel vorliegenden Teilen benigne Prostatavergrößerung (BPE), Symptomen des unteren Harntrakts (LUTS) und Blasenauslassobstruktion (BOO) bzw. benigne Prostataobstruktion (BPO). Der Arbeitskreis BPS der Deutschen Gesellschaft für Urologie hat in seiner Neufassung die verschiedenen diagnostischen Verfahren einer eingehenden Prüfung und Bewertung unterzogen.

Ziel der Arbeit (Fragestellung)

Es handelt sich um die Darstellung und evidenzbasierte Bewertung der Tests zur Diagnostik des BPS.

Material und Methoden

Der Artikel fasst die Kap. 5, 6 und 8 der aktuellen Langfassung der deutschen S2e-Leitlinie zusammen.

Ergebnisse

Die Diagnostik soll klären, (1) ob die Beschwerden des Patienten dem BPS zuzuordnen sind, (2) wie das Ausmaß der Beschwerden ist und ob Behandlungsbedarf besteht, (3) ob bereits Komplikationen am unteren oder oberen Harntrakt eingetreten sind und (4) welche Therapieverfahren infrage kommen. Die Basisdiagnostik soll bei allen Patienten mit BPS durchgeführt werden und besteht aus Anamnese, Messung der Symptomatik und Lebensqualität, Urinanalyse, prostataspezifisches Antigen, Restharnmessung, Sonographie des unteren Harntrakts mit Messung des Prostatavolumens, der intravesikalen prostatischen Protrusion und der Detrusordicke sowie der Sonographie des oberen Harntrakts. Die weiterführende Diagnostik sollte dann erfolgen, wenn mit der Basisdiagnostik nicht alle Fragestellungen beantwortet werden konnten. Zu diesen fakultativen Untersuchungen zählen Blasentagebuch, Uroflowmetrie, Kreatininkonzentration im Serum, urologische Endoskopie, weitere noninvasive Tests wie Penismanschettentest, Kondomkathetermethode und Nahinfrarotspektroskopie sowie andere bildgebende Verfahren wie Röntgenuntersuchungen und Magnetresonanztomographie.

Schlussfolgerungen

Die aktualisierte deutsche S2e-Leitlinie fasst die Empfehlungen zur evidenzbasierten Diagnostik des BPS zusammen, inklusive deren Teilkomponenten BPE, LUTS und BOO/BPO.

Abstract

Background

Lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH; in German guidelines: benign prostatic syndrome [BPS]) is the most frequent urological disease in men and can result in a considerable deterioration of quality-of-life. BPS can be associated with LUTS, benign prostatic enlargement (BPE), and bladder outlet obstruction (BOO) or benign prostatic obstruction (BPO), respectively. The expert group on BPS of the German Society of Urology has re-evaluated the tests for the assessment of BPH and provides evidence-based recommendations.

Objectives

Presentation and evidence-based rating of tests for the assessment of patients with BPS.

Materials and methods

Summary and overview of chapters 5, 6, and 8 of the latest long version of the German S2e guideline on BPS.

Results

The diagnostic work-up should clarify (1) whether the complaints of the patient are caused by BPS, (2) how relevant the complaints are and whether treatment is necessary, (3) whether complications of the lower or upper urinary tract already exist, and (4) which treatment will be most suitable. Baseline assessment should be done in all BPS patients and include history, measurement of LUTS and quality-of-life, urinalysis, serum prostate-specific antigen, post-void residual, ultrasound of the lower urinary tract, including measurements of prostate volume, intravesical prostatic protrusion and detrusor wall thickness, and ultrasound of the upper urinary tract. Additional tests can follow when questions remain unanswered after baseline assessment. These optional tests include bladder diaries, uroflowmetry, serum creatinine, urethrocystoscopy, other noninvasive tests for the determination of BOO/BPO such as penile cuff test, condom catheter method and near-infrared spectroscopy, and other imagining tests such as X‑ray and MRI investigations.

Conclusions

The updated German S2e guideline summarizes evidence-based recommendations on the diagnostic work-up, including the assessment of the BPS components BPE, LUTS, and BOO/BPO.

