Pharmakotherapie der Belastungsinkontinenz (Stressinkontinenz)

Zusammenfassung

Harninkontinenz ist ein bei Frauen weit verbreitetes medizinisches und soziales Problem. Die Belastungsinkontinenz (auch Stressinkontinenz genannt) ist die bei Frauen am häufigsten vorkommende Form der Harninkontinenz und macht 49 % aller Inkontinenzfälle aus, einschließlich der Mischformen sogar 78 %. Bisher gibt es außer einer „Off-Label”-Therapie keine medikamentöse Behandlung.. Zum Beispiel werden Östrogene bei Patientinnen in der Menopause eingesetzt, obwohl ein ausreichender Effekt bei der Belastungsinkontinenz bisher nicht nachgewiesen wurde. Zur „Off-Label”-Therapie gehören auch a-Adrenergika wie Phenylpropanolamin und Midodrin und b-Adrenergika wie Clenbuterol. Eine Meta-Analyse von 15 randomisierten Studien mit Patientinnen, die a- oder b-Adrenergika erhielten, konnte aber gegenüber Plazebo keine bessere Wirksamkeit zeigen. Trizyklische Antidepressiva, wie Imipramin und Doxepin, werden ebenfalls zur „Off-Label”-Therapie bei der Belastungsinkontinenz eingesetzt, aber Plazebo-kontrollierte Studien existieren nicht. Der Serotonin-Noradrenalin-Aufnahmehemmer Duloxetin stellt einen neuen therapeutischen Ansatz in der Behandlung der Belastungsinkontinenz dar. Duloxetin zeigte in tierexperimentellen Studien positive Wirkungen auf Harnblase und Harnröhre , wahrscheinlich durch einen Angriffspunkt im Nukleus Onuf des Rückenmarks. In randomisierten, Plazebo-kontrollierten Studien der Phase II und III zeigte sich bei Frauen mit Belastungsinkontinenz eine signifikante und klinisch relevante Senkung der Harninkontinenzepisoden, sowie eine Verbesserung der Lebensqualität gegenüber Plazebo.

Summary

Female urinary incontinence is a medical and social problem with a large prevalence. Stress urinary incontinence (SUI) is the most common form of urinary incontinence and is responsible for 49 % of all incontinence, if mixed forms are included even for 78 %. As of yet, apart from „off-label” treatment, there is no pharmacological treatment available for stress urinary incontinence. For instance, estrogens are used in menopausal patients but a substantial effect in the treatment of SUI has not been demonstrated. a-Adrenergics, such as phenylpropanolamine and midodrine, and b-adrenergics, such as clenbuterol, are also used in „off-label” therapy. A recently conducted meta-analysis of 15 randomised studies with female patients who received a- und b-adrenergics as part of their therapy, failed to detect efficacy compared to placebo. Tricyclic antidepressives, such as imipramine and doxepine, which are used for the treatment of urge incontinence, are also used „off-label” in the treatment of SUI. However, no placebo-controlled studies have been conducted so far. The serotonin-norepinephrine reuptake inhibitor duloxetine represents a new therapeutic approach in the treatment of SUI. It has shown positive effects on bladder and urethra in animal experiments, most likely through an effect on the Onuf’s nucleus in the spinal cord. In randomised, placebo-controlled studies (phase II and III) in women with SUI, a significant and clinically relevant reduction in urinary incontinence episodes as well as an improvement in the quality of life compared to placebo was shown.

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