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Behandlungsverfahren der Blase bei Querschnittlähmung und Myelomeningozele

Unconventional treatment procedures of the bladder in paraplegia and myelomeningocele

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Zusammenfassung

Die Therapie der neurogenen Blasenfunktionsstörung (nBFS) bei Querschnittlähmung (SCI) und Myelomeningozele (MMC) ist primär konservativ und setzt am unteren Harntrakt an. So gilt heute z. B. die orale antimuskarinerge Medikation als Standardtherapie der neurogenen Detrusorüberaktivität. In den letzten Jahren stehen jedoch zunehmend Behandlungsoptionen, welche direkt oder indirekt Einfluss auf die Innervation des Harntrakts nehmen, im Fokus des Interesses. Die aktuelle Evidenzlage rechtfertigt den Einsatz von Nervenumleitungsoperationen bis heute nicht. Die vorliegenden präliminären Daten sind für MMC-Patienten deutlich positiver als für Personen mit traumatischer SCI. Die sakrale Neuromodulation stellt bei inkomplett querschnittgelähmten Patienten mit neurogener Blasenfunktionsstörung schon heute eine Therapieoption dar. Erste Daten weisen darauf hin, dass ein Einsatz bereits im spinalen Schock auch bei kompletter SCI die Entwicklung einer nBFS verhindern kann. Die Zulassung von Onabotulinumtoxin (Botox®) erleichtert den Einsatz dieser Substanz zur Therapie der nBFS, allerdings nur für die Indikation der neurogenen Detrusorüberaktivitätsinkontinenz in der Dosierung von 200 IE. Die genannten unkonventionellen Behandlungsverfahren stellen somit, obwohl z. T. kontrovers diskutiert, vielversprechende neue Behandlungsoptionen der nBFS dar.

Abstract

The established treatment of neurogenic lower urinary tract dysfunction (NLUTD) in patients with spinal cord injury (SCI) or meningomyelocele (MMC) is mainly conservative and is aimed at the lower urinary tract. For example, oral antimuscarinic medication is the standard treatment of neurogenic detrusor overactivity. Recently, however, treatment aiming directly or indirectly at the innervation of the urinary tract has gained increasing attention. Current evidence does not justify the use of nerve rerouting but the existing preliminary data are more promising for MMC patients than for those with SCI. Sacral neuromodulation is already a therapeutic option for incomplete SCI patients. Initial data from a pilot study indicate that in patients with complete SCI implementation in the spinal shock phase may prevent the development of NLUTD. Licensing of onabotulinum toxin A (Botox®) facilitated its clinical use for treating NLUTD but it is limited to the indication of neurogenic detrusor overactivity incontinence with a dosage of 200 IU. The mentioned unconventional treatments, although discussed controversially, are promising future treatment options for NLUTD.

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Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: K.-D. Sievert und B. Amend: Allergan, Medtronic.

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Sievert, KD., Kessler, T., Amend, B. et al. Behandlungsverfahren der Blase bei Querschnittlähmung und Myelomeningozele. Urologe 51, 1692–1696 (2012). https://doi.org/10.1007/s00120-012-3052-x

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  • DOI: https://doi.org/10.1007/s00120-012-3052-x

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