Skip to main content
Erschienen in: Die Urologie 10/2023

04.10.2023 | Benigne Prostatahyperplasie | Leitlinien der DGU

Konservative und medikamentöse Therapie des benignen Prostatasyndroms

Die deutsche S2e-Leitlinie 2023 – Teil 2

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

Erschienen in: Die Urologie | Ausgabe 10/2023

Einloggen, um Zugang zu erhalten

Zusammenfassung

Hintergrund

Das benigne Prostatasyndrom (BPS) gilt als häufigste Erkrankung des unteren Harntrakts beim Mann und kann enormen Einfluss auf die Lebensqualität der betroffenen Patienten nehmen. Der konservativen und medikamentösen Therapie dieser Erkrankung wird dabei ein großer Stellenwert zugeschrieben, sowohl bei Verbesserung der Symptomatik als auch bei der Reduktion progressionsbedingter Komplikationen.

Ziel der Arbeit (Fragestellung)

Es handelt sich um die Darstellung der konservativen und medikamentösen Therapieoptionen entsprechend der aktuellen deutschen S2e-Leitlinie zur Diagnostik und Therapie des BPS.

Material und Methoden

Der Artikel fasst die Kapitel 9 und 10 der aktuellen deutschen S2e-Leitlinie zusammen.

Ergebnisse

Neben einem kontrollierten Zuwarten steht BPS-Patienten ohne absolute Indikation zur Prostataoperation eine Vielzahl an phytopharmakologischen Präparaten und synthetischen Medikamenten entsprechend der Symptomatik und dem klinischen Verlauf zur Verfügung. Pflanzliche Produkte sollten aufgrund inkonsistenter Studiendaten lediglich bei leichten oder moderaten Symptomen in Erwägung gezogen werden. Als synthetische Medikamente kommen Alpha-Blocker, 5α-Reduktasehemmer, Phosphodiesterasehemmer und Antimuskarinika in Frage; der β3-Agonist Mirabegron wurde neu in die Leitlinie aufgenommen. Zudem sind verschiedene Kombinationstherapien aufgeführt, die entsprechend ihrer Indikation, ihren Wirkungen und Nebenwirkungen bewertet wurden.

Schlussfolgerungen

Die aktuelle deutsche S2e-Leitlinie zur Diagnostik und Therapie des BPS bietet eine evidenzbasierte Grundlage zur Findung der bestmöglichen und effektivsten Medikation.
Literatur
1.
Zurück zum Zitat Abrams P, Kaplan S, De Koning Gans HJ et al (2006) Safety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstruction. J Urol 175:999–1004 (discussion 1004)PubMed Abrams P, Kaplan S, De Koning Gans HJ et al (2006) Safety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstruction. J Urol 175:999–1004 (discussion 1004)PubMed
2.
Zurück zum Zitat Aggarwal S, Verma A, Shukla R et al (2014) An overview of phytotherapeutic approaches for the treatment of benign prostatic hyperplasia. Mini Rev Med Chem 14:257–270PubMed Aggarwal S, Verma A, Shukla R et al (2014) An overview of phytotherapeutic approaches for the treatment of benign prostatic hyperplasia. Mini Rev Med Chem 14:257–270PubMed
3.
Zurück zum Zitat Bansal A, Arora A (2017) Transurethral resection of prostate and bleeding: a prospective, randomized, double-blind placebo-controlled trial to see the efficacy of short-term use of finasteride and dutasteride on operative blood loss and prostatic microvessel density. J Endourol 31:910–917PubMed Bansal A, Arora A (2017) Transurethral resection of prostate and bleeding: a prospective, randomized, double-blind placebo-controlled trial to see the efficacy of short-term use of finasteride and dutasteride on operative blood loss and prostatic microvessel density. J Endourol 31:910–917PubMed
4.
Zurück zum Zitat Barendrecht MM, Abrams P, Schumacher H et al (2008) Do alpha1-adrenoceptor antagonists improve lower urinary tract symptoms by reducing bladder outlet resistance? Neurourol Urodyn 27:226–230PubMed Barendrecht MM, Abrams P, Schumacher H et al (2008) Do alpha1-adrenoceptor antagonists improve lower urinary tract symptoms by reducing bladder outlet resistance? Neurourol Urodyn 27:226–230PubMed
5.
Zurück zum Zitat Barry MJ, Meleth S, Lee JY et al (2011) Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA 306:1344–1351PubMedPubMedCentral Barry MJ, Meleth S, Lee JY et al (2011) Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA 306:1344–1351PubMedPubMedCentral
6.
Zurück zum Zitat Bent S, Kane C, Shinohara K et al (2006) Saw palmetto for benign prostatic hyperplasia. N Engl J Med 354:557–566PubMed Bent S, Kane C, Shinohara K et al (2006) Saw palmetto for benign prostatic hyperplasia. N Engl J Med 354:557–566PubMed
7.
Zurück zum Zitat Berges RR, Michel MC, Jonas U (2002) alpha 1‑receptor blockade in therapy of benign prostatic hyperplasia syndrome. Correct dosing for optimal effectiveness. Urologe A 41:452–457PubMed Berges RR, Michel MC, Jonas U (2002) alpha 1‑receptor blockade in therapy of benign prostatic hyperplasia syndrome. Correct dosing for optimal effectiveness. Urologe A 41:452–457PubMed
8.
Zurück zum Zitat Boyle P, Gould AL, Roehrborn CG (1996) Prostate volume predicts outcome of treatment of benign prostatic hyperplasia with finasteride: meta-analysis of randomized clinical trials. Urology 48:398–405PubMed Boyle P, Gould AL, Roehrborn CG (1996) Prostate volume predicts outcome of treatment of benign prostatic hyperplasia with finasteride: meta-analysis of randomized clinical trials. Urology 48:398–405PubMed
9.
Zurück zum Zitat Braverman AS, Doumanian LR, Ruggieri MR Sr. (2006) M2 and M3 muscarinic receptor activation of urinary bladder contractile signal transduction. II. Denervated rat bladder. J Pharmacol Exp Ther 316:875–880PubMed Braverman AS, Doumanian LR, Ruggieri MR Sr. (2006) M2 and M3 muscarinic receptor activation of urinary bladder contractile signal transduction. II. Denervated rat bladder. J Pharmacol Exp Ther 316:875–880PubMed
10.
Zurück zum Zitat Casabé A, Roehrborn CG, Da Pozzo LF et al (2014) Efficacy and safety of the coadministration of tadalafil once daily with finasteride for 6 months in men with lower urinary tract symptoms and prostatic enlargement secondary to benign prostatic hyperplasia. J Urol 191:727–733PubMed Casabé A, Roehrborn CG, Da Pozzo LF et al (2014) Efficacy and safety of the coadministration of tadalafil once daily with finasteride for 6 months in men with lower urinary tract symptoms and prostatic enlargement secondary to benign prostatic hyperplasia. J Urol 191:727–733PubMed
11.
Zurück zum Zitat Chapple CR, Roehrborn CG (2006) A shifted paradigm for the further understanding, evaluation, and treatment of lower urinary tract symptoms in men: focus on the bladder. Eur Urol 49:651–658PubMed Chapple CR, Roehrborn CG (2006) A shifted paradigm for the further understanding, evaluation, and treatment of lower urinary tract symptoms in men: focus on the bladder. Eur Urol 49:651–658PubMed
12.
Zurück zum Zitat Cindolo L, Alvarez-Maestro M, Castellucci R et al (2015) Efficacy and safety of dutasteride for the treatment of symptomatic Benign Prostatic Hyperplasia (BPH): a systematic review and meta-analysis. World J Urol 33:441–442PubMed Cindolo L, Alvarez-Maestro M, Castellucci R et al (2015) Efficacy and safety of dutasteride for the treatment of symptomatic Benign Prostatic Hyperplasia (BPH): a systematic review and meta-analysis. World J Urol 33:441–442PubMed
13.
Zurück zum Zitat Corona G, Tirabassi G, Santi D et al (2017) Sexual dysfunction in subjects treated with inhibitors of 5α-reductase for benign prostatic hyperplasia: a comprehensive review and meta-analysis. Andrology 5:671–678PubMed Corona G, Tirabassi G, Santi D et al (2017) Sexual dysfunction in subjects treated with inhibitors of 5α-reductase for benign prostatic hyperplasia: a comprehensive review and meta-analysis. Andrology 5:671–678PubMed
14.
Zurück zum Zitat D’Agate S, Chavan C, Manyak M et al (2021) Impact of early vs. delayed initiation of dutasteride/tamsulosin combination therapy on the risk of acute urinary retention or BPH-related surgery in LUTS/BPH patients with moderate-to-severe symptoms at risk of disease progression. World J Urol 39:2635–2643PubMed D’Agate S, Chavan C, Manyak M et al (2021) Impact of early vs. delayed initiation of dutasteride/tamsulosin combination therapy on the risk of acute urinary retention or BPH-related surgery in LUTS/BPH patients with moderate-to-severe symptoms at risk of disease progression. World J Urol 39:2635–2643PubMed
15.
Zurück zum Zitat D’Agate S, Wilson T, Adalig B et al (2020) Impact of disease progression on individual IPSS trajectories and consequences of immediate versus delayed start of treatment in patients with moderate or severe LUTS associated with BPH. World J Urol 38:463–472PubMed D’Agate S, Wilson T, Adalig B et al (2020) Impact of disease progression on individual IPSS trajectories and consequences of immediate versus delayed start of treatment in patients with moderate or severe LUTS associated with BPH. World J Urol 38:463–472PubMed
16.
Zurück zum Zitat Dong Y, Hao L, Shi Z et al (2013) Efficacy and safety of tadalafil monotherapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a meta-analysis. Urol Int 91:10–18PubMed Dong Y, Hao L, Shi Z et al (2013) Efficacy and safety of tadalafil monotherapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a meta-analysis. Urol Int 91:10–18PubMed
17.
Zurück zum Zitat Fusco F, Creta M, De Nunzio C et al (2018) Alpha‑1 adrenergic antagonists, 5‑alpha reductase inhibitors, phosphodiesterase type 5 inhibitors, and phytotherapic compounds in men with lower urinary tract symptoms suggestive of benign prostatic obstruction: a systematic review and meta-analysis of urodynamic studies. Neurourol Urodyn 37:1865–1874PubMed Fusco F, Creta M, De Nunzio C et al (2018) Alpha‑1 adrenergic antagonists, 5‑alpha reductase inhibitors, phosphodiesterase type 5 inhibitors, and phytotherapic compounds in men with lower urinary tract symptoms suggestive of benign prostatic obstruction: a systematic review and meta-analysis of urodynamic studies. Neurourol Urodyn 37:1865–1874PubMed
18.
Zurück zum Zitat Gacci M, Ficarra V, Sebastianelli A et al (2014) Impact of medical treatments for male lower urinary tract symptoms due to benign prostatic hyperplasia on ejaculatory function: a systematic review and meta-analysis. J Sex Med 11:1554–1566PubMed Gacci M, Ficarra V, Sebastianelli A et al (2014) Impact of medical treatments for male lower urinary tract symptoms due to benign prostatic hyperplasia on ejaculatory function: a systematic review and meta-analysis. J Sex Med 11:1554–1566PubMed
19.
Zurück zum Zitat Gravas S, Cornu JN, Gacci M, Gratzke C, Herrmann TRW, Mamoulakis C, Rieken M, Speakman MJ, Tikkinen KAO (2022) EAU guideline: management of non-neurogenic male Lower Urinary Tract Symptoms (LUTS), incl, Benign Prostatic Obstruction (BPO)— UPDATE MARCH 2022 Gravas S, Cornu JN, Gacci M, Gratzke C, Herrmann TRW, Mamoulakis C, Rieken M, Speakman MJ, Tikkinen KAO (2022) EAU guideline: management of non-neurogenic male Lower Urinary Tract Symptoms (LUTS), incl, Benign Prostatic Obstruction (BPO)— UPDATE MARCH 2022
20.
Zurück zum Zitat Guo B, Chen X, Wang M et al (2020) Comparative effectiveness of tadalafil versus tamsulosin in treating lower urinary tract symptoms suggestive of benign prostate hyperplasia: a meta-analysis of randomized controlled trials. Med Sci Monit 26:e923179PubMedPubMedCentral Guo B, Chen X, Wang M et al (2020) Comparative effectiveness of tadalafil versus tamsulosin in treating lower urinary tract symptoms suggestive of benign prostate hyperplasia: a meta-analysis of randomized controlled trials. Med Sci Monit 26:e923179PubMedPubMedCentral
21.
Zurück zum Zitat Hao N, Tian Y, Liu W et al (2014) Antimuscarinics and α‑blockers or α‑blockers monotherapy on lower urinary tract symptoms—A meta-analysis. Urology 83:556–562PubMed Hao N, Tian Y, Liu W et al (2014) Antimuscarinics and α‑blockers or α‑blockers monotherapy on lower urinary tract symptoms—A meta-analysis. Urology 83:556–562PubMed
22.
Zurück zum Zitat Herschorn S, McVary KT, Cambronero Santos J et al (2021) Mirabegron vs placebo add-on therapy in men with overactive bladder symptoms receiving tamsulosin for underlying benign prostatic hyperplasia: a safety analysis from the randomized, phase 4 PLUS study. Urology 147:235–242PubMed Herschorn S, McVary KT, Cambronero Santos J et al (2021) Mirabegron vs placebo add-on therapy in men with overactive bladder symptoms receiving tamsulosin for underlying benign prostatic hyperplasia: a safety analysis from the randomized, phase 4 PLUS study. Urology 147:235–242PubMed
23.
Zurück zum Zitat Höfner K (2014) Wirkung verschiedener BPS-Therapien auf die Blasenauslassobstruktion (BOO). In: Höfner K, Bach T, Berges R et al (Hrsg) S2e Leitlinie Therapie des benignen Prostatasyndroms (BPS) Höfner K (2014) Wirkung verschiedener BPS-Therapien auf die Blasenauslassobstruktion (BOO). In: Höfner K, Bach T, Berges R et al (Hrsg) S2e Leitlinie Therapie des benignen Prostatasyndroms (BPS)
24.
Zurück zum Zitat Kakizaki H, Lee KS, Yamamoto O et al (2020) Mirabegron add-on therapy to tamsulosin for the treatment of overactive bladder in men with lower urinary tract symptoms: a randomized, placebo-controlled study (MATCH). Eur Urol Focus 6:729–737PubMed Kakizaki H, Lee KS, Yamamoto O et al (2020) Mirabegron add-on therapy to tamsulosin for the treatment of overactive bladder in men with lower urinary tract symptoms: a randomized, placebo-controlled study (MATCH). Eur Urol Focus 6:729–737PubMed
25.
Zurück zum Zitat Kallidonis P, Adamou C, Kotsiris D et al (2020) Combination therapy with alpha-blocker and phosphodiesterase‑5 inhibitor for improving lower urinary tract symptoms and erectile dysfunction in comparison with monotherapy: a systematic review and meta-analysis. Eur Urol Focus 6:537–558PubMed Kallidonis P, Adamou C, Kotsiris D et al (2020) Combination therapy with alpha-blocker and phosphodiesterase‑5 inhibitor for improving lower urinary tract symptoms and erectile dysfunction in comparison with monotherapy: a systematic review and meta-analysis. Eur Urol Focus 6:537–558PubMed
26.
Zurück zum Zitat Kang D, Hu C, Fu Y et al (2017) Combination of α‑blocker and 5α-reductase inhibitor for treatment of benign prostatic hyperplasia. Clin Invest Med 40:E200–E210PubMed Kang D, Hu C, Fu Y et al (2017) Combination of α‑blocker and 5α-reductase inhibitor for treatment of benign prostatic hyperplasia. Clin Invest Med 40:E200–E210PubMed
27.
Zurück zum Zitat Kaplan SA, Herschorn S, McVary KT et al (2020) Efficacy and safety of mirabegron versus placebo add-on therapy in men with overactive bladder symptoms receiving tamsulosin for underlying benign prostatic hyperplasia: a randomized, phase 4 study (PLUS). J Urol 203:1163–1171PubMed Kaplan SA, Herschorn S, McVary KT et al (2020) Efficacy and safety of mirabegron versus placebo add-on therapy in men with overactive bladder symptoms receiving tamsulosin for underlying benign prostatic hyperplasia: a randomized, phase 4 study (PLUS). J Urol 203:1163–1171PubMed
28.
Zurück zum Zitat Kim HJ, Sun HY, Choi H et al (2017) Efficacy and safety of initial combination treatment of an alpha blocker with an anticholinergic medication in benign prostatic hyperplasia patients with lower urinary tract symptoms: updated meta-analysis. PLoS ONE 12:e169248PubMedPubMedCentral Kim HJ, Sun HY, Choi H et al (2017) Efficacy and safety of initial combination treatment of an alpha blocker with an anticholinergic medication in benign prostatic hyperplasia patients with lower urinary tract symptoms: updated meta-analysis. PLoS ONE 12:e169248PubMedPubMedCentral
29.
Zurück zum Zitat Kirby RS, Roehrborn C, Boyle P et al (2003) Efficacy and tolerability of doxazosin and finasteride, alone or in combination, in treatment of symptomatic benign prostatic hyperplasia: the Prospective European Doxazosin and Combination Therapy (PREDICT) trial. Urology 61:119–126PubMed Kirby RS, Roehrborn C, Boyle P et al (2003) Efficacy and tolerability of doxazosin and finasteride, alone or in combination, in treatment of symptomatic benign prostatic hyperplasia: the Prospective European Doxazosin and Combination Therapy (PREDICT) trial. Urology 61:119–126PubMed
30.
Zurück zum Zitat Kloner RA, Kostis JB, McGraw TP et al (2022) Analysis of integrated clinical safety data of tadalafil in patients receiving concomitant antihypertensive medications. J Clin Hypertens (Greenwich) 24:167–178PubMed Kloner RA, Kostis JB, McGraw TP et al (2022) Analysis of integrated clinical safety data of tadalafil in patients receiving concomitant antihypertensive medications. J Clin Hypertens (Greenwich) 24:167–178PubMed
31.
Zurück zum Zitat Latil A, Pétrissans MT, Rouquet J et al (2015) Effects of hexanic extract of serenoa repens (permixon® 160 mg) on inflammation biomarkers in the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia. Prostate 75:1857–1867PubMedPubMedCentral Latil A, Pétrissans MT, Rouquet J et al (2015) Effects of hexanic extract of serenoa repens (permixon® 160 mg) on inflammation biomarkers in the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia. Prostate 75:1857–1867PubMedPubMedCentral
32.
Zurück zum Zitat Lightner DJ, Gomelsky A, Souter L et al (2019) Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: aUA/SUFU guideline amendment 2019. J Urol 202:558–563PubMed Lightner DJ, Gomelsky A, Souter L et al (2019) Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: aUA/SUFU guideline amendment 2019. J Urol 202:558–563PubMed
33.
Zurück zum Zitat Madersbacher S, Marszalek M, Lackner J et al (2007) The long-term outcome of medical therapy for BPH. Eur Urol 51:1522–1533PubMed Madersbacher S, Marszalek M, Lackner J et al (2007) The long-term outcome of medical therapy for BPH. Eur Urol 51:1522–1533PubMed
34.
Zurück zum Zitat McConnell JD, Bruskewitz R, Walsh P et al (1998) The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride long-term efficacy and safety study group. N Engl J Med 338:557–563PubMed McConnell JD, Bruskewitz R, Walsh P et al (1998) The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride long-term efficacy and safety study group. N Engl J Med 338:557–563PubMed
35.
Zurück zum Zitat McNicholas T, Kirby R (2011) Benign prostatic hyperplasia and male Lower Urinary Tract Symptoms (LUTS). BMJ Clin Evid 2011:1801–1840PubMedPubMedCentral McNicholas T, Kirby R (2011) Benign prostatic hyperplasia and male Lower Urinary Tract Symptoms (LUTS). BMJ Clin Evid 2011:1801–1840PubMedPubMedCentral
36.
Zurück zum Zitat Michel MC, Madersbacher S (2022) Medical treatment of male lower urinary tract symptoms: what’s new? Aktuelle Urol 53:240–245PubMed Michel MC, Madersbacher S (2022) Medical treatment of male lower urinary tract symptoms: what’s new? Aktuelle Urol 53:240–245PubMed
37.
Zurück zum Zitat Milani S, Djavan B (2005) Lower urinary tract symptoms suggestive of benign prostatic hyperplasia: latest update on alpha-adrenoceptor antagonists. BJU Int 95(Suppl 4):29–36PubMed Milani S, Djavan B (2005) Lower urinary tract symptoms suggestive of benign prostatic hyperplasia: latest update on alpha-adrenoceptor antagonists. BJU Int 95(Suppl 4):29–36PubMed
38.
Zurück zum Zitat Nickel JC, Sander S, Moon TD (2008) A meta-analysis of the vascular-related safety profile and efficacy of alpha-adrenergic blockers for symptoms related to benign prostatic hyperplasia. Int J Clin Pract 62:1547–1559PubMed Nickel JC, Sander S, Moon TD (2008) A meta-analysis of the vascular-related safety profile and efficacy of alpha-adrenergic blockers for symptoms related to benign prostatic hyperplasia. Int J Clin Pract 62:1547–1559PubMed
39.
Zurück zum Zitat Oelke M, Gericke A, Michel MC (2014) Cardiovascular and ocular safety of α1-adrenoceptor antagonists in the treatment of male lower urinary tract symptoms. Expert Opin Drug Saf 13:1187–1197PubMed Oelke M, Gericke A, Michel MC (2014) Cardiovascular and ocular safety of α1-adrenoceptor antagonists in the treatment of male lower urinary tract symptoms. Expert Opin Drug Saf 13:1187–1197PubMed
40.
Zurück zum Zitat Oelke M, Giuliano F, Mirone V et al (2012) Monotherapy with tadalafil or tamsulosin similarly improved lower urinary tract symptoms suggestive of benign prostatic hyperplasia in an international, randomised, parallel, placebo-controlled clinical trial. Eur Urol 61:917–925PubMed Oelke M, Giuliano F, Mirone V et al (2012) Monotherapy with tadalafil or tamsulosin similarly improved lower urinary tract symptoms suggestive of benign prostatic hyperplasia in an international, randomised, parallel, placebo-controlled clinical trial. Eur Urol 61:917–925PubMed
41.
Zurück zum Zitat Pang R, Zhou XY, Wang X et al (2021) Anticholinergics combined with Alpha-blockers for treating lower urinary tract symptoms related to benign prostatic obstruction. Cochrane Database Syst Rev 2:Cd12336PubMed Pang R, Zhou XY, Wang X et al (2021) Anticholinergics combined with Alpha-blockers for treating lower urinary tract symptoms related to benign prostatic obstruction. Cochrane Database Syst Rev 2:Cd12336PubMed
42.
Zurück zum Zitat Park T, Choi JY (2014) Efficacy and safety of dutasteride for the treatment of symptomatic Benign Prostatic Hyperplasia (BPH): a systematic review and meta-analysis. World J Urol 32:1093–1105PubMed Park T, Choi JY (2014) Efficacy and safety of dutasteride for the treatment of symptomatic Benign Prostatic Hyperplasia (BPH): a systematic review and meta-analysis. World J Urol 32:1093–1105PubMed
43.
Zurück zum Zitat Pattanaik S, Mavuduru RS, Panda A et al (2018) Phosphodiesterase inhibitors for lower urinary tract symptoms consistent with benign prostatic hyperplasia. Cochrane Database Syst Rev 11:Cd10060PubMed Pattanaik S, Mavuduru RS, Panda A et al (2018) Phosphodiesterase inhibitors for lower urinary tract symptoms consistent with benign prostatic hyperplasia. Cochrane Database Syst Rev 11:Cd10060PubMed
44.
Zurück zum Zitat Roehrborn CG, Chapple C, Oelke M et al (2014) Effects of tadalafil once daily on maximum urinary flow rate in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. J Urol 191:1045–1050PubMed Roehrborn CG, Chapple C, Oelke M et al (2014) Effects of tadalafil once daily on maximum urinