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Erschienen in: Die Urologie 8/2023

03.07.2023 | Benigne Prostatahyperplasie | Leitlinien der DGU

Diagnostik des benignen Prostatasyndroms

Die deutsche S2e-Leitlinie 2023 Teil 1

verfasst von: Prof. Dr. med. Dr. phil. Matthias Oelke, S. Dominik Abt, Klaus F. Becher, Kurt Dreikorn, Stephan Madersbacher, Giuseppe Magistro, Martin C. Michel, Rolf Muschter, Oliver Reich, Malte Rieken, Johannes Salem, Sandra Schönburg, Klaus Höfner, Thomas Bschleipfer

Erschienen in: Die Urologie | Ausgabe 8/2023

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Zusammenfassung

Hintergrund

Das benigne Prostatasyndrom (BPS) ist die häufigste urologische Erkrankung erwachsener Männer und kann zur erheblichen Beeinträchtigung der Lebensqualität beim Betroffenen führen. Das BPS besteht aus den individuell variabel vorliegenden Teilen benigne Prostatavergrößerung (BPE), Symptomen des unteren Harntrakts (LUTS) und Blasenauslassobstruktion (BOO) bzw. benigne Prostataobstruktion (BPO). Der Arbeitskreis BPS der Deutschen Gesellschaft für Urologie hat in seiner Neufassung die verschiedenen diagnostischen Verfahren einer eingehenden Prüfung und Bewertung unterzogen.

Ziel der Arbeit (Fragestellung)

Es handelt sich um die Darstellung und evidenzbasierte Bewertung der Tests zur Diagnostik des BPS.

Material und Methoden

Der Artikel fasst die Kap. 5, 6 und 8 der aktuellen Langfassung der deutschen S2e-Leitlinie zusammen.

Ergebnisse

Die Diagnostik soll klären, (1) ob die Beschwerden des Patienten dem BPS zuzuordnen sind, (2) wie das Ausmaß der Beschwerden ist und ob Behandlungsbedarf besteht, (3) ob bereits Komplikationen am unteren oder oberen Harntrakt eingetreten sind und (4) welche Therapieverfahren infrage kommen. Die Basisdiagnostik soll bei allen Patienten mit BPS durchgeführt werden und besteht aus Anamnese, Messung der Symptomatik und Lebensqualität, Urinanalyse, prostataspezifisches Antigen, Restharnmessung, Sonographie des unteren Harntrakts mit Messung des Prostatavolumens, der intravesikalen prostatischen Protrusion und der Detrusordicke sowie der Sonographie des oberen Harntrakts. Die weiterführende Diagnostik sollte dann erfolgen, wenn mit der Basisdiagnostik nicht alle Fragestellungen beantwortet werden konnten. Zu diesen fakultativen Untersuchungen zählen Blasentagebuch, Uroflowmetrie, Kreatininkonzentration im Serum, urologische Endoskopie, weitere noninvasive Tests wie Penismanschettentest, Kondomkathetermethode und Nahinfrarotspektroskopie sowie andere bildgebende Verfahren wie Röntgenuntersuchungen und Magnetresonanztomographie.

