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Diagnostik und Therapie von Harnröhrenstrikturen – Leitlinienübersicht 2024

Teil 2 – posteriore Harnröhre

Evaluation and management of urethral strictures—guideline summary 2024

Part 2—posterior urethra

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Zusammenfassung

Die vorliegende Arbeit verfolgte das Ziel, angesichts der kürzlich veröffentlichten internationalen Leitlinien zur Diagnose, Therapie und Nachsorge von Harnröhrenstrikturen und -stenosen eine Zusammenfassung der Empfehlungen der American Urological Association (AUA, 2023), der Société Internationale d’Urologie (SIU, 2010) und der European Association of Urology (EAU, 2023) zu erstellen. Die Empfehlungen dieser drei urologischen Gesellschaften sowie die Leitlinien zu Harnröhrentraumata der EAU, AUA und der Urological Society of India (USI) wurden hinsichtlich ihrer Therapiestrategien für posteriore Harnröhrenstenosen ausgewertet. Insgesamt zeigen sich weitgehende Übereinstimmungen in den Empfehlungen der verschiedenen Leitlinien. Im Vergleich zur AUA betonen SIU und EAU jedoch die Bedeutung wiederholter endoskopischer Behandlungen stärker. Die optimale Therapie für strahleninduzierte bulbomembranöse Stenosen bleibt ein kontrovers diskutiertes Thema. Zusätzlich könnten erweiterte endoskopische Behandlungen mit intraläsionalen Therapien eine wichtige Rolle bei der Behandlung von vollständig obliterierten Strikturen spielen.

Abstract

In light of recently published international guidelines concerning the diagnosis, treatment, and aftercare of urethral strictures and stenoses, the objective of this study was to synthesize an overview of guideline recommendations provided by the American Urological Association (AUA, 2023), the Société Internationale d’Urologie (SIU, 2010), and the European Association of Urology (EAU, 2023). The recommendations offered by these three associations, as well as the guidelines addressing urethral trauma from the EAU, AUA, and the Urological Society of India (USI), were assessed in terms of their guidance on posterior urethral stenosis. On the whole, the recommendations from the various guidelines exhibit considerable alignment. However, SIU and EAU place a stronger emphasis on the role of repeated endoscopic treatment compared to AUA. The preferred approach for managing radiation-induced bulbomembranous stenosis remains a subject of debate. Furthermore, endoscopic treatments enhanced with intralesional therapies may potentially serve as a significant treatment modality for addressing even fully obliterated stenoses.

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Abbreviations

AUA:

American Urological Association

BPH:

Benigne Prostatahyperplasie

EAU:

European Association of Urology

ISD:

Intermittierende Selbstdilatation

MCU:

Miktionszysturethrographie

PFUI:

„Pelvic fracture urethral injury“

RUG:

Retrograde Urethrographie

SIU:

Société Internationale d’Urologie

SPK:

Suprapubische Katheterisierung

TUR:

Transurethrale Resektion

USI:

Urological Society of India

VUAS:

Vesikourethrale Anastomosenstenose

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Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    Jakob Klemm, Roland Dahlem, Margit Fisch &  Malte W. Vetterlein

  2. Comprehensive Cancer Center, Medizinische Universität Wien, Universitätsklinik für Urologie, Wien, Österreich

    Jakob Klemm & Shahrokh F. Shariat

  3. Klinik für Urologie, Universitätsklinikum Frankfurt am Main, Frankfurt am Main, Deutschland

    Luis A. Kluth

  4. Klinik für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland

    Clemens M. Rosenbaum

  5. Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordanien

    Shahrokh F. Shariat

  6. Karl Landsteiner Institut für Urologie und Andrologie, Wien, Österreich

    Shahrokh F. Shariat

  7. Department of Urology, Weill Cornell Medical College, New York, NY, USA

    Shahrokh F. Shariat

  8. Department of Urology, University of Texas Southwestern, Dallas, TX, USA

    Shahrokh F. Shariat

  9. Department of Urology, Second Faculty of Medicine, Charles University, Prag, Tschechien

    Shahrokh F. Shariat

Authors
  1. Jakob Klemm
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  2. Roland Dahlem
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  3. Luis A. Kluth
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  4. Clemens M. Rosenbaum
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  5. Shahrokh F. Shariat
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  6. Margit Fisch
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  7. Malte W. Vetterlein
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Trauma and Reconstructive Urology Working Party of the European Association of Urology Young Academic Urologists

Corresponding author

Correspondence to Malte W. Vetterlein.

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Interessenkonflikt

J. Klemm, R. Dahlem, L.A. Kluth, C.M. Rosenbaum, S.F. Shariat, M. Fisch und M.W. Vetterlein 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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Klemm, J., Dahlem, R., Kluth, L.A. et al. Diagnostik und Therapie von Harnröhrenstrikturen – Leitlinienübersicht 2024. Urologie 63, 15–24 (2024). https://doi.org/10.1007/s00120-023-02241-y

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