Zusammenfassung
Harnspeicherung und Miktion sind komplexe physiologische Funktionen und erfordern eine Koordination von allen 3 efferenten Bereichen des Nervensystems (Parasympathikus, Sympathikus, somatisches Nervensystem). Der N. pudendus setzt sich sowohl aus efferenten als auch afferenten Fasern zusammen; erstere haben ihren Ursprung im Nucleus Onuf. Eine Vielzahl von Studien hat 5-HT- und NE-Systeme mit der Steuerung des unteren Harntraktes in Verbindung gebracht.
Bisherige Kenntnisse über die Steuerung des unteren Harntrakts beim Menschen wurden überwiegend durch tierexperimentelle Studien erworben. Duloxetin, ein kombinierter Serotonin-/Noradrenalin-Wiederaufnahmehemmer, bietet hier einen neuen therapeutischen Ansatz zur medikamentösen Behandlung der Belastungsinkontinenz. Duloxetin scheint am präsynaptischen Neuron im Nucleus Onuf zu wirken. Eine Phase-II- und 3 Phase-III-Studien zeigten eine signifikante und klinisch relevante Reduktion der Harninkontinenzepisodenfrequenz und Lebensqualität der behandelten Patientinnen im Vergleich zu Placebo. Als häufigste Nebenwirkung wurde Übelkeit genannt.
Abstract
Urinary continence and voiding are complex physiological processes and require the coordination of all three efferent areas of the nervous system (parasympathetic, sympathetic, somatic). The pudendal nerve contains efferent as well as afferent fibers, the former ones having their origin in Onuf’s nucleus. A number of studies see a link in the central modulation of lower urinary tract activity through 5-HT and NE receptor agonists as well as antagonists.
Previous information about the modulation of the lower urinary tract in humans has been obtained from animal experiments. Duloxetin, a combined serotonin/norepinephrine reuptake inhibitor may prove to be a new therapeutic agent for stress urinary incontinence. Duloxetin appears to act at the presynaptic neuron of Onuf’s nucleus. A phase II and three phase III studies have shown significant and clinically relevant improvement in several parameters in comparison to placebo control. The most frequent adverse event observed was nausea.
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Jost, W.H., Marsalek, P., Manning, M. et al. Medikamentöse Therapie der Belastungsinkontinenz. Urologe [A] 43, 1249–1253 (2004). https://doi.org/10.1007/s00120-004-0670-y
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DOI: https://doi.org/10.1007/s00120-004-0670-y