Schlussfolgerungen

Die aktualisierte deutsche S2e-Leitlinie fasst die Empfehlungen zur evidenzbasierten Diagnostik des BPS zusammen, inklusive deren Teilkomponenten BPE, LUTS und BOO/BPO.
Literatur
1.
Zurück zum Zitat Abrams PH, Griffiths DJ (1979) The assessment of prostatic obstruction from urodynamic measurements and from residual urine. Br J Urol 51(2):129–134PubMed Abrams PH, Griffiths DJ (1979) The assessment of prostatic obstruction from urodynamic measurements and from residual urine. Br J Urol 51(2):129–134PubMed
2.
Zurück zum Zitat Anderson JB, Grant JB (1991) Postoperative retention of urine: a prospective urodynamic study. BMJ 302(6781):894–896PubMedPubMedCentral Anderson JB, Grant JB (1991) Postoperative retention of urine: a prospective urodynamic study. BMJ 302(6781):894–896PubMedPubMedCentral
3.
Zurück zum Zitat Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) (2020) AWMF-Regelwerk „Leitlinien“, 2. Aufl. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) (2020) AWMF-Regelwerk „Leitlinien“, 2. Aufl.
5.
Zurück zum Zitat Badia X, Garcia-Losa M, Dal-Re R (1997) Ten-language translation and harmonization of the international prostate symptom score: developing a methodology for multinational clinical trials. Eur Urol 31(2):129–140PubMed Badia X, Garcia-Losa M, Dal-Re R (1997) Ten-language translation and harmonization of the international prostate symptom score: developing a methodology for multinational clinical trials. Eur Urol 31(2):129–140PubMed
6.
Zurück zum Zitat Blanker MH, Bohnen AM, Groeneveld FP et al (2000) Normal voiding patterns and determinants of increased diurnal and nocturnal voiding frequency in elderly men. J Urol 164(4):1201–1205PubMed Blanker MH, Bohnen AM, Groeneveld FP et al (2000) Normal voiding patterns and determinants of increased diurnal and nocturnal voiding frequency in elderly men. J Urol 164(4):1201–1205PubMed
7.
Zurück zum Zitat Bliwise DL, Wagg A, Sand PK (2019) Nocturia: a highly prevalent disorder with multifaceted consequences. Urology 133s:3–13PubMed Bliwise DL, Wagg A, Sand PK (2019) Nocturia: a highly prevalent disorder with multifaceted consequences. Urology 133s:3–13PubMed
8.
Zurück zum Zitat Boushel R, Piantadosi CA (2000) Near-infrared spectroscopy for monitoring muscle oxygenation. Acta Physiol Scand 168(4):615–622PubMed Boushel R, Piantadosi CA (2000) Near-infrared spectroscopy for monitoring muscle oxygenation. Acta Physiol Scand 168(4):615–622PubMed
9.
Zurück zum Zitat Bradley CS, Erickson BA, Messersmith EE et al (2017) Evidence of the impact of diet, fluid intake, caffeine, alcohol and tobacco on lower urinary tract symptoms: a systematic review. J Urol 198(5):1010–1020PubMedPubMedCentral Bradley CS, Erickson BA, Messersmith EE et al (2017) Evidence of the impact of diet, fluid intake, caffeine, alcohol and tobacco on lower urinary tract symptoms: a systematic review. J Urol 198(5):1010–1020PubMedPubMedCentral
10.
Zurück zum Zitat Brookman-May S, Burger M, Hoschke B et al (2010) Association between residual urinary volume and urinary tract infection: prospective trial in 225 male patients. Urologe A 49(9):1163–1168PubMed Brookman-May S, Burger M, Hoschke B et al (2010) Association between residual urinary volume and urinary tract infection: prospective trial in 225 male patients. Urologe A 49(9):1163–1168PubMed
11.
Zurück zum Zitat Chakraborty A, Vashisht S, Gupta NP, Berry M (1990) Transrectal ultrasonic volume determination of the prostate—a pre and postoperative study. Indian J Radiol Imaging 44(1):37–39 Chakraborty A, Vashisht S, Gupta NP, Berry M (1990) Transrectal ultrasonic volume determination of the prostate—a pre and postoperative study. Indian J Radiol Imaging 44(1):37–39
12.
Zurück zum Zitat Chia SJ, Heng CT, Chan SP, Foo KT (2003) Correlation of intravesical prostatic protrusion with bladder outlet obstruction. BJU Int 91(4):371–374PubMed Chia SJ, Heng CT, Chan SP, Foo KT (2003) Correlation of intravesical prostatic protrusion with bladder outlet obstruction. BJU Int 91(4):371–374PubMed
13.
Zurück zum Zitat Cumpanas AA, Botoca M, Minciu R, Bucuras V (2013) Intravesical prostatic protrusion can be a predicting factor for the treatment outcome in patients with lower urinary tract symptoms due to benign prostatic obstruction treated with tamsulosin. Urology 81(4):859–863PubMed Cumpanas AA, Botoca M, Minciu R, Bucuras V (2013) Intravesical prostatic protrusion can be a predicting factor for the treatment outcome in patients with lower urinary tract symptoms due to benign prostatic obstruction treated with tamsulosin. Urology 81(4):859–863PubMed
14.
