Download PDF
Aktuelle Urol 2024; 55(04): 344-350
DOI: 10.1055/a-2307-4049
Übersicht

Intravesikale Behandlungsoptionen in der Neuro-Urologie – eine Übersicht

A review of intravesical treatment options in neuro-urology
Anke K. Jaekel
1   Neuro-Urologie, Johanniter Neurologisches Rehabilitationszentrum Godeshoehe GmbH, Bonn, Germany
2   Klinik und Poliklinik für Urologie und Kinderurologie, Sektion Neuro-Urologie, Universitätsklinikum Bonn, Bonn, Germany
,
Stephanie C. Knüpfer
1   Neuro-Urologie, Johanniter Neurologisches Rehabilitationszentrum Godeshoehe GmbH, Bonn, Germany
2   Klinik und Poliklinik für Urologie und Kinderurologie, Sektion Neuro-Urologie, Universitätsklinikum Bonn, Bonn, Germany
,
Ruth Kirschner-Hermanns
1   Neuro-Urologie, Johanniter Neurologisches Rehabilitationszentrum Godeshoehe GmbH, Bonn, Germany
2   Klinik und Poliklinik für Urologie und Kinderurologie, Sektion Neuro-Urologie, Universitätsklinikum Bonn, Bonn, Germany
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Zusammenfassung

Die Ursache der neurogenen Dysfunktion des unteren Harntraktes sind verschiedenste Schädigungen des zentralen und peripheren Nervensystems. Daraus können diverse Störungen von Harnspeicher- und Harnentleerungsfunktion der Blase entstehen, die sich in Symptomen wie Drangbeschwerden, Harninkontinenz, rezidivierenden Harnwegsinfekten und Blasenentleerungsstörungen äußern. Lebensqualitätseinschränkungen, Gefahr für den oberen Harntrakt, Einschränkung der Erwerbsfähigkeit und Verschlechterung der Symptome der Grunderkrankung sind häufig die Folge. Ziel der Neuro-Urologie ist daher, neben dem Schutz des oberen Harntraktes, Kontinenz zu erhalten bzw. wiederherzustellen und die Lebensqualität der Betroffenen zu verbessern. Dazu stehen neben oraler Medikation und operativen Maßnahmen auch medikamentöse und elektrophysikalische intravesikale Therapieoptionen zur Verfügung. Die Übersicht geht daher auf diese intravesikalen Therapieverfahren sowie deren Indikation und Stellenwert in der Neuro-Urologie ein.

Abstract

Neurogenic lower urinary tract dysfunction is caused by various disorders of the central and peripheral nervous system. This can result in several malfunctions of the storage and voiding phase, which are reflected in symptoms such as urgency, urinary incontinence, recurrent urinary tract infections and post-void residual urine. Reduced quality of life, impairment of the upper urinary tract, reduced employment opportunities and worsening of the symptoms of the underlying condition can be the consequences. Therefore, the primary goals of neuro-urology are to protect the upper urinary tract, maintain continence and improve the quality of life of those affected. To achieve these goals, different intravesical drug and electrophysical therapy options are available. These article addresses these intravesical therapy options as well as their indication and relevance in neuro-urology.

Schlüsselwörter

neurogene Dysfunktion des unteren Harntrakts - Harnwegsinfekt - Neuro-Urologie - intermittierender Katheterismus - intravesikale Therapie

Keywords

neurogenic lower urinary tract dysfunction - urinary tract infection - clean intermittent catheterization - intravesical therapy - neuro-urology


