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Harninkontinenz und Urodynamik

Urinary incontinence and urodynamics

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Zusammenfassung

Inkontinenz kann auf einer Funktionsstörung des Detrusors oder/und des Verschlussmechanismus beruhen. Deshalb sollte präoperativ eine Dokumentation der Pathomorphologie sowie der Pathophysiologie erfolgen, sodass im Falle eines Misserfolgs nachvollziehbar ist, welche Veränderungen durch eine Operation hervorgerufen wurden und warum ein Misserfolg in der Behandlung eingetreten ist. Die vaginale Beckenbodenrekonstruktion beim Vaginalprolaps ist ein effektives und sicheres Operationsverfahren, gerade für die ältere Patientin. Die abdominale Scheidenstumpffixation durch offene oder laparoskopische Sakrokolpopexie erzielt langfristig haltbare und anatomisch günstige Fixierungen v. a. bei der jüngeren, sexuell aktiven Frau, ist jedoch mit einer höheren Morbidität verbunden. Die Inkontinenztherapie des Mannes avanciert allmählich zu einer eigenen Subspezialisierung. Pharmakologisch werden bei Dranginkontinenz detrusorrelaxierende oder -desensibilisierende Substanzen (Antimuskarinika, Östrogene, α-Blocker, β-Mimetika, Botulinumtoxin A, Resiniferatoxin, Vinpocetin) eingesetzt, während die Belastungsinkontinenz eine Stimulierung des Sphinkter- und Beckenbodenapparats erfordert (α-Mimetika, Östrogene, Duloxetin). Die Klassifikation kindlicher Blasenfunktionsstörungen ist zwar i. A. nichtinvasiv möglich, die Therapie bleibt aber eine schwierige und oft jahrelange Geduldsprobe für die Kinder, deren Eltern und den Arzt.

Abstract

Incontinence can be the result of impaired functioning of the detrusor muscle and/or the sphincter mechanism. For this reason, the pathomorphology and the pathophysiology should be documented before surgery, so that if it is not successful it is possible to deduce what alterations have been caused by an operation and the reason why the treatment has not been successful. Vaginal reconstruction of the pelvic floor following vaginal prolapse is a safe, effective surgical procedure, particularly for older women. Abdominal fixation of the vaginal stump through open or laparoscopic sacrocolpopexy gives long-lasting and anatomically favourable results especially for younger women who are sexually active, but is associated with a higher mortality rate. Incontinence treatment in men is itself gradually becoming accepted as a subspecialty. Pharmacological treatment that is used for urge incontinence takes the form of substances that relax or desensitize the detrusor (antimuscarinics, oestrogens, α-blockers, β-mimetics, botulinum toxin A, resiniferatoxin, vinpocetin), while stress incontinence requires stimulation of the sphincter and pelvic floor (α-mimetics, oestrogens, duloxetin). Bladder function disturbances in children can be classified by noninvasive methods, but the therapy remains a difficult endurance test for the children, their parents and the doctor, often extending over years.

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Authors and Affiliations

  1. Abteilung für Urologie und Kinderurologie, Städtisches Krankenhaus Sindelfingen, Sindelfingen, Deutschland

    H. Palmtag

  2. Urologische Klinik und Poliklinik, Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland

    C. Hampel

  3. Abteilung für Urologie, Allg. Krankenhaus Linz, Linz, Österreich

    H. Heidler

  4. Klinik und Poliklinik für Geburtshilfe und Frauenkrankheiten, Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland

    G. Naumann & H. Kölbl

  5. Kontinenzzentrum Südwest, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Deutschland

    D. Schultz-Lampel

  6. Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 7, 24105 , Kiel, Deutschland

    K.-P. Jünemann & C. van der Horst

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  1. K.-P. Jünemann
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Correspondence to K.-P. Jünemann.

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Jünemann, KP., Palmtag, H., Hampel, C. et al. Harninkontinenz und Urodynamik. Urologe 45 (Suppl 4), 106–121 (2006). https://doi.org/10.1007/s00120-006-1192-6

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