Zurück zum Zitat D’Ancona C, Haylen B, Oelke M et al (2019) The international continence society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn 38(2):433–477PubMed D’Ancona C, Haylen B, Oelke M et al (2019) The international continence society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn 38(2):433–477PubMed
15.
Zurück zum Zitat Eckhardt MD, van Venrooij GE, van Melick HH, Boon TA (2001) Prevalence and bothersomeness of lower urinary tract symptoms in benign prostatic hyperplasia and their impact on well-being. J Urol 166(2):563–568PubMed Eckhardt MD, van Venrooij GE, van Melick HH, Boon TA (2001) Prevalence and bothersomeness of lower urinary tract symptoms in benign prostatic hyperplasia and their impact on well-being. J Urol 166(2):563–568PubMed
16.
Zurück zum Zitat ElSaied W, Mosharafa A, ElFayoumy H et al (2013) Detrusor wall thickness compared to other non-invasive methods in diagnosing men with bladder outlet obstruction: a prospective controlled study. Afr J Urol 19(4):160–164 ElSaied W, Mosharafa A, ElFayoumy H et al (2013) Detrusor wall thickness compared to other non-invasive methods in diagnosing men with bladder outlet obstruction: a prospective controlled study. Afr J Urol 19(4):160–164
17.
Zurück zum Zitat Egilmez T, Pourbagher MA, Guvel S et al (2006) Effects of selective alpha-1-adrenergic receptor blockers on bladder weight. Urol Int 76(1):42–50PubMed Egilmez T, Pourbagher MA, Guvel S et al (2006) Effects of selective alpha-1-adrenergic receptor blockers on bladder weight. Urol Int 76(1):42–50PubMed
18.
Zurück zum Zitat el Din KE, de Wildt MJ, Rosier PF et al (1996) The correlation between urodynamic and cystoscopic findings in elderly men with voiding complaints. J Urol 155:1018–1022PubMed el Din KE, de Wildt MJ, Rosier PF et al (1996) The correlation between urodynamic and cystoscopic findings in elderly men with voiding complaints. J Urol 155:1018–1022PubMed
19.
Zurück zum Zitat Eze BU, Mbaeri TU, Oranusi KC et al (2019) Correlation between intravesical prostatic protrusion and international prostate symptom score among Nigerian men with benign prostatic hyperplasia. Niger J Clin Pract 22(4):454–459PubMed Eze BU, Mbaeri TU, Oranusi KC et al (2019) Correlation between intravesical prostatic protrusion and international prostate symptom score among Nigerian men with benign prostatic hyperplasia. Niger J Clin Pract 22(4):454–459PubMed
20.
Zurück zum Zitat Feng KK, Chiang IN, Huang CY, Pu YS (2017) Analysis of transrectal and suprapubic ultrasonography for prostate size evaluation. Urol Sci 28(3):166–168 Feng KK, Chiang IN, Huang CY, Pu YS (2017) Analysis of transrectal and suprapubic ultrasonography for prostate size evaluation. Urol Sci 28(3):166–168
21.
Zurück zum Zitat Flanigan RC, Reda DJ, Wasson JH et al (1998) 5‑year outcome of surgical resection and watchful waiting for men with moderately symptomatic benign prostatic hyperplasia: a department of veterans affairs cooperative study. J Urol 160(1):12–16PubMed Flanigan RC, Reda DJ, Wasson JH et al (1998) 5‑year outcome of surgical resection and watchful waiting for men with moderately symptomatic benign prostatic hyperplasia: a department of veterans affairs cooperative study. J Urol 160(1):12–16PubMed
22.
Zurück zum Zitat Gabuev A, Oelke M (2011) Latest trends and recommendations on epidemiology, assessment, and treatment of benign prostatic hyperplasia (BPH). Aktuelle Urol 42:167–178PubMed Gabuev A, Oelke M (2011) Latest trends and recommendations on epidemiology, assessment, and treatment of benign prostatic hyperplasia (BPH). Aktuelle Urol 42:167–178PubMed
23.
Zurück zum Zitat Harding CK, Robson W, Drinnan MJ et al (2004) An automated penile compression release maneuver as a noninvasive test for diagnosis of bladder outlet obstruction. J Urol 172(6):2312–2315PubMed Harding CK, Robson W, Drinnan MJ et al (2004) An automated penile compression release maneuver as a noninvasive test for diagnosis of bladder outlet obstruction. J Urol 172(6):2312–2315PubMed
24.
Zurück zum Zitat Hirayama K, Masui K, Hamada A et al (2015) Evaluation of intravesical prostatic protrusion as a predictor of dutasteride-resistant lower urinary tract symptoms/benign prostatic enlargement with a high likelihood of surgical intervention. Urology 86(3):565–569PubMed Hirayama K, Masui K, Hamada A et al (2015) Evaluation of intravesical prostatic protrusion as a predictor of dutasteride-resistant lower urinary tract symptoms/benign prostatic enlargement with a high likelihood of surgical intervention. Urology 86(3):565–569PubMed
25.
