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Prähabilitation bei radikaler Zystektomie

Prehabilitation prior to radical cystectomy

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Zusammenfassung

Das Urothelkarzinom der Harnblase ist in Deutschland mit jährlich 30.000 Neuerkrankungen eine bedeutende Belastung für das Gesundheitssystem. Die radikale Zystektomie ist der Goldstandard für das nicht-metastasierte muskelinvasive Harnblasenkarzinom und stellt gleichzeitig den uroonkologischen Standardeingriff mit der höchsten Sterblichkeit dar. Aufgrund der alternden Bevölkerung steigt die Zahl von Patienten mit einem Urothelkarzinom der Harnblase, die bereits vor dem Eingriff ein hohes Alter, eine reduzierte körperliche Fitness und zahlreiche Komorbiditäten aufweisen. Die Prähabilitation vor der Zystektomie zielt darauf ab, Patienten, welche besonders für postoperative Komplikationen gefährdet sind, präoperativ zu identifizieren und deren physischen Zustand zu verbessern. Dies umfasst Konditions- und Krafttraining, Atemübungen zur Lungenkapazitätsverbesserung und Ernährungsschulungen. Studien zur Prähabilitation vor diversen abdominellen Tumoroperationen zeigen bislang heterogene Ergebnisse. Positive Effekte konnten bisher für die Verbesserung funktioneller Parameter, nicht aber für eine Verringerung von Komplikationen oder Mortalität gezeigt werden. Weitere Forschung besonders im deutschen Gesundheitssystem ist erforderlich, um den Nutzen der Prähabilitation bei der Zystektomie zu bestätigen.

Abstract

Urothelial carcinoma of the urinary bladder places a significant burden on the healthcare system in Germany, with 30,000 new cases annually. Radical cystectomy still remains the standard treatment for nonmetastatic, muscle invasive bladder cancer. Radical cystectomy represents the standard uro-oncologic procedure with the highest mortality. Due to the aging population, the number of elderly patients with urothelial carcinoma of the urinary bladder and reduced physical fitness and numerous comorbidities before the procedure is increasing. Prehabilitation before cystectomy aims to preoperatively identify patients at risk for postoperative complications and improve their physical condition. This includes conditioning and strength training, breathing exercises to improve lung capacity, and nutritional education. Studies on prehabilitation before various abdominal tumor surgeries have shown heterogeneous results so far. Positive effects have been shown for the improvement of functional parameters, but not for a reduction of complications or mortality. Further research, especially in the German healthcare system, is needed to confirm the benefit of prehabilitation, for example, in cystectomy.

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Authors and Affiliations

  1. Klinik für Urologie, Universitätsklinikum Marburg, Marburg, Deutschland

    Matthias Giese, Johannes Huber &  Christer Groeben

  2. Urologisches Kompetenzzentrum für die Rehabilitation (UKR), Kliniken Hartenstein, Bad Wildungen, Deutschland

    Marius Butea-Bocu

  3. Klinik für Urologie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstr., 35043, Marburg, Deutschland

    Christer Groeben

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  1. Matthias Giese
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  4. Christer Groeben
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Correspondence to Christer Groeben.

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M. Giese, M. Butea-Bocu, J. Huber und C. Groeben 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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Giese, M., Butea-Bocu, M., Huber, J. et al. Prähabilitation bei radikaler Zystektomie. Urologie 62, 1034–1040 (2023). https://doi.org/10.1007/s00120-023-02172-8

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