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Inkontinenzmanagement beim orthotopen Blasenersatz

Management of urinary incontinence after orthotopic urinary diversion

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Zusammenfassung

Derzeit wird weltweit bei fast jeder zweiten radikalen Zystektomie die Indikation zur Anlage einer Neoblase gestellt. Mit diesem Artikel soll ein Überblick über die Inzidenz, die Pathophysiologie und das Management der Inkontinenz nach orthotopem Blasenersatz (OBE) gegeben werden. Insgesamt leiden nach Anlage einer Neoblase tagsüber bis zu 15%, nachts bis zu 45% der Patienten an einer Inkontinenz. Frauen sind häufiger betroffen als Männer. Pathophysiologisch handelt es sich tagsüber meist um eine Belastungsinkontinenz. Nachts beruht die Inkontinenz wahrscheinlich auf dem fehlenden vesikourethralen Reflex und einem reduzierten Tonus des M. sphincter externus. Neben konservativen Therapien stehen bei leichtgradiger Belastungsinkontinenz operative Therapieverfahren mit adjustierbaren und nicht-adjustierbaren Bändern sowie das ProACT® zur Verfügung. Der AMS800® kann als Standardtherapie der Belastungsinkontinenz nach OBE betrachtet werden. Bei den neueren Verfahren wie dem ATOMS®-Band und den artifiziellen Schließmuskeln FlowSecure® bzw. Zephyr® ZSI 375 ist die Datenlage beschränkt.

Abstract

Orthotopic urinary diversion (OUD) is performed in almost half of all radical cystectomies. This review presents an overview of the incidence, pathophysiology, and management of urinary incontinence (UI) after OUD. Daytime and nighttime UI are reported in up to 15% and 45% of cases after OUD, respectively. UI after OUD is more frequent in women. Stress incontinence is the most common reason for daytime urinary leakage, while an absent vesicourethral reflex with reduced external sphincter muscle tone is associated with nighttime UI. Conservative management has limited therapeutic value in UI after OUD. Surgical approaches include adjustable and nonadjustable slings as well as the ProACT® system in mild stress UI. Implantation of the artificial urinary sphincter system AMS 800® is the standard treatment for stress UI after OUD. Very limited data exist regarding results after implantation of newer artificial urinary sphincter systems such as the FlowSecure® and the Zephyr® ZSI 375 after OUD.

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Abbreviations

AMS:

„American Medical Systems“

BMI:

„Body Mass Index“

IIQ-SF:

„incontinence impact questionnaire short form“

k.A.:

keine Angabe

MCU:

Miktionszystourethrogramm

MRT:

Magnetresonanztomographie

OBE:

orthotoper Blasenersatz

OUD:

„orthotopic urinary diversion“

RUG:

retrogrades Urethrogramm

UI:

„urinary incontinence“

UDI-SF:

„urogenital distress inventory short form“

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Authors and Affiliations

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

    A. Soave, R. Dahlem, M. Rink, S. Ahyai & M. Fisch

  2. Department of Urology, Weill Cornell Medical Center, New York, USA

    M. Rink

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  1. A. Soave
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  2. R. Dahlem
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  4. S. Ahyai
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Correspondence to A. Soave.

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Soave, A., Dahlem, R., Rink, M. et al. Inkontinenzmanagement beim orthotopen Blasenersatz. Urologe 51, 494–499 (2012). https://doi.org/10.1007/s00120-012-2814-9

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  • DOI: https://doi.org/10.1007/s00120-012-2814-9

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