Zurück zum Zitat Ho CC, Ngoo KS, Hamzaini AH et al (2014) Urinary bladder characteristics via ultrasound as predictors of acute urinary retention in men with benign prostatic hyperplasia. Clin Ther 165(2):75–81 Ho CC, Ngoo KS, Hamzaini AH et al (2014) Urinary bladder characteristics via ultrasound as predictors of acute urinary retention in men with benign prostatic hyperplasia. Clin Ther 165(2):75–81
26.
Zurück zum Zitat Höfner K, Bach T, Berges R et al (2016) S2e guideline of the German urologists: conservative and pharmacologic treatment of benign prostatic hyperplasia. Urologe A 55(2):184–194PubMed Höfner K, Bach T, Berges R et al (2016) S2e guideline of the German urologists: conservative and pharmacologic treatment of benign prostatic hyperplasia. Urologe A 55(2):184–194PubMed
27.
Zurück zum Zitat Huang Foen Chung JW, de Vries SH, Raaijmakers R et al (2004) Prostate volume ultrasonography: the influence of transabdominal versus transrectal approach, device type and operator. Eur Urol 46(3):352–356PubMed Huang Foen Chung JW, de Vries SH, Raaijmakers R et al (2004) Prostate volume ultrasonography: the influence of transabdominal versus transrectal approach, device type and operator. Eur Urol 46(3):352–356PubMed
28.
Zurück zum Zitat Huang Foen Chung JW, Bohnen AM, Pel JJ et al (2004) Applicability and reproducibility of condom catheter method for measuring isovolumetric bladder pressure. Urology 63(1):56–60PubMed Huang Foen Chung JW, Bohnen AM, Pel JJ et al (2004) Applicability and reproducibility of condom catheter method for measuring isovolumetric bladder pressure. Urology 63(1):56–60PubMed
29.
Zurück zum Zitat Huang W, Cao JJ, Cao M et al (2017) Risk factors for bladder calculi in patients with benign prostatic hyperplasia. Medicine 96(32):e7728PubMedPubMedCentral Huang W, Cao JJ, Cao M et al (2017) Risk factors for bladder calculi in patients with benign prostatic hyperplasia. Medicine 96(32):e7728PubMedPubMedCentral
30.
Zurück zum Zitat Ito K, Takashima Y, Akamatsu S et al (2018) Intravesical prostatic protrusion is not always the same shape: evaluation by preoperative cystoscopy and outcome in hoLEP. Neurourol Urodyn 37(7):2160–2166PubMed Ito K, Takashima Y, Akamatsu S et al (2018) Intravesical prostatic protrusion is not always the same shape: evaluation by preoperative cystoscopy and outcome in hoLEP. Neurourol Urodyn 37(7):2160–2166PubMed
31.
Zurück zum Zitat Jensen KM, Jorgensen TB, Mogensen P (1996) Long-term predictive role of urodynamics: an 8‑year follow-up of prostatic surgery for lower urinary tract symptoms. Br J Urol 78(2):213–218PubMed Jensen KM, Jorgensen TB, Mogensen P (1996) Long-term predictive role of urodynamics: an 8‑year follow-up of prostatic surgery for lower urinary tract symptoms. Br J Urol 78(2):213–218PubMed
32.
Zurück zum Zitat Kalkanli A, Tandogdu Z, Aydin M et al (2016) Intravesical prostatic protrusion: a potential marker of alpha-blocker treatment success in patients with benign prostatic enlargement. Urology 88:161–165PubMed Kalkanli A, Tandogdu Z, Aydin M et al (2016) Intravesical prostatic protrusion: a potential marker of alpha-blocker treatment success in patients with benign prostatic enlargement. Urology 88:161–165PubMed
33.
Zurück zum Zitat Kessler TM, Gerber R, Burkhard FC et al (2006) Ultrasound assessment of detrusor thickness in men—can it predict bladder outlet obstruction and replace pressure flow study? J Urol 175(6):2170–2173PubMed Kessler TM, Gerber R, Burkhard FC et al (2006) Ultrasound assessment of detrusor thickness in men—can it predict bladder outlet obstruction and replace pressure flow study? J Urol 175(6):2170–2173PubMed
34.
Zurück zum Zitat Kim M, Jeong CW, Oh SJ (2017) Diagnostic value of urodynamic bladder outlet obstruction to select patients for transurethral surgery of the prostate: systematic review and meta-analysis. PLoS One 12(2):e172590PubMedPubMedCentral Kim M, Jeong CW, Oh SJ (2017) Diagnostic value of urodynamic bladder outlet obstruction to select patients for transurethral surgery of the prostate: systematic review and meta-analysis. PLoS One 12(2):e172590PubMedPubMedCentral
35.
Zurück zum Zitat Kim JW, Oh MM, Park HS et al (2014) Intravesical prostatic protrusion is a risk factor for bladder stone in patients with benign prostatic hyperplasia. Urology 84(5):1026–1029PubMed Kim JW, Oh MM, Park HS et al (2014) Intravesical prostatic protrusion is a risk factor for bladder stone in patients with benign prostatic hyperplasia. Urology 84(5):1026–1029PubMed
36.
Zurück zum Zitat Kim MS, Park KK, Chung BH, Lee SH (2013) Effect of photoselective vaporization prostatectomy on lower urinary tract symptoms in benign prostatic hyperplasia with or without intravesical prostatic protrusion. Korean J Urol 54(1):36–41PubMedPubMedCentral Kim MS, Park KK, Chung BH, Lee SH (2013) Effect of photoselective vaporization prostatectomy on lower urinary tract symptoms in benign prostatic hyperplasia with or without intravesical prostatic protrusion. Korean J Urol 54(1):36–41PubMedPubMedCentral
