Zusammenfassung
Neben dem Verständnis und der Therapie der neurogenen Störung der Speicherfunktion der Harnblase stellt der intermittierende Katheterismus als druck- und restharnfreie Form der Entleerung ein zentrales Therapieprinzip der neurogenen Blasenfunktionsstörung dar. Der in Deutschland und Europa empfohlene aseptische Einmalkatheterismus hat sich auch in der Langzeitanwendung als komplikationsarm erwiesen. Voraussetzung ist allerdings u. a. eine regelmäßige klinische und urodynamische Kontrolluntersuchung der Patienten in risikoadaptierten Intervallen. Im Vordergrund stehen hierbei das frühzeitige Erkennen und Verhindern drohender Komplikationen. Von großer Bedeutung zur Vermeidung von Komplikationen ist die Motivation und Compliance des gut geschulten Patienten sowie eine schonende Katheterisierungstechnik mit individuell optimalem Katheter.
Obwohl der intermittierende aseptische Einmalkatheterismus seit Jahren erfolgreich praktiziert wird, fehlen noch immer randomisierte kontrollierte Studien zu wichtigen Detailfragen der Methode: so kann bis heute kein optimaler Kathetertyp definiert werden. Auch wären durch entsprechende Studien gesicherte Aussagen zur selbst eingeschätzten Lebensqualität der Patienten mit intermittierendem Katheterismus, insbesondere unter Berücksichtigung des Fremdkatheterismus, sehr wünschenswert. Der intermittierende Katheterismus stellt niemals eine Lösung „von der Stange“, sondern immer eine individuelle zu erarbeitende Therapieform für Patienten mit neurogener Blasenfunktionsstörung dar.
Abstract
Together with comprehension and therapy of neurogenic failure of the storage function of the urinary bladder, intermittent catheterization as a pressure-free voiding method without residual urine, represents a major principle of therapy in lower urinary tract dysfunction. Aseptic intermittent catheterization is recommended in Germany and Europe and seems to be acceptable even in long-term application with low complication rates. It is a precondition that patients are seen for clinical and urodynamic reevaluation at risk-adapted time intervals. The major focus is on early recognition and avoidance of threatening complications. The most important preventive measures are the motivation and compliance of the well-educated patient and the use of careful catheterization techniques with individually optimized catheters.
Although aseptic intermittent catheterization has been used effectively for many years there is still a lack of randomized controlled studies for some important questions of details and an optimal catheter has still to be defined. Furthermore, valid conclusions based on well-conducted studies on the self-estimated quality of life of patients with intermittent catheterization, especially those with catheterization by attendant, are urgently needed. Intermittent catheterization is never a ready-made solution but always an individually tailored treatment for patients with lower urinary tract dysfunction.
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Böthig, R., Burgdörfer, H. Die Bedeutung des Katheterismus in der Neurourologie. Urologe 51, 204–211 (2012). https://doi.org/10.1007/s00120-011-2708-2
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DOI: https://doi.org/10.1007/s00120-011-2708-2
Schlüsselwörter
- Intermittierender Katheterismus
- Neurogene Blasenfunktionsstörung
- Langzeitanwendung
- Einmalkatheterismus
- Katheterisierungstechnik