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Medikamentöse Therapie der Harninkontinenz

Medical therapy of urinary incontinence

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Zusammenfassung

Die Prävalenz von Harninkontinenz ist bei beiden Geschlechtern hoch. Frauen sind häufiger von einer Stress- und Männer häufiger von einer Dranginkontinenz betroffen, andere Inkontinenzarten sind demgegenüber selten. Pathophysiologisch liegt bei Stressinkontinenz ein insuffizienter Harnröhrenverschluss und bei Dranginkontinenz unwillkürliche Detrusorkontraktionen vor. Medikamente sind ein Teil im Gesamtkonzept der Inkontinenztherapie. Bei Stressinkontinenz ist es mit dem neuen Wirkstoff Duloxetin, einem Serotonin- und Noradrenalinwiederaufnahmehemmer, möglich, den urethralen Verschlussdruck zu erhöhen und Inkontinenzepisoden um bis zu 64% zu reduzieren. Bei Dranginkontinenz bewirken Muskarinrezeptorantagonisten eine Relaxierung des Detrusors, was eine signifikante Abnahme der Miktionsfrequenz und Inkontinenzepisoden sowie eine Zunahme der Blasenkapazität zur Folge hat. Trospiumchlorid, Tolterodin, Solifenacin, Oxybutynin und Propiverin sind in Deutschland zugelassene antimuskarinerge Medikamente. Bei geringen Unterschieden in der Effektivität weisen diese Medikamente z. T. große Unterschiede bei Nebenwirkungen auf. Mundtrockenheit ist häufig ein therapielimitierender Faktor. Keines der zugelassenen Medikamente hat allerdings bei allen Patienten eine ausreichende Wirkung, weshalb sich zurzeit neue Medikamente mit anderen Wirkmechanismen in der Erprobung befinden.

Abstract

Urinary incontinence has a high prevalence in both men and women. Women suffer predominantly from stress urinary incontinence and men from urge incontinence. Other types of incontinence are less frequent. Stress urinary incontinence is caused by an insufficient urethral closure mechanism and urge incontinence by unhibited detrusor contractions. Medical treatment is beside other conservative options and operations only one part of the treatment strategy in incontinence. Duloxetine, a serotonine-norepinephrine reuptake inhibitor, is used to treat stress urinary incontinence, can increase activity of the external urethral sphincter and is able to reduce incontinence episodes in up to 64%. Antagonists of muscarinic receptors can reduce urgency, frequency and urge incontinence as well as increase bladder capacity significantly. In Germany, trospium chloride, tolterodine, solifenacin, oxybutynin and propiverine are available to treat urge incontinence. Efficacy of these agents are comparable. However, tolerability is different and side effects, especially dry mouth, often limit their use. None of the agents show ideal efficacy or tolerability in all patients and, therefore, new agents and formulations are currently under clinical investigation.

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Literatur

  1. Abrams P, Freeman R, Anderstrom C, Mattiasson A (1998) Tolterodine, a new antimuscarinic agent: as effective butter better tolerated than oxybutynin in patients with overactive bladder. Br J Urol 81: 801–810

    Article  Google Scholar 

  2. Abrams P, Cardozo L, Fall M et al. (2002) The standardisation of terminology of lower urinary tract function: Report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 21: 167–178

    Article  PubMed  Google Scholar 

  3. Appell RA, Sand P, Dmochowski R et al. (2001) Prospective randomized controlled trial of extended-release oxybutynin chloride and tolterodine tartrate in the treatment of overactive bladder: Results of the OBJECT Study. Mayo Clin Proc 76: 358–363

    CAS  PubMed  Google Scholar 

  4. Blok BFM, Willemsen ATM, Holstege G (1997) A PET study on brain control of micturition in humans. Brain 120: 111–121

    Article  Google Scholar 

  5. Caulfiled MP, Birdsall NJM (1998) International Union of Pharmacology. XVII. Classification of muscarinic acetylcholine receptors. Pharmacol Rev 50: 279–290

    CAS  PubMed  Google Scholar 

  6. Chapple CR, Parkhouse H, Gardener C, Milroy EJG (1990) Double-blind, placebo-controlled, cross-over study of flavoxate in the treatment of idiopathic detrusor instability. Br J Urol 66: 491–494