37.
Zurück zum Zitat Knutson T, Edlund C, Fall M, Dahlstrand C (2001) BPH with coexisting overactive bladder dysfunction—an everyday urological dilemma. Neurourol Urodyn 20(3):237–247PubMed Knutson T, Edlund C, Fall M, Dahlstrand C (2001) BPH with coexisting overactive bladder dysfunction—an everyday urological dilemma. Neurourol Urodyn 20(3):237–247PubMed
38.
Zurück zum Zitat Kojima M, Inui E, Ochiai A et al (1996) Ultrasonic estimation of bladder weight as a measure of bladder hypertrophy in men with infravesical obstruction: a preliminary report. Urology 47(6):942–947PubMed Kojima M, Inui E, Ochiai A et al (1996) Ultrasonic estimation of bladder weight as a measure of bladder hypertrophy in men with infravesical obstruction: a preliminary report. Urology 47(6):942–947PubMed
39.
Zurück zum Zitat Koch WF, Ezz el Din K, de Wildt MJ et al (1996) The outcome of renal ultrasound in the assessment of 556 consecutive patients with benign prostatic hyperplasia. J Urol 155(1):186–189PubMed Koch WF, Ezz el Din K, de Wildt MJ et al (1996) The outcome of renal ultrasound in the assessment of 556 consecutive patients with benign prostatic hyperplasia. J Urol 155(1):186–189PubMed
40.
Zurück zum Zitat Kupelian AS, Horsley H, Khasriya R et al (2013) Discrediting microscopic pyuria and leucocyte esterase as diagnostic surrogates for infection in patients with lower urinary tract symptoms: results from a clinical and laboratory evaluation. BJU Int 112(2):231–238PubMed Kupelian AS, Horsley H, Khasriya R et al (2013) Discrediting microscopic pyuria and leucocyte esterase as diagnostic surrogates for infection in patients with lower urinary tract symptoms: results from a clinical and laboratory evaluation. BJU Int 112(2):231–238PubMed
41.
Zurück zum Zitat Lebdai S, Ammi M, Bigot P et al (2014) Clinical impact of the intravesical prostatic protrusion: a review by the LUTS committee of the French urological association. Prog Urol 24(5):313–318PubMed Lebdai S, Ammi M, Bigot P et al (2014) Clinical impact of the intravesical prostatic protrusion: a review by the LUTS committee of the French urological association. Prog Urol 24(5):313–318PubMed
42.
Zurück zum Zitat Lee H, Choo M, Kim M et al (2014) Changes in bladder wall thickness and detrusor wall thickness after surgical treatment of benign prostatic enlargement in patients with lower urinary tract symptoms: a preliminary report. Korean J Urol 55(1):47–51PubMedPubMedCentral Lee H, Choo M, Kim M et al (2014) Changes in bladder wall thickness and detrusor wall thickness after surgical treatment of benign prostatic enlargement in patients with lower urinary tract symptoms: a preliminary report. Korean J Urol 55(1):47–51PubMedPubMedCentral
43.
Zurück zum Zitat Lee LS, Sim HG, Lim KB et al (2010) Intravesical prostatic protrusion predicts clinical progression of benign prostatic enlargement in patients receiving medical treatment. Int J Urol 17(1):69–74PubMed Lee LS, Sim HG, Lim KB et al (2010) Intravesical prostatic protrusion predicts clinical progression of benign prostatic enlargement in patients receiving medical treatment. Int J Urol 17(1):69–74PubMed
44.
Zurück zum Zitat Levin RM, Haugaard N, O’Connor L et al (2000) Obstructive response of human bladder to BPH vs. rabbit bladder response to partial outlet obstruction: a direct comparison. Neurourol Urodyn 19(5):609–629PubMed Levin RM, Haugaard N, O’Connor L et al (2000) Obstructive response of human bladder to BPH vs. rabbit bladder response to partial outlet obstruction: a direct comparison. Neurourol Urodyn 19(5):609–629PubMed
45.
Zurück zum Zitat Liu Q, Zhu Y, Liu J et al (2017) Ultrasound image features of intravesical prostatic protrusion indicated failure of medication therapy of finasteride and doxazosin in patients with benign prostatic hyperplasia (LUTS/BPH). Int Urol Nephrol 49(3):399–404PubMed Liu Q, Zhu Y, Liu J et al (2017) Ultrasound image features of intravesical prostatic protrusion indicated failure of medication therapy of finasteride and doxazosin in patients with benign prostatic hyperplasia (LUTS/BPH). Int Urol Nephrol 49(3):399–404PubMed
46.
Zurück zum Zitat Machino R, Kakizaki H, Ameda K et al (2002) Detrusor instability with equivocal obstruction: a predictor of unfavorable symptomatic outcomes after transurethral prostatectomy. Neurourol Urodyn 21(5):444–449PubMed Machino R, Kakizaki H, Ameda K et al (2002) Detrusor instability with equivocal obstruction: a predictor of unfavorable symptomatic outcomes after transurethral prostatectomy. Neurourol Urodyn 21(5):444–449PubMed
47.
Zurück zum Zitat Macnab AJ, Stothers L (2008) Development of a near-infrared spectroscopy instrument for applications in urology. Can J Urol 15(5):4233–4240PubMed Macnab AJ, Stothers L (2008) Development of a near-infrared spectroscopy instrument for applications in urology. Can J Urol 15(5):4233–4240PubMed
48.
Zurück zum Zitat Madersbacher S, Pycha A, Schatzl G et al (1998) The aging lower urinary tract: a comparative urodynamic study of men and women. Urology 51(2):206–212PubMed Madersbacher S, Pycha A, Schatzl G et al (1998) The aging lower urinary tract: a comparative urodynamic study of men and women. Urology 51(2):206–212PubMed
49.
Zurück zum Zitat Malde S, Nambiar AK, Umbach R et al (2017) Systematic review of the performance of noninvasive tests in diagnosing bladder outlet obstruction in men with lower urinary tract symptoms. Eur Urol 71(3):391–402PubMed Malde S, Nambiar AK, Umbach R et al (2017) Systematic review of the performance of noninvasive tests in diagnosing bladder outlet obstruction in men with lower urinary tract symptoms. Eur Urol 71(3):391–402PubMed
50.
Zurück zum Zitat Marberger MJ, Andersen JT, Nickel JC et al (2000) Prostate volume and serum prostate-specific antigen as predictors of acute urinary retention. Combined experience from three large multinational placebo-controlled trials. Eur Urol 38(5):563–568PubMed Marberger MJ, Andersen JT, Nickel JC et al (2000) Prostate volume and serum prostate-specific antigen as predictors of acute urinary retention. Combined experience from three large multinational placebo-controlled trials. Eur Urol 38(5):563–568PubMed
51.
Zurück zum Zitat Matthiesen TB, Rittig S, Mortensen JT, Djurhuus JC (1999) Nocturia and polyuria in men referred with lower urinary tract symptoms, assessed using a 7-day frequency-volume chart. BJU Int 83(9):1017–1022PubMed Matthiesen TB, Rittig S, Mortensen JT, Djurhuus JC (1999) Nocturia and polyuria in men referred with lower urinary tract symptoms, assessed using a 7-day frequency-volume chart. BJU Int 83(9):1017–1022PubMed
52.
Zurück zum Zitat McConnell JD, Roehrborn CG, Bautista O et al (2003) The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 349(25):2387–2398PubMed McConnell JD, Roehrborn CG, Bautista O et al (2003) The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 349(25):2387–2398PubMed
53.
Zurück zum Zitat Miyashita H, Kojima M, Miki T (2002) Ultrasonic measurement of bladder weight as a possible predictor of acute urinary retention in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Ultrasound Med Biol 28(8):985–990PubMed Miyashita H, Kojima M, Miki T (2002) Ultrasonic measurement of bladder weight as a possible predictor of acute urinary retention in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Ultrasound Med Biol 28(8):985–990PubMed
54.
Zurück zum Zitat Mochtar CA, Kiemeneyn LA, van Riemsdijk MM et al (2003) Prostate-specific antigen as an estimator of prostate volume in the management of patients with symptomatic benign prostatic hyperplasia. Eur Urol 44(6):695–700PubMed Mochtar CA, Kiemeneyn LA, van Riemsdijk MM et al (2003) Prostate-specific antigen as an estimator of prostate volume in the management of patients with symptomatic benign prostatic hyperplasia. Eur Urol 44(6):695–700PubMed
55.
Zurück zum Zitat Mochtar CA, Kiemeney LA, van Riemsdijk MM et al (2006) Post-void residual urine volume is not a good predictor of the need for invasive therapy among patients with benign prostatic hyperplasia. J Urol 175(1):213–216PubMed Mochtar CA, Kiemeney LA, van Riemsdijk MM et al (2006) Post-void residual urine volume is not a good predictor of the need for invasive therapy among patients with benign prostatic hyperplasia. J Urol 175(1):213–216PubMed
56.
Zurück zum Zitat Oelke M, Höfner K, Wiese B et al (2002) Increase in detrusor wall thickness indicates bladder outlet obstruction (BOO) in men. World J Urol 19(6):443–452PubMed Oelke M, Höfner K, Wiese B et al (2002) Increase in detrusor wall thickness indicates bladder outlet obstruction (BOO) in men. World J Urol 19(6):443–452PubMed
57.
Zurück zum Zitat Oelke M, Höfner K, Jonas U et al (2006) Ultrasound measurement of detrusor wall thickness in healthy adults. Neurourol Urodyn 25:308–317PubMed Oelke M, Höfner K, Jonas U et al (2006) Ultrasound measurement of detrusor wall thickness in healthy adults. Neurourol Urodyn 25:308–317PubMed
58.
Zurück zum Zitat Oelke M, Höfner K, Jonas U et al (2007) Diagnostic accuracy of noninvasive tests to evaluate bladder outlet obstruction in men: detrusor wall thickness, uroflowmetry, postvoid residual urine, and prostate volume. Eur Urol 52(3):827–835PubMed Oelke M, Höfner K, Jonas U et al (2007) Diagnostic accuracy of noninvasive tests to evaluate bladder outlet obstruction in men: detrusor wall thickness, uroflowmetry, postvoid residual urine, and prostate volume. Eur Urol 52(3):827–835PubMed
59.
Zurück zum Zitat Oelke M, Baard J, Wijkstra H et al (2008) Age and bladder outlet obstruction are independently associated with detrusor overactivity in patients with benign prostatic hyperplasia. Eur Urol 54(2):419–426PubMed Oelke M, Baard J, Wijkstra H et al (2008) Age and bladder outlet obstruction are independently associated with detrusor overactivity in patients with benign prostatic hyperplasia. Eur Urol 54(2):419–426PubMed
60.
Zurück zum Zitat Oelke M, Kirschner-Hermanns R, Thiruchelvam N, Heesakkers J (2012) Can we identify men who will have complications from benign prostatic obstruction (BPO)? ICI-RS 2011. Neurourol Urodyn 31(3):322–326PubMed Oelke M, Kirschner-Hermanns R, Thiruchelvam N, Heesakkers J (2012) Can we identify men who will have complications from benign prostatic obstruction (BPO)? ICI-RS 2011. Neurourol Urodyn 31(3):322–326PubMed
61.
Zurück zum Zitat Oelke M, Wiese B, Berges R (2014) Nocturia and its impact on health related quality of life and health care seeking behaviour in German community-dwelling men aged 50 years or older. World J Urol 32(5):1155–1162PubMed Oelke M, Wiese B, Berges R (2014) Nocturia and its impact on health related quality of life and health care seeking behaviour in German community-dwelling men aged 50 years or older. World J Urol 32(5):1155–1162PubMed
62.
Zurück zum Zitat Pel JJ, van Mastrigt R (2001) The variable outflow resistance catheter: a new method to measure bladder pressure noninvasively. J Urol 165(2):647–652PubMed Pel JJ, van Mastrigt R (2001) The variable outflow resistance catheter: a new method to measure bladder pressure noninvasively. J Urol 165(2):647–652PubMed
63.
Zurück zum Zitat Pel JJ, Bosch JL, Blom JH et al (2002) Development of a non-invasive strategy to classify bladder outlet obstruction in male patients with LUTS. Neurourol Urodyn 21(2):117–125PubMed Pel JJ, Bosch JL, Blom JH et al (2002) Development of a non-invasive strategy to classify bladder outlet obstruction in male patients with LUTS. Neurourol Urodyn 21(2):117–125PubMed
64.
Zurück zum Zitat Rafique M (2006) Value of routine renal and abdominal ultrasonography in patients undergoing prostatectomy. Int Urol Nephrol 38(1):153–156PubMed Rafique M (2006) Value of routine renal and abdominal ultrasonography in patients undergoing prostatectomy. Int Urol Nephrol 38(1):153–156PubMed
65.
Zurück zum Zitat Riehmann M, Goetzman B, Langer E et al (1994) Risk factors for bacteriuria in men. Urology 43(5):617–620PubMed Riehmann M, Goetzman B, Langer E et al (1994) Risk factors for bacteriuria in men. Urology 43(5):617–620PubMed
66.
Zurück zum Zitat Rieken M, Presicce F, Autorino R, Denunzio C (2017) Clinical significance of intravesical prostatic protrusion in the management of benign prostatic enlargement: a systematic review and critical analysis of current evidence. Minerva Urol Nefrol 69(6):548–555PubMed Rieken M, Presicce F, Autorino R, Denunzio C (2017) Clinical significance of intravesical prostatic protrusion in the management of benign prostatic enlargement: a systematic review and critical analysis of current evidence. Minerva Urol Nefrol 69(6):548–555PubMed
67.
Zurück zum Zitat Roehrborn CG, Andersen JT, Correa R et al (1996) Initial diagnostic evaluation of men with lower urinary tract symptoms. Scientific Communication International Ltd, S 167–254 (Proceedings of the Third International Consultation on Benign prostatic hyperplasia (BPH)) Roehrborn CG, Andersen JT, Correa R et al (1996) Initial diagnostic evaluation of men with lower urinary tract symptoms. Scientific Communication International Ltd, S 167–254 (Proceedings of the Third International Consultation on Benign prostatic hyperplasia (BPH))
68.
Zurück zum Zitat Roehrborn CG, Girman CJ, Rhodes T et al (1997) Correlation between prostate size estimated by digital rectal examination and measured by transrectal ultrasound. Urology 49(4):548–557PubMed Roehrborn CG, Girman CJ, Rhodes T et al (1997) Correlation between prostate size estimated by digital rectal examination and measured by transrectal ultrasound. Urology 49(4):548–557PubMed
69.