Publication History

Received: 07 February 2024

Accepted after revision: 08 April 2024

Article published online:
19 June 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 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
  • 2 Blok B, Castro-Diaz D, Del Popolo G. et al. EAU Guidelines on Neuro-Urology 2022. Accessed December 04, 2023 at: https://uroweb.org/guidelines/neuro-urology
    PubMed
  • 3 Haensch C-A. Deutsche Gesellschaft für Neurologie. et al. Diagnostik und Therapie von neurogenen Blasenstörungen. In: Leitlinien für Diagnostik und Therapie in der Neurologie. S1-Leitlinie. 2020. Accessed January 15, 2024 at: https://register.awmf.org/assets/guidelines/030–121l_S1_Diagnostik-Therapie-Neurogene-Blasenstoerungen_2020–06.pdf
    Search in Google Scholar
  • 4 Koschorke M, Leitner L, Sadri H. et al. Intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity incontinence: do we need urodynamic investigation for outcome assessment?. BJU Int 2017; 120: 848-854
    CrossrefPubMedSearch in Google Scholar
  • 5 Lawrenson R, Wyndaele JJ, Vlachonikolis I. et al. Renal failure in patients with neurogenic lower urinary tract dysfunction. Neuroepidemiology 2001; 20: 138-143
    CrossrefPubMedSearch in Google Scholar
  • 6 Hemmett L, Holmes J, Barnes M. et al. What drives quality of life in multiple sclerosis?. QJM 2004; 97: 671-676
    CrossrefPubMedSearch in Google Scholar
  • 7 Kurze I, Bremer J, Kaufmann A. et al. Neuro-urologische Versorgung querschnittgelähmter Patienten. AWMF-Leitlinie Registernummer 179/001 [S2k Leitlinie]. Accessed December 11, 2023 at: https://register.awmf.org/assets/guidelines/179–001l_S2k_Neuro-urologische-Versorgung-querschnittgelaehmter-Patienten_2021–11.pdf
    PubMed
  • 8 Musco S, Ecclestone H, Hoen't L. et al. Efficacy and Safety of Surgical Treatments for Neurogenic Stress Urinary Incontinence in Adults: A Systematic Review. Eur Urol Focus 2022; 8: 1090-1102
    CrossrefPubMedSearch in Google Scholar
  • 9 Kutzenberger J, Angermund A, Domurath B. et al. Medikamentöse Therapie der neurogenen Dysfuntion des unteren Harntraktes (NLUTD). AWMF Leitlinie Registernummer 043–053 [S2k-Leitlinie] (02.02.2022). Accessed November 26, 2023 at: https://register.awmf.org/de/leitlinien/detail/043–053
    PubMed
  • 10 Böthig R, Kurze I, Geng V. et al. Management und Durchführung des Intermittierenden Katheterismus (IK) bei neurogener Dysfunktion des unteren Harntraktes. S2k-Leitlinie Version 2.1 [AWMF-Register-Nr.: 043–048] (12.12.2019). Accessed September 05, 2023 at: https://register.awmf.org/de/leitlinien/detail/043–048
    PubMed
  • 11 Dykstra DD, Sidi AA, Scott AB. et al. Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients. J Urol 1988; 139: 919-922
    CrossrefPubMedSearch in Google Scholar
  • 12 Dykstra DD, Sidi AA. Treatment of detrusor-sphincter dyssynergia with botulinum A toxin: a double-blind study. Arch Phys Med Rehabil 1990; 71: 24-26
    PubMedSearch in Google Scholar
  • 13 Stöhrer M, Schurch B, Kramer G. et al. Botulinum A-toxin in the treatment of detrusor hyperreflexia in spinal cord injured patients: A new alternative to medical and surgical procedures?. Neurourol Urodyn 18 1999; 401-402
    PubMedSearch in Google Scholar
  • 14 Schurch B, Stöhrer M, Kramer G. et al. Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol 2000; 164: 692-697
    CrossrefPubMedSearch in Google Scholar
  • 15 Schulte-Baukloh H, Michael T, Schobert J. et al. Efficacy of botulinum-a toxin in children with detrusor hyperreflexia due to myelomeningocele: preliminary results. Urology 2002; 59: 325-328
    CrossrefPubMedSearch in Google Scholar
  • 16 Nitti VW, Dmochowski R, Herschorn S. et al. OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence: results of a phase 3, randomized, placebo controlled trial. J Urol 2013; 189: 2186-2193
