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Neurogene oder idiopathische Detrusorüberaktivität nach erfolgloser antimuskarinerger Therapie

Klinische Wertigkeit der externen temporären Elektrostimulation

Neurogenic or idiopathic destrusor overactivity after failed antimuscarinic treatment

Clinical value of external temporary electrostimulation

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Zusammenfassung

Standardbehandlung der symptomatischen Detrusorüberaktivität ist die antimuskarinerge Medikation. Unerwünschte Wirkungen und mangelnder Therapieerfolg führen mittelfristig bei mehr als der Hälfte der Patienten zum Therapieabbruch. Wir evaluierten den klinischen Nutzen der funktionellen externen Elektrostimulation (FES) als „Second-line-Therapie“ bei Patienten mit symptomatischer idiopathischer oder neurogener Detrusorüberaktivität.

In einer retrospektiven Studie wurden die Daten von 52 Patienten (38 Frauen, 14 Männer) bezüglich klinischem Erfolg der FES mindestens 1 Jahr nach Therapie ausgewertet. Als erfolgreich stuften die FES 18 Patienten (32,7%) ein, bei 34 Patienten (65,4%) trat keine Veränderung auf, eine Patientin berichtete über eine Verschlechterung. Der Therapieerfolg hielt 13,2 Monate an. Bei erfolgreich behandelten Patienten sank die Miktionsfrequenz signifikant von 13,3/24 h auf 6,1/24 h unter FES und auf 6,75/24 h zum Zeitpunkt der Befragung. Die FES stellt auch nach Versagen der medikamentösen Therapie eine gut tolerierte konservative Behandlungsoption bei neurogener oder idiopathischer Detrusorüberaktivität dar.

Abstract

Antimuscarinic drugs are regarded as the standard treatment of detrusor overactivity (DO). However, side effects and lack of efficacy cause patients to discontinue long-term therapy. We evaluated the clinical efficacy of functional external electrostimulation (FES) as “second-line” therapy in patients with symptomatic idiopathic or neurogenic DO.

In a retrospective study, 52 patients (38 women and 14 men) were evaluated at least 1 year after FES. Eighteen patients (32.7%) regarded FES as successful. No change occurred in 34 patients (65.4%) and 1 patient reported worsening of symptoms. Treatment success lasted for 13.2 months. In successfully treated patients, voiding frequency was significantly reduced from 13.3/24 h to 6.1/24 h under FES and to 6.75/24 h at follow-up. FES is a clinically useful, well-tolerated, conservative second-line treatment option after failed antimuscarinic treatment in patients with idiopathic or neurogenic DO.

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  1. Neuro-Urologie, Schweizer Paraplegiker-Zentrum, Guido A. Zäch-Straße 1, CH-6207, Nottwil, Schweiz

    J. Pannek & S. Janek

  2. Urologische Klinik, Universitätsklinik, Marienhospital, Herne, Deutschland

    J. Noldus

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  1. J. Pannek
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Correspondence to J. Pannek.

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Pannek, J., Janek, S. & Noldus, J. Neurogene oder idiopathische Detrusorüberaktivität nach erfolgloser antimuskarinerger Therapie. Urologe 49, 530–535 (2010). https://doi.org/10.1007/s00120-009-2179-x

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