Zurück zum Zitat Roehrborn CG, Boyle P, Bergner D et al (1999) Serum prostate-specific antigen and prostate volume predict long-term changes in symptoms and flow rate: results of a four-year, randomized trial comparing finasteride versus placebo. PLESS study group. Urology 54(4):662–669PubMed Roehrborn CG, Boyle P, Bergner D et al (1999) Serum prostate-specific antigen and prostate volume predict long-term changes in symptoms and flow rate: results of a four-year, randomized trial comparing finasteride versus placebo. PLESS study group. Urology 54(4):662–669PubMed
70.
Zurück zum Zitat Roehrborn CG, McConnell J, Bonilla J et al (2000) Serum prostate specific antigen is a strong predictor of future prostate growth in men with benign prostatic hyperplasia. PROSCAR long-term efficacy and safety study. J Urol 163(1):13–20PubMed Roehrborn CG, McConnell J, Bonilla J et al (2000) Serum prostate specific antigen is a strong predictor of future prostate growth in men with benign prostatic hyperplasia. PROSCAR long-term efficacy and safety study. J Urol 163(1):13–20PubMed
71.
Zurück zum Zitat Roehrborn CG (2006) Definition of at-risk patients: baseline variables. BJU Int 97(2):7–11PubMed Roehrborn CG (2006) Definition of at-risk patients: baseline variables. BJU Int 97(2):7–11PubMed
72.
Zurück zum Zitat Rule AD, Lieber MM, Jacobsen SJ (2005) Is benign prostatic hyperplasia a risk factor for chronic renal failure? J Urol 173(3):691–696PubMed Rule AD, Lieber MM, Jacobsen SJ (2005) Is benign prostatic hyperplasia a risk factor for chronic renal failure? J Urol 173(3):691–696PubMed
74.
Zurück zum Zitat Thomas AW, Cannon A, Bartlett E et al (2004) The natural history of lower urinary tract dysfunction in men: the influence of detrusor underactivity on the outcome after transurethral resection of the prostate with a minimum 10-year urodynamic follow-up. BJU Int 93(6):745–750PubMed Thomas AW, Cannon A, Bartlett E et al (2004) The natural history of lower urinary tract dysfunction in men: the influence of detrusor underactivity on the outcome after transurethral resection of the prostate with a minimum 10-year urodynamic follow-up. BJU Int 93(6):745–750PubMed
75.
Zurück zum Zitat Topazio L, Perugia C, De Nunzio C et al (2018) Intravescical prostatic protrusion is a predictor of alpha blockers response: results from an observational study. BMC Urol 18(1):6PubMedPubMedCentral Topazio L, Perugia C, De Nunzio C et al (2018) Intravescical prostatic protrusion is a predictor of alpha blockers response: results from an observational study. BMC Urol 18(1):6PubMedPubMedCentral
76.
Zurück zum Zitat Tubaro A, Carter S, Hind A et al (2001) A prospective study of the safety and efficacy of suprapubic transvesical prostatectomy in patients with benign prostatic hyperplasia. J Urol 166(1):172–176PubMed Tubaro A, Carter S, Hind A et al (2001) A prospective study of the safety and efficacy of suprapubic transvesical prostatectomy in patients with benign prostatic hyperplasia. J Urol 166(1):172–176PubMed
77.
Zurück zum Zitat Verhamme KM, Sturkenboom MC, Stricker BH, Bosch R (2008) Drug-induced urinary retention: incidence, management and prevention. Drug Saf 31(5):373–388PubMed Verhamme KM, Sturkenboom MC, Stricker BH, Bosch R (2008) Drug-induced urinary retention: incidence, management and prevention. Drug Saf 31(5):373–388PubMed
78.
Zurück zum Zitat Yoshida T, Kinoshita H, Yoshida K et al (2016) Intravesical prostatic protrusion as a predicting factor for the adverse clinical outcome in patients with symptomatic benign prostatic enlargement treated with dutasteride. Urology 91:154–157PubMed Yoshida T, Kinoshita H, Yoshida K et al (2016) Intravesical prostatic protrusion as a predicting factor for the adverse clinical outcome in patients with symptomatic benign prostatic enlargement treated with dutasteride. Urology 91:154–157PubMed
79.
Zurück zum Zitat Yuen JS, Ngiap JT, Cheng CW, Foo KT (2002) Effects of bladder volume on transabdominal ultrasound measurements of intravesical prostatic protrusion and volume. Int J Urol 9(4):225–229PubMed Yuen JS, Ngiap JT, Cheng CW, Foo KT (2002) Effects of bladder volume on transabdominal ultrasound measurements of intravesical prostatic protrusion and volume. Int J Urol 9(4):225–229PubMed
Metadaten
Titel
Diagnostik des benignen Prostatasyndroms
Die deutsche S2e-Leitlinie 2023 Teil 1
verfasst von
Prof. Dr. med. Dr. phil. Matthias Oelke
S. Dominik Abt
Klaus F. Becher
Kurt Dreikorn
Stephan Madersbacher
Giuseppe Magistro
Martin C. Michel
Rolf Muschter
Oliver Reich
Malte Rieken
Johannes Salem
Sandra Schönburg
Klaus Höfner
Thomas Bschleipfer
Publikationsdatum
03.07.2023
Verlag
Springer Medizin
Erschienen in
Die Urologie / Ausgabe 8/2023
Print ISSN: 2731-7064
Elektronische ISSN: 2731-7072
DOI
https://doi.org/10.1007/s00120-023-02142-0

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