    CrossrefPubMedSearch in Google Scholar
  • 17 Dmochowski R, Chapple C, Nitti VW. et al. Efficacy and safety of onabotulinumtoxinA for idiopathic overactive bladder: a double-blind, placebo controlled, randomized, dose ranging trial. J Urol 2010; 184: 2416-2422
    CrossrefPubMedSearch in Google Scholar
  • 18 Eisenbrand G, Schreier P. RÖMPP Lexikon Lebensmittelchemie. Thieme-Verlag; 2006
    Thieme ConnectSearch in Google Scholar
  • 19 Asafu-Adjei D, Small A, McWilliams G. et al. The intravesical injection of highly purified botulinum toxin for the treatment of neurogenic detrusor overactivity. Can Urol Assoc J 2020; 14: E520-E526
    CrossrefPubMedSearch in Google Scholar
  • 20 Mangera A, Andersson K-E, Apostolidis A. et al. Contemporary management of lower urinary tract disease with botulinum toxin A: a systematic review of botox (onabotulinumtoxinA) and dysport (abobotulinumtoxinA). Eur Urol 2011; 60: 784-795
    CrossrefPubMedSearch in Google Scholar
  • 21 Anderson RU, Orenberg EK, Glowe P. OnabotulinumtoxinA office treatment for neurogenic bladder incontinence in Parkinson's disease. Urology 2014; 83: 22-27
    CrossrefPubMedSearch in Google Scholar
  • 22 Knüpfer SC, Schneider SA, Averhoff MM. et al. Preserved micturition after intradetrusor onabotulinumtoxinA injection for treatment of neurogenic bladder dysfunction in Parkinson's disease. BMC Urol 2016; 16: 55
    CrossrefPubMedSearch in Google Scholar
  • 23 Yuan H, Cui Y, Wu J. et al. Efficacy and Adverse Events Associated With Use of OnabotulinumtoxinA for Treatment of Neurogenic Detrusor Overactivity: A Meta-Analysis. Int Neurourol J 2017; 21: 53-61
    CrossrefPubMedSearch in Google Scholar
  • 24 Stein R, Assion C, Bredel Geißler A. et al. Diagnostik und Therapie der neurogenen Blasenfunktionsstörungen bei Kindern und Jugendlichen mit spinaler Dysraphie. S2k-Leitlinie Version 2.0 [AWMF-Register-Nr.: 043–047]. AWMF online (30.03.2019). 2019 Accessed June 25, 2021 at: https://register.awmf.org/assets/guidelines/043–047l_S2k_neurogene_Blasenfunktionsstörungen_spinale_Dysraphie_2019–08-verlaengert.pdf
    PubMedSearch in Google Scholar
  • 25 Ipsen Pharma GmbH. Fachinformation Dysport 300/500 Einheiten. 2022
    PubMedSearch in Google Scholar
  • 26 Dyer LL, Franco I. Botulinum Toxin-A therapy in pediatric urology: indications for the neurogenic and non-neurogenic neurogenic bladder. ScientificWorldJournal 2009; 9: 1300-1305
    CrossrefPubMedSearch in Google Scholar
  • 27 Engeler D. EAU Guideline on Chronic Pelvic Pain. Accessed January 22, 2024 at: http://uroweb.org/guidelines/compilations-of-all-guidelines/
    PubMed
  • 28 Young MJ, Osman NI, Phillips L. et al. Another Therapeutic Role for Intravesical Botulinum Toxin: Patients with Long-stay Catheters and Refractory Bladder Pain and Catheter Bypass Leakage. Eur Urol Focus 2020; 6: 339-343
    CrossrefPubMedSearch in Google Scholar
  • 29 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
    CrossrefPubMedSearch in Google Scholar
  • 30 Faure Walker N, Macpherson F, Tasleem A. et al. Interventions to improve tolerability of local anesthetic intradetrusor Botulinum toxin injections: A systematic review. Neurourol Urodyn 2023; 42: 23-32
    CrossrefPubMedSearch in Google Scholar
  • 31 Ladi-Seyedian S-S, Sharifi-Rad L, Kajbafzadeh A-M. Intravesical Electromotive Botulinum Toxin Type "A" Administration for Management of Urinary Incontinence Secondary to Neuropathic Detrusor Overactivity in Children: Long-term Follow-up. Urology 2018; 114: 167-174
    CrossrefPubMedSearch in Google Scholar
  • 32 Sharifi-Rad L, Ladi-Seyedian S-S, Nabavizadeh B. et al. Intravesical Electromotive Botulinum Toxin Type A (Dysport) Administration in Children With Myelomeningocele. Urology 2019; 132: 210-211
    CrossrefPubMedSearch in Google Scholar
