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Therapieoptionen der rezidivierenden oder persistierenden Belastungsharninkontinenz

Therapy of persistent or recurrent stress urinary incontinence

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Zusammenfassung

Bei bis zu 16 % der Frauen persistiert oder rezidiviert eine Belastungsharninkontinenz (BI) nach Implantation eines synthetischen Bandes. Das gleiche gilt für bis zu 45,5 % der Männer nach AdVance®-Bandimplantation. Aktuell fehlen randomisierte Studien, die einen direkten Vergleich der Effektivität verschiedener Therapieformen der persistierenden und rezidivierenden BI erlauben. Retrospektive Daten liegen für synthetische Bänder und den artifiziellen Sphinkter AMS 800® für Männer vor. Bei nicht vorbestrahlten Patienten mit leichtgradiger persistierender BI sind synthetische Bänder empfehlenswert. Bei vorbestrahlten Patienten und bei hochgradiger BI bleibt der AMS 800® die Option der Wahl.

Für Frauen liegen retrospektive Studien sowohl zur Kolposuspension und autologen Schlingen als auch zu synthetischen Bändern und zum AMS 800® vor. Hinsichtlich Kolposuspension und autologer Schlingen sollte beachtet werden, dass mit den synthetischen Bändern ein Verfahren mit ähnlichen Erfolgsraten bei schnellerer postoperativer Rekonvaleszenz zur Verfügung steht. Den hohen Erfolgsraten nach Implantation eines AMS 800® stehen bei beiden Geschlechtern die Komplikations- bzw. Revisionsraten gegenüber. Voraussetzung für die AMS 800®-Implantation ist u. a. eine ausreichende manuelle Geschicklichkeit der Patienten und Patientinnen. Für adjustierbare Bänder, das ACT® sowie neue artifizielle Sphinktersysteme wie Flow-Secure® oder Zephyr® ZSI 375 fehlen für beide Geschlechter Studien zur Effizienz bei der Therapie der persistierenden und rezidivierenden BI.

Abstract

After synthetic sling procedures, up to 16 % of women and 45.5 % of men complain about a persistent or recurrent stress urinary incontinence (SUI). Currently, randomized studies comparing the different treatment modalities of persistent or recurrent SUI are lacking. There are data of retrospective studies investigating the efficiency of synthetic slings and the artificial urinary sphincter AMS 800® in men. Synthetic slings can be applied in patients with mild SUI and without prior radiation of the pelvic region. The AMS 800® is the treatment of choice in patients with severe SUI or previous radiation.

In women with persistent and recurrent SUI, the efficiency of colposuspensions, autologous and synthetic slings as well as the AMS 800® has been investigated in retrospective studies. Due to comparable cure rates and a faster postoperative recovery, synthetic slings are now superseding colposuspensions and autologous slings. Excellent success rates after AMS 800® implantation have been described for both genders; nonetheless, postoperative complications and revisions as well as the requirement of dexterity of the patients should be taken into account. Data about the efficiency of adjustable slings, the ACT® and newer artificial urinary sphincter devices like Flow-Secure® and Zephyr® ZSI 375 in the treatment of persistent and recurrent SUI is lacking.

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Abbreviations

ACT:

„adjustable continence therapy“

AMS:

„American Medical Systems“

BI:

Belastungsharninkontinenz

IIQ-SF:

„incontinence impact questionnaire short form“

k.A.:

keine Angabe

M.:

Musculus

RP:

radikale Prostatektomie

TOT:

„transobturator vaginal tape“

TVT:

„tension-free transvaginal tape“

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Einhaltung ethischer Richtlinien

Interessenkonflikt. Margit Fisch ist beratend bei Myopowers und Precision Medical Devices tätig und hat Vorträge für American Medical Systems gehalten. Michael Rink wird durch das GEROK Stipendium der Universität Hamburg gefördert. Armin Soave, Oliver Engel und Roland Dahlem geben keine Interessenskonflikte an. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

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

    A. Soave, O. Engel, M. Rink, M. Fisch & R. Dahlem

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  1. A. Soave
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  2. O. Engel
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  3. M. Rink
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  4. M. Fisch
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  5. R. Dahlem
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Correspondence to A. Soave.

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Armin Soave und Oliver Engel haben gleichermaßen zu dieser Arbeit beigetragen.

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Soave, A., Engel, O., Rink, M. et al. Therapieoptionen der rezidivierenden oder persistierenden Belastungsharninkontinenz. Urologe 53, 346–353 (2014). https://doi.org/10.1007/s00120-013-3352-9

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