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Abbreviations

AWMF:

Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften

BOO:

„Bladder outlet obstruction“ (Blasenauslassobstruktion)

BPE:

„Benign prostatic enlargement“ (benigne Prostatavergrößerung)

BPH:

Benigne Prostatahyperplasie

BPO:

„Benign prostatic obstruction“ (benigne Prostataobstruktion, BOO durch BPE)

BPS:

Benignes Prostatasyndrom

CT:

Computertomographie

DWT:

„Detrusor wall thickness“ (Detrusordicke)

EK:

Expertenkonsens

IPP:

Intravesikale prostatische Protrusion

IPSS:

Internationaler Prostatasymptomenscore

LUTS:

„Lower urinary tract symptoms“ (Symptome des unteren Harntrakts)

MRT:

Magnetresonanztomographie

PSA:

Prostataspezifisches Antigen

Pves.iso :

Isovolumetrischer Blasendruck

SIGN:

Scottish Intercollegiate Guidelines Network

TAUS:

Transabdomineller Ultraschall (der Prostata)

TRUS:

Transrektaler Ultraschall (der Prostata)

TURP:

Transurethrale Resektion der Prostata

Qmax :

Maximale Harnstrahlstärke

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Authors and Affiliations

  1. Klinik für Urologie, Urologische Onkologie und Roboter-assistierte Chirurgie, St. Antonius-Hospital GmbH, Möllenweg 22, 48599, Gronau, Deutschland

    Matthias Oelke

  2. Klinik für Urologie, Spitalzentrum Biel, Biel, Schweiz

    S. Dominik Abt

  3. Klinik für Rehabilitation, Klinik Wartenberg Professor Dr. Selmair GmbH & Co. KG, Wartenberg, Deutschland

    Klaus F. Becher

  4. Urologicum, Bremen, Deutschland

    Kurt Dreikorn

  5. Klinik für Urologie und Andrologie, Klinik Favoriten, Wien, Österreich

    Stephan Madersbacher

  6. Klinik für Urologie, Asklepios Westklinikum GmbH, Hamburg, Deutschland

    Giuseppe Magistro

  7. Abteilung Pharmakologie, Johannes Gutenberg Universität, Mainz, Deutschland

    Martin C. Michel

  8. Urologische Abteilung, ALTA Klinik, Bielefeld, Deutschland

    Rolf Muschter

  9. Urologische Privatpraxis Prof. Dr. Oliver Reich, München, Deutschland

    Oliver Reich

  10. Praxis alta uro, Basel, Schweiz

    Malte Rieken

  11. CUROS urologisches Zentrum, Klinik LINKS VOM RHEIN, Köln, Deutschland

    Johannes Salem

  12. Klinik für Urologie und Kinderurologie, Universitätsklinikum, Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg a.d. Havel, Deutschland

    Johannes Salem

  13. Universitätsklinik und Poliklinik für Urologie, Martin-Luther Universität Halle-Wittenberg, Halle (Saale), Deutschland

    Sandra Schönburg

  14. Klinik für Urologie, Evangelisches Krankenhaus, Oberhausen, Deutschland

    Klaus Höfner

  15. Klinik für Urologie und Kinderurologie, Regiomed Klinikum, Coburg, Deutschland

    Thomas Bschleipfer

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Corresponding author

Correspondence to Matthias Oelke.

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Interessenkonflikt

M. Oelke, S. D. Abt, K.F. Becher, K. Dreikorn, S. Madersbacher, G. Magistro, M.C. Michel, R. Muschter, O. Reich, M. Rieken, J. Salem, S. Schönburg, K. Höfner und T. Bschleipfer geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Dies ist der erste Teil einer vierteiligen Reihe zur aktuellen deutschen S2e-Leitlinie BPS.

Die Autoren Klaus Höfner und Thomas Bschleipfer haben zu gleichen Teilen zum Manuskript beigetragen.

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Oelke, M., Abt, S.D., Becher, K.F. et al. Diagnostik des benignen Prostatasyndroms. Urologie 62, 805–817 (2023). https://doi.org/10.1007/s00120-023-02142-0

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