  • 33 Koh C, Melling CV, Jennings C. et al. Efficacy of electromotive drug administration in delivering botulinum toxin a in children with neuropathic detrusor overactivity-outcomes of a pilot study. J Pediatr Urol 2019; 15: 552.e1-552.e8
    CrossrefPubMedSearch in Google Scholar
  • 34 Brendler CB, Radebaugh LC, Mohler JL. Topical oxybutynin chloride for relaxation of dysfunctional bladders. J Urol 1989; 141: 1350-1352
    CrossrefPubMedSearch in Google Scholar
  • 35 FARCO-Pharma GmbH. Fachinformation. Vesoxx 1mg/ml Lösung zur intravesikalen Anwendnung. 2022
    PubMedSearch in Google Scholar
  • 36 Schröder 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
    CrossrefPubMedSearch in Google Scholar
  • 37 Reitz A, Schurch B. Intravesical therapy options for neurogenic detrusor overactivity. Spinal Cord 2004; 42: 267-272
    CrossrefPubMedSearch in Google Scholar
  • 38 Phé V, Schneider MP, Peyronnet B. et al. Intravesical vanilloids 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 2018; 37: 67-82
    CrossrefPubMedSearch in Google Scholar
  • 39 Fader M, Glickman S, Haggar V. et al. Intravesical atropine compared to oral oxybutynin for neurogenic detrusor overactivity: a double-blind, randomized crossover trial. J Urol 2007; 177: 208-213
    CrossrefPubMedSearch in Google Scholar
  • 40 Münstermann N, Dilk O, Heinecke A. et al. Verbesserung der Effektivität von Blaseninstillationstherapien in der Behandlung der Interstitiellen Cystitis durch EMDA (elektromotive drug administration): Ergebnisse einer randomisierten, placebo-kontrollierten Doppelblind Studie. Urologe A 2009; 48 (Suppl. 01) 41 P9.4 (A)
    PubMedSearch in Google Scholar
  • 41 Hashemi S, Sahai A, Malde S. Applications of electromotive drug administration in urology. Urol Ann 2020; 12: 301-308
    CrossrefPubMedSearch in Google Scholar
  • 42 Gontero P. EAU Guideline on Non-muscle-invasive Bladder Cancer. Accessed January 22, 2024 at: https://uroweb.org/guidelines/non-muscle-invasive-bladder-cancer
    PubMed
  • 43 Lombardi G, Celso M, Mencarini M. et al. Clinical efficacy of intravesical electrostimulation on incomplete spinal cord patients suffering from chronic neurogenic non-obstructive retention: a 15-year single centre retrospective study. Spinal Cord 2013; 51: 232-237
    CrossrefPubMedSearch in Google Scholar
  • 44 Katona F, Benyo I, Lang I. Uber intraluminäre Elektrotherapie von verschiedenen paralytischen Zuständen des gastrointestinalen Traktes mit Quadrangulärstrom. Zentralbl Chir 1959; 84: 929-933
    PubMedSearch in Google Scholar
  • 45 Ebner A, Jiang C, Lindström S. Intravesical electrical stimulation--an experimental analysis of the mechanism of action. J Urol 1992; 148: 920-924
    CrossrefPubMedSearch in Google Scholar
  • 46 Huber ER, Kiss G, Berger T. et al. Der Stellenwert der intravesikalen Elektrostimulation in der Therapie der akuten prolongierten Blasenüberdehnung. Urologe A 2007; 46: 662-666
    CrossrefPubMedSearch in Google Scholar
  • 47 Liao L, Deng H, Chen G. et al. Randomized controlled trial of intravesical electrical stimulation for underactive bladder. BJU Int 2023; 131: 321-329
    CrossrefPubMedSearch in Google Scholar
  • 48 Hagerty JA, Richards I, Kaplan WE. Intravesical electrotherapy for neurogenic bladder dysfunction: a 22-year experience. J Urol 2007; 178: 1680-1683
    CrossrefPubMedSearch in Google Scholar
  • 49 Primus G, Kramer G, Pummer K. Restoration of micturition in patients with acontractile and hypocontractile detrusor by transurethral electrical bladder stimulation. Neurourol Urodyn 1996; 15: 489-497
    CrossrefPubMedSearch in Google Scholar
  • 50 Deng H, Liao L, Wu J. et al. Intravesical Electrical Stimulation Improves Abnormal Prefrontal Brain Activity in Patients With Underactive Bladder: A Possible Central Mechanism. Int Neurourol J 2023; 27: 260-270
    CrossrefPubMedSearch in Google Scholar