    Google Scholar 

  7. Chapple CR, Arano P, Bosch JL, de Ridder D, Kramer AE, Ridder AM (2004) Solifenacin appears effective and well tolerated in patients with symptomatic idiopathic detrusor overactivity in a placebo- and tolterodine-controlled phase 2 dose-finding study. BJU Int 93: 71–77

    Article  Google Scholar 

  8. Chapple CR, Rechberger T, Al-Shukri S, Meffan P, Everaert K, Huang M, Ridder A (2004) Rondomized, double-blind placebo- and tolterodine-controlled trial of the once-daily antimuscarinic agent solifenacin in patients with symptomatic overactive bladder. BJU Int 93: 303–310

    Article  CAS  PubMed  Google Scholar 

  9. de Groat WC (1998) Anatomy of the central neural pathways controlling the lower urinary tract. Eur Urol 34 [Suppl 1]: 2–5

    Article  Google Scholar 

  10. Diokno AC, Appell RA, Sand PK et al. (2003) Prospective, randomized, double-blind study of the efficacy and tolerability of the extended-release formulations of oxybutynin and tolterodine for overactive bladder: Results of the OPERA trial. Mayo Clin Proc 78: 687–695

    CAS  PubMed  Google Scholar 

  11. Dmochowski RR, Miklos JR, Norton PA, Zinner NR, Yalcin I, Bump RC (2003) Duloxetine versus placebo for the treatment of North American women with stress urinary incontinence. J Urol 170: 1259–1263

    Article  CAS  PubMed  Google Scholar 

  12. Drutz H, Cardozo L, Baygani S, Bump R (2003) Duloxetine treatment of women with only urodynamic stress incontinence awaiting continence surgery. Neurourol Urodyn 22: 523–524

    Google Scholar 

  13. Durant PAC, Lucas PC, Yaksh TL (1988) Micturition in the unanesthetized rat: spinal vs. peripherial pharmacology of the adrenergic system. J Pharmacol Exp Ther 245: 426–435

    Google Scholar 

  14. Eglen RM, Hedge SS, Watson N (1996) Muscarinic receptor subtypes and smooth muscle function. Pharmacol Rev 48: 531–565

    Google Scholar 

  15. Espey MJ, Downie JW, Fine A (1992) Effect of 5-HT receptor and adrenoceptor antagonists on micturition in conscious cats. Eur J Pharmacol 221: 167–170

    Article  CAS  PubMed  Google Scholar 

  16. Fetscher C, Fleichman M, Schmidt M, Krege S, Michel MC (2002) M3 muscarinic receptors mediate contraction of human urinary bladder. Br J Pharmacol 136: 641–643

    Google Scholar 

  17. Fröhlich G, Bulitta M, Strosser W (2002) Trospium chloride in patients with detrusor overactivity. Meta-analysis of placebo-controlled, randomized, double-blind, multi-center clinical trials on the efficacy and safety of 20 mg trospium chloride twice daily. Int J Clin Pharmacol Ther 40: 295–303

    Google Scholar 

  18. Giannantoni A, Di Stasi SM, Stephen RL, Navarra R, Scivoletto G, Mearini E, Porena M (2002) Intravesical capsaicin versus resiniferatoxin in patients with detrusor hyperreflexia: A prospective randomized study. J Urol 167: 1710–1714

    Article  CAS  PubMed  Google Scholar 

  19. Goldstein DJ, Mallinckrodt C, Lu Y, Demitrack MA (2002) Duloxetin in the treatment of major depressive disorder: a double-blind clinical trial. J Clin Psychiatry 63: 225–231

    CAS  PubMed  Google Scholar 

  20. Haab F, Steward L, Dwyer P (2004) Darifenacin, an M-3 selective receptor antagonist, is an effective and well-tolerated once-daily treatment for overactive bladder. Eur Urol 45: 420–429

    Article  CAS  PubMed  Google Scholar 

  21. Halaska M, Ralph G, Wiedemann A, Primus G, Ballering-Bruhl B, Höfner K, Jonas U (2003) Controlled, double-blind, multicentre clinical trial to investigate long-term tolerability and efficacy of trospium chloride in patients with detrusor instability. World J Urol 20: 392–399

    CAS  PubMed  Google Scholar 

  22. Hannestad YS, Rortveit G, Sandvik H, Hunskaar S (2000) A community-based epidemiological survey of female urinary incontinence: The Norwegian EPINCONT Study. J Clin Epidemiol 53: 1150–1157

