„Pressure kills kidneys“: Schutz des oberen Harntrakts durch neuro-urologisches Management

Zusammenfassung

Bei der Low Compliance handelt es sich um keine eigene Krankheitsentität, sondern ein schweres Erscheinungsbild als Folge unterschiedlicher Störungen der Speicher- und Ausscheidungsfunktion der Harnblase. Die verminderte Dehnbarkeit des Detrusors kann zu einer Druckbelastung des oberen Harntrakts führen, aber auch drangdominante LUTS und Harnwegsinfektionen können resultieren. Neurogene Ursachen, v.a. die Querschnittslähmung/Spina bifida aber auch iatrogene Schäden oder eine subvesikale Obstruktion können u.a. zur Entstehung beitragen. Der Beitrag soll über die Verbreitung und komplexen pathogenetischen Mechanismen, aber auch notwendige diagnostische Schritte informieren. Unterschiedliche medikamentöse, interventionelle und operative Behandlungsstrategien werden anhand aktueller wissenschaftlicher Erkenntnisse bewertet und der Leser so in der Betreuung dieses komplexen Patientenklientels unterstützt.

Abstract

Low compliance is not an independent disease but a severe manifestation resulting from various disorders of the storage and excretory function of the bladder. Reduced distensibility of the detrusor muscle can lead to a pressure load on the upper urinary tract but also to urge-dominant LUTS and urinary tract infections. Neurogenic causes, especially spinal cord injury/spina bifida but also iatrogenic damage or subvesical obstruction, can contribute to the development. This article is intended to provide information about the epidemiology and complex pathogenetic mechanisms as well as the necessary diagnostic steps. Various medical, interventional and surgical treatment strategies are evaluated on the basis of current scientific findings, thus supporting the reader in the care of this complex patient group.

Schlüsselwörter

Detrusor Sphincter Dyssynergie - Vesikoureteraler Reflux - Urodynamik - Hochdruckblase - Neurourologie

Keywords

Detrusor sphincter dyssynergia - Vesicoureteral reflux - Urodynamics - High-pressure bladder - Neurourology

