Download PDF
Aktuelle Urol 2024; 55(04): 337-343
DOI: 10.1055/a-2266-4721
Originalarbeit

Neurogene, nicht-obstruktive Harnretention: Diagnose und Therapie

Neurogenic, non-obstructive urinary retention: diagnosis and treatment
Albert Kaufmann
1   Neuro-Urologie, Schweizer Paraplegiker Zentrum, Nottwil, Schweiz (Ringgold ID: RIN60550)
,
Lorenz Leitner
2   Neuro-Urologie, Universitätsklinik Balgrist, Universität Zürich, Zürich, Schweiz (Ringgold ID: RIN31031)
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Zusammenfassung

Die Ätiologie der neurogenen, nicht-obstruktiven Harnretention ist mannigfaltig. Neben zentralnervösen Erkrankungen kommen auch Erkrankungen des peripheren Nervensystems in Betracht. Die Restharnbildung kann zu erheblichen Problemen führen, die die Patient*innen in ihrem täglichen Leben enorm beeinflussen können. Nur eine differenzierte Diagnostik macht eine der Harnblasenfunktionsstörung und auch der Lebenssituation der Patient*innen angepasste Therapie möglich. Sowohl konservative als auch operative therapeutische Strategien stehen zur Verfügung, medikamentöse Therapieansätze treten in den Hintergrund.

Als kausale Therapie der Funktionsstörung sind insbesondere neuromodulative Verfahren geeignet. Wenn eine artifizielle Harnblasenentleerung notwendig wird, sollte der intermittierende Selbstkatheterismus wenn immer möglich einem Dauerkatheter vorgezogen werden.

Abstract

Neurogenic, non-obstructive urinary retention has a varied aetiology. The condition can be caused by central-nervous diseases as well as by disorders of the peripheral nervous system. The formation of residual urine may lead to considerable problems that can have a significant impact on a patient’s everyday life. A treatment appropriate for the lower urinary tract dysfunction and suited to the patient’s situation in life is only possible if a differentiated diagnostic evaluation has been performed. Both conservative and surgical therapeutic strategies are available, while drug treatment approaches are less relevant.

Neuromodulative procedures are particularly suitable for causal treatment of the dysfunction. For patients requiring artificial bladder voiding, intermittent self-catheterization is generally preferable to using an indwelling catheter.

Schlüsselwörter

Neurogene Dysfunktion des unteren Harntraktes - chronische Harnretention - Neuromodulation

Keywords

neurogenic lower urinary tract dysfunction - urinary retention - neuromodulation


Publication History

Received: 08 February 2024

Accepted: 15 March 2024

Article published online:
24 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 D'Ancona C, Haylen B, Oelke M. Standardisation Steering Committee ICS, the ICSWGoTfMLUT, Pelvic Floor S, Dysfunction. et al. The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn 2019; 38: 433-477
    CrossrefPubMedSearch in Google Scholar
  • 2 Panicker JN, Fowler CJ, Kessler TM. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol 2015; 14: 720-732
    CrossrefPubMedSearch in Google Scholar
  • 3 Osman NI, Chapple CR. Contemporary concepts in the aetiopathogenesis of detrusor underactivity. Nat Rev Urol 2014; 11: 639-648
    CrossrefPubMedSearch in Google Scholar
  • 4 Uren AD, Cotterill N, Harding C. et al. Qualitative Exploration of the Patient Experience of Underactive Bladder. Eur Urol 2017; 72: 402-407
    CrossrefPubMedSearch in Google Scholar
  • 5 Stoffel J, Lightner D, Peterson A. et al. Non-neurogenic chronic urinary retention: consensus definition, management strategies, and future opportunities. AUA White Paper. Linthicum MD: : American Urological Association; 2016
    Search in Google Scholar
  • 6 Block Bea. EAU Guidelines on Neuro-Urology. EAU Guidelines Edn presented at the EAU Annual Congress Milan. 2023
    PubMedSearch in Google Scholar
  • 7 Wiedemann A, Dundar V, Heese M. et al. Adverse drug reaction affecting the urinary tract – the Witten urinary tract adverse reaction score. Aktuelle Urol 2021; 52: 481-489
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Gacci M, Sakalis VI, Karavitakis M. et al. European Association of Urology Guidelines on Male Urinary Incontinence. Eur Urol 2022; 82: 387-398
    CrossrefPubMedSearch in Google Scholar
  • 9 Nambiar AK, Arlandis S, Bo K. et al. European Association of Urology Guidelines on the Diagnosis and Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 1: Diagnostics, Overactive Bladder, Stress Urinary Incontinence, and Mixed Urinary Incontinence. Eur Urol 2022; 82: 49-59
    CrossrefPubMedSearch in Google Scholar
  • 10 Cameron AP, Wiseman JB, Smith AR. et al. Are three-day voiding diaries feasible and reliable? Results from the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) cohort. Neurourol Urodyn 2019; 38: 2185-2193
    CrossrefPubMedSearch in Google Scholar
  • 11 (DGU) DGfU, (DMGP) DMGfPeV. S2k-Management und Durchführung des Intermittierenden Katheterismus (IK) bei neurogener Dysfunktion des unteren Harntraktes; Version 2.1. 2019; Registernummer 043–048.
    PubMed
  • 12 Sandhu JS, Bixler BR, Dahm P. et al. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia (BPH): AUA Guideline Amendment 2023. J Urol 2024; 211: 11-19
    CrossrefPubMedSearch in Google Scholar
  • 13 Vahr S, Cobussen-Boekhorst H, Eikenboom J. et al. Catheterisation Urethral Intermittent in adults. EAUN; 2017
    Search in Google Scholar
  • 14 Barendrecht MM, Oelke M, Laguna MP. et al. Is the use of parasympathomimetics for treating an underactive urinary bladder evidence-based?. BJU Int 2007; 99: 749-752
    CrossrefPubMedSearch in Google Scholar
  • 15 Kutzenberger J, Angermund A, Domurath B. Deutsche Gesellschaft für Urologie e. V. (DGU). et al. S2k-Medikamentöse Therapie der neurogenen Dysfunktion des unteren Harntraktes (NLUTD); S2k. AWMF-Register-Nr.: 043–053. 2022
    PubMedSearch in Google Scholar
  • 16 Schneider MP, Tornic J, Sykora R. et al. Alpha-blockers for treating neurogenic lower urinary tract dysfunction in patients with multiple sclerosis: A systematic review and meta-analysis. A report from the Neuro-Urology Promotion Committee of the International Continence Society (ICS). Neurourol Urodyn 2019; 38: 1482-1491
    CrossrefPubMedSearch in Google Scholar
  • 17 Stoller M. Afferent nerve stimulation for pelvic floor dysfunction. INTERNATIONAL UROGYNECOLOGY JOURNAL 1999; 10: P99-P
    PubMedSearch in Google Scholar
  • 18 Gaziev G, Topazio L, Iacovelli V. et al. Percutaneous Tibial Nerve Stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions: a systematic review. BMC Urol 2013; 13: 61
    CrossrefPubMedSearch in Google Scholar
  • 19 Ho FCS, He C, Yao HH. et al. Efficacy of sacral neuromodulation and percutaneous tibial nerve stimulation in the treatment of chronic nonobstructive urinary retention: A systematic review. Neurourol Urodyn 2021; 40: 1078-1088
    CrossrefPubMedSearch in Google Scholar
  • 20 Burks FN, Bui DT, Peters KM. Neuromodulation and the neurogenic bladder. Urol Clin North Am 2010; 37: 559-565
    CrossrefPubMedSearch in Google Scholar
  • 21 Tanagho EA, Schmidt RA. Electrical stimulation in the clinical management of the neurogenic bladder. J Urol 1988; 140: 1331-1339
    CrossrefPubMedSearch in Google Scholar
  • 22 Leitner L, Walter M, Freund P. et al. Protocol for a prospective magnetic resonance imaging study on supraspinal lower urinary tract control in healthy subjects and spinal cord injury patients undergoing intradetrusor onabotulinumtoxinA injections for treating neurogenic detrusor overactivity. BMC Urol 2014; 14: 68
    CrossrefPubMedSearch in Google Scholar
  • 23 Leng WW, Chancellor MB. How sacral nerve stimulation neuromodulation works. Urol Clin North Am 2005; 32: 11-18
    CrossrefPubMedSearch in Google Scholar
  • 24 De Wachter S, Vaganee D, Kessler TM. Sacral Neuromodulation: Mechanism of Action. Eur Urol Focus 2020; 6: 823-825
    CrossrefPubMedSearch in Google Scholar
  • 25 Kessler TM, Fowler CJ. Sacral neuromodulation for urinary retention. Nat Clin Pract Urol 2008; 5: 657-666
    CrossrefPubMedSearch in Google Scholar
  • 26 Dasgupta R, Critchley HD, Dolan RJ. et al. Changes in brain activity following sacral neuromodulation for urinary retention. J Urol 2005; 174: 2268-2272
    CrossrefPubMedSearch in Google Scholar
  • 27 Fowler CJ, Christmas TJ, Chapple CR. et al. Abnormal electromyographic activity of the urethral sphincter, voiding dysfunction, and polycystic ovaries: a new syndrome?. BMJ 1988; 297: 1436-1438
    CrossrefPubMedSearch in Google Scholar
  • 28 Gill BC, Pizarro-Berdichevsky J, Bhattacharyya PK. et al. Real-Time Changes in Brain Activity during Sacral Neuromodulation for Overactive Bladder. J Urol 2017; 198: 1379-1385
    CrossrefPubMedSearch in Google Scholar
  • 29 Jonas U, Fowler CJ, Chancellor MB. et al. Efficacy of sacral nerve stimulation for urinary retention: results 18 months after implantation. J Urol 2001; 165: 15-19
    CrossrefPubMedSearch in Google Scholar
  • 30 Blok BF, Groen J, Bosch JL. et al. Different brain effects during chronic and acute sacral neuromodulation in urge incontinent patients with implanted neurostimulators. BJU Int 2006; 98: 1238-1243
    CrossrefPubMedSearch in Google Scholar
  • 31 Groen J, Ruud Bosch JL, Mastrigt R van. Sacral neuromodulation in women with idiopathic detrusor overactivity incontinence: decreased overactivity but unchanged bladder contraction strength and urethral resistance during voiding. J Urol 2006; 175: 1005-1009
    CrossrefPubMedSearch in Google Scholar
  • 32 Sievert KD, Amend B, Gakis G. et al. Early sacral neuromodulation prevents urinary incontinence after complete spinal cord injury. Ann Neurol 2010; 67: 74-84
    CrossrefPubMedSearch in Google Scholar
  • 33 Arlen AM, Powell CR, Kreder KJ. Sacral neuromodulation for refractory urge incontinence is less effective following spinal surgery. ScientificWorldJournal 2011; 11: 142-146
    CrossrefPubMedSearch in Google Scholar
  • 34 Chaabane W, Guillotreau J, Castel-Lacanal E. et al. Sacral neuromodulation for treating neurogenic bladder dysfunction: clinical and urodynamic study. Neurourol Urodyn 2011; 30: 547-550
    CrossrefPubMedSearch in Google Scholar
  • 35 Liechti MD, Lely S van der, Knupfer SC. et al. Sacral Neuromodulation for Neurogenic Lower Urinary Tract Dysfunction. NEJM Evid 2022; 1: EVIDoa2200071
    CrossrefPubMedSearch in Google Scholar
  • 36 Hernandez-Hernandez D, Padilla-Fernandez B, Castro Romera M. et al. Long-term Outcomes of Sacral Nerve Stimulation in Pelvic Floor Dysfunctions. Int Neurourol J 2021; 25: 319-326
    CrossrefPubMedSearch in Google Scholar
  • 37 Coolen RL, Groen J, Stillebroer AB. et al. Two-Staged Sacral Neuromodulation for the Treatment of Nonobstructive Urinary Retention: A Multicenter Study Assessing Predictors of Success. Neuromodulation 2023; 26: 1823-1830
    CrossrefPubMedSearch in Google Scholar
  • 38 e.V. DMGfP. S2k-Leitlinie Neuro-urologische Versorgung querschnittgelähmter Patienten; Version 2.1. (Registernummer 179–001). 2021
    PubMedSearch in Google Scholar
  • 39 Forte AJ, Boczar D, Huayllani MT. et al. Latissimus dorsi detrusor myoplasty for bladder acontractility: a systematic review. Arch Plast Surg 2021; 48: 528-533
    Thieme ConnectPubMedSearch in Google Scholar
  • 40 Koeveringe G van, Rademakers K, Stenzl A. Latissimus dorsi detrusor myoplasty to restore voiding in patients with an acontractile bladder – fact or fiction?. Curr Urol Rep 2013; 14: 426-434
    CrossrefPubMedSearch in Google Scholar