    Article  Google Scholar 

  23. Hampel C, Wienhold D, Benken N, Eggersmann C, Thüroff JW (1997) Prevalence and natural history of female incontinence. Eur Urol 32, [Suppl] 2: 3–12

    Google Scholar 

  24. Herbison P, Hay-Smith J, Ellis G, Moore K (2003) Effectiveness of anticholinergic drugs compared with placebo in the treatment of overactive bladder: systematic review. BMJ 326: 841–844

    Article  Google Scholar 

  25. Höfner K (2000) Pathophysiologie der Harninkontinenz. In: Höfner K, Jonas U (Hrsg) Praxisratgeber Harninkontinenz. UNI-MED, Bremen London Boston, S 43–63

  26. Höfner K, Oelke M, Machtens S, Grünewald V (2001) Trospium chloride—an effective drug in the treatment of overactive bladder and detrusor hyperreflexia. World J Urol 19: 336–343

    Article  Google Scholar 

  27. Höfner K (2003) Therapie der instabilen Blase—mit Antimuskarinika. Urologe A 42: 793–799

    Article  Google Scholar 

  28. Homma Y, Paick JS, Lee JG, Kawabe K (2003) Clinical efficacy and tolerability of extended-release tolterodine and immediate-release oxybutynin in Japanese and Korean patients with an overactive bladder: a randomized, placebo-controlled trial. BJU Int 92: 741–747

    Article  CAS  PubMed  Google Scholar 

  29. Hunskaar S, Burgio K, Diokno A, Herzog AR, Hjalmas K, Lapitan MC (2003) Epidemiology and natural history of urinary incontinence in women. Urology 62 [Suppl 4A]: 16–23

    Article  Google Scholar 

  30. Jonas U, Wenderoth U (1979) Urodynamisch-röntgenologische Kombinationsuntersuchung: Erfahrungen mit 1000 Messungen bei Erwachsenen und Kindern. Elektromedica 47: 76–79

    Google Scholar 

  31. Jost WH, Marsalek P (2003) Duloxetin: Wirkmechanismus am unteren Harntrakt und auf den Onuf-Nukleus. Akt Neurol 30: 397–400

    Article  Google Scholar 

  32. Kasabian NG, Vlachiotis JD, Lais A, Klumpp B, Kelly MD, Siroky MB, Bauer SB (1994) The use of intravesical oxybutynin chloride in patients with detrusor hypertonicity and detrusor hyperreflexia. J Urol 151: 944–945

    Google Scholar 

  33. Lee JG, Hong JY, Choo MS et al. (2002) Tolterodine: As effective but better tolerated than oxybutynin in Asian patients with symptoms of overactive bladder. Int J Urol 9: 247–252

    Article  Google Scholar 

  34. Leung HY, Yip SK, Cheon C et al. (2002) A randomized controlled trial of tolterodine and oxybutynin on tolerability and clinical efficacy for treating Chinese women with an overactive bladder. BJU Int 90: 375–380

    Article  Google Scholar 

  35. Madersbacher H, Stöhrer M, Richter R, Burgdorfer H, Hachen HJ, Mürtz G (1995) Trospium chloride versus oxybutynin: a randomized, double-blind, multicentre trial in the treatment of detrusor hyper-reflexia. Br J Urol 75: 452–456

    Google Scholar 

  36. Madersbacher H, Halaska M, Voigt R, Alloussi S, Höfner K (1999) A placebo-controlled, multicentre study comparing the tolerability and efficacy of propiverine and oxybutynin in patients with urgency and urge incontinence. BJU Int 84: 646–651

    Article  CAS  PubMed  Google Scholar 

  37. Malone-Lee J, Shaffu B, Anand C, Powell C (2001) Tolterodine: Superior tolerability than and comparable efficacy to oxybutynin in individuals 50 years old or older with overactive bladder: A randomized controlled study. J Urol 165: 1452–1456

    Article  Google Scholar 

  38. Michel MC (2003) Neue pharmakologische Therapiekonzepte bei instabiler Blase. Urologe A 42: 807–811

    Article  Google Scholar 

  39. Michel MC, Oelke M, Peters SL (2005) The neuro-urological connection. Eur Urol [Suppl 4]: 18–28

  40. Millard RJ, Moore K, Rencken R, Yalcin I, Bump RC (2004) Duloxetine vs placebo in the treatment of stress urinary incontinence: a four-continent randomized clinical trial. BJU Int 93: 311–318

    Article  CAS  PubMed  Google Scholar 

  41. Norton PA, Zinner NR, Yalcin I, Bump RC (2002) Duloxetine versus placebo in the treatment of stress urinary incontinence. Am J Obstet Gynecol 187: 40–48

    Article  CAS  PubMed  Google Scholar 

  42. Oelke M (2000) Diagnostik der Harninkontinenz. In: Höfner K, Jonas U (Hrsg) Praxisratgeber Harninkontinenz. UNI-MED, Bremen London Boston, S 65–81

  43. Reitz A, Stöhrer M, Kramer G et al. (2004) European experience of 200 cases treated with botulinum-A toxin injections into the detrusor muscle for urinary incontinence due to neurogenic detrusor overactivity. Eur Urol 45: 510–515

    Article  Google Scholar 

  44. Rud T, Andersson KE, Ulmstein U (1979) Effects of nifedipine in women with unstable bladders. Urol Int 34: 421–429

    Google Scholar 

  45. Sand PK, Miklos J, Ritter H, Appell R (2004) A comparison of extended-release oxybutynin and tolterodine for treatment of overactive bladder in women. Int J Urogyn 15: 243–248

    Google Scholar 

  46. Sussman D, Garely A (2002) Treatment of overactive bladder with once-daily extended-release tolterodine or oxybutynin: The antimuscarinic clinical effectiveness trial (ACET). Curr Med Res Opin 18: 177–184

    Article  CAS  PubMed  Google Scholar 

  47. Thom DH, Haan MN, VandenEeden SK (1997) Medically recognized urinary incontinence and risk factors of hospitalization, nursing home admission and mortality. Age Ageing 26: 367–374

    Google Scholar 

  48. Thom D (1998) Variation in estimates of urinary incontinence prevalence in the community: effects of differences in definition, population characteristics, and study type. J Am Geriatr Soc 46: 473–480

    Google Scholar 

  49. Thor KB, Katofiasc MA (1995) Effects of duloxetine, a combined serotonin and norepinephrine reuptake inhibitor, on central neural control of lower urinary tract function in the chloralose-anesthetized female cat. J Pharmacol Exp Ther 274: 1014–1024

    CAS  PubMed  Google Scholar 

  50. Thor KB (2003) Serotonin and norepinephrine involvement in efferent pathways to the urethral rhabdosphincter: Implications for treating stress urinary incontinence. Urology 62 [Suppl 1]: 3–9

    Article  Google Scholar 

  51. van Kerrebroeck P, Kreder K, Jonas U, Zinner N, Wein AN (2001) Tolterodine once-daily: superior efficacy and tolerability in the treatment of the overactive bladder. Urology 57: 414–421

    Article  PubMed  Google Scholar 

  52. van Kerrebroeck P, Abrams P, Lange R, Slack M, Wyndaele JJ, Yalcin I, Bump RC (2004) Duloxetine versus placebo in the treatment of European and Canadian women with stress urinary incontinence. Br J Obstet Gynaecol 111: 249–257

    Google Scholar 

  53. Wagner TH, Hu TW (1998) Economic costs of urinary incontinence in 1995. Urology 51: 355–360

    Article  Google Scholar 

  54. Wein AJ, Rovner ES (2002) Definition and epidemiology of overactive bladder. Urology 60 [Suppl 1]: 7–12

    Article  Google Scholar 

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Authors and Affiliations

  1. Abteilung Urologie, Universität von Amsterdam, Niederlande

    M. Oelke & J. J. de la Rosette

  2. Abteilung Pharmakologie und Pharmakotherapie, Universität von Amsterdam, Niederlande

    M. C. Michel

  3. Abteilung Urologie, Medizinische Hochschule Hannover

    M. Oelke & U. Jonas

  4. Abteilung Urologie, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ, Amsterdam, Niederlande

    M. Oelke

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  1. M. Oelke
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  2. J. J. de la Rosette
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  3. M. C. Michel
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  4. U. Jonas
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Correspondence to M. Oelke.

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Oelke, M., de la Rosette, J.J., Michel, M.C. et al. Medikamentöse Therapie der Harninkontinenz. Internist 46, 75–82 (2005). https://doi.org/10.1007/s00108-004-1334-0

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