Publication History

Received: 12 January 2024

Accepted after revision: 07 March 2024

Article published online:
23 April 2024

• Literatur

• 1 Ek A, Bradley WE. History of cystometry. Urology 1983; 22: 335-350
• 2 Chartier-Kastler E, Ayoub N, Even-Schneider A. et al. Neurogenic bladder: pathophysiology of the disorder of compliance. Prog Urol 2004; 14: 472-478
• 3 Cho SY, Yi JS, Oh SJ. The clinical significance of poor bladder compliance. Neurourol Urodyn 2009; 28: 1010-1014
• 4 Weld KJ, Graney MJ, Dmochowski RR. Differences in bladder compliance with time and associations of bladder management with compliance in spinal cord injured patients. J Urol 2000; 163: 1228-1233
• 5 Bellucci CHS, Ribeiro WO, Hemerly TS. et al. Increased detrusor collagen is associated with detrusor overactivity and decreased bladder compliance in men with benign prostatic obstruction. Prostate Int 2017; 5: 70-74
• 6 Yao HH, Hoe V, Shamout S. et al. Impact of radiotherapy for localized prostate cancer on bladder function as demonstrated on urodynamics study: A systematic review. Can Urol Assoc J 2021; 15: E664-E671
• 7 Oda Y, Todo Y, Hanley S. et al. Risk factors for persistent low bladder compliance after radical hysterectomy. Int J Gynecol Cancer 2011; 21: 167-172
• 8 Tangpaitoon T, Swatesutipun V. Factors associated with low-compliance bladder in end-stage renal disease patients and development of a clinical prediction model for urodynamic evaluation: the DUDi score. Int Urol Nephrol 2023; 55: 75-84
• 9 Kudo S, Tsushima N, Sawada Y. et al. Serious complications of intravesical bacillus Calmette-Guerin therapy in patients with bladder cancer. Nihon Hinyokika Gakkai Zasshi 1991; 82: 1594-1602
• 10 Ghoniem GM, Roach MB, Lewis VH. et al. The value of leak pressure and bladder compliance in the urodynamic evaluation of meningomyelocele patients. J Urol 1990; 144: 1440-1442
• 11 McGuire EJ, Woodside JR, Borden TA. et al. Prognostic value of urodynamic testing in myelodysplastic patients. J Urol 1981; 126: 205-209
• 12 S2k-Leitlinie Medikamentöse Therapie der neurogenen Dysfunktion des unteren Harntraktes (NLUTD) (2022). AWMF Online.
• 13 Weld KJ, Dmochowski RR. Association of level of injury and bladder behavior in patients with post-traumatic spinal cord injury. Urology 2000; 55: 490-494
• 14 S2k-Leitlinie: Neuro-urologische Versorgung querschnittgelähmter Patienten, AWMF-Register Nr.: 179/001 (2020). AWMF Online.
• 15 Musco S, Padilla-Fernandez B, Del Popolo G. et al. Value of urodynamic findings in predicting upper urinary tract damage in neuro-urological patients: A systematic review. Neurourol Urodyn 2018; 37: 1522-1540
• 16 Leng WW, McGuire EJ. bstructive uropathy induced bladder dysfunction can be reversible: bladder compliance measures before and after treatment. O J Urol 2003; 169: 563-566
• 17 Kaga K, Yamanishi T, Kaga M. et al. Urodynamic efficacy of fesoterodine for the treatment of neurogenic detrusor overactivity and/or low compliance bladder. Int J Urol 2020; 27: 899-904
• 18 Krebs J, Pannek J. Effects of solifenacin in patients with neurogenic detrusor overactivity as a result of spinal cord lesion. E Spinal Cord 2013; 51: 306-309
• 19 Vasudeva P, Yadav S, Madersbacher H. et al. Efficacy and safety of mirabegron for the treatment of low compliance bladder resulting from sacral/infrasacral lesions: A prospective study. Int J Urol 2020; 27: 552-558
• 20 Cameron AP, Clemens JQ, Latini JM. et al. Combination drug therapy improves compliance of the neurogenic bladder. J Urol 2009; 182: 1062-1067
• 21 Schroder A, Albrecht U, Schnitker J. et al. Efficacy, safety, and tolerability of intravesically administered 0.1% oxybutynin hydrochloride solution in adult patients with neurogenic bladder: A randomized, prospective, controlled multi-center trial. Neurourol Urodyn 2016; 35: 582-588
• 22 Cruz F, Herschorn S, Aliotta P. et al. Efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: a randomised, double-blind, placebo-controlled trial. Eur Urol 2011; 60: 742-750
• 23 Ginsberg D, Gousse A, Keppenne V. et al. Phase 3 efficacy and tolerability study of onabotulinumtoxinA for urinary incontinence from neurogenic detrusor overactivity. J Urol 2012; 187: 2131-2139
• 24 Danacioglu YO, Keser F, Ersoz C. et al. Factors predicting the success of intradetrusor onabotulinum toxin-A treatment in children with neurogenic bladders due to myelomeningocele: The outcomes of a large cohort. J Pediatr Urol 2021; 17: 520 e521-520 e527
• 25 Horst M, Weber DM, Bodmer C. et al. Repeated Botulinum-A toxin injection in the treatment of neuropathic bladder dysfunction and poor bladder compliance in children with myelomeningocele. Neurourol Urodyn 2011; 30: 1546-1549
• 26 Rawashdeh YF, Jorgensen TM, Olsen LH. et al. The outcome of detrusor myotomy in children with neurogenic bladder dysfunction. J Urol 2004; 171: 2654-2656
• 27 Gobeaux N, Yates DR, Denys P. et al. Supratrigonal cystectomy with Hautmann pouch as treatment for neurogenic bladder in spinal cord injury patients: long-term functional results. Neurourol Urodyn 2012; 31: 672-676
• 28 Ho CH, Sung KC, Lim SW. et al. Chronic Indwelling Urinary Catheter Increase the Risk of Bladder Cancer, Even in Patients Without Spinal Cord Injury.. Medicine 2015; 94: e1736
• 29 Hird AE, Saskin R, Liu Y. et al. Association between chronic bladder catheterisation and bladder cancer incidence and mortality: a population-based retrospective cohort study in Ontario, Canada. BMJ Open 2021; 11: e050728
• 30 Taweel WA, Seyam R. Neurogenic bladder in spinal cord injury patients. Res Rep Urol 2015; 7: 85-99
• 31 EAU Guidelines. Edn. presented at the EAU Annual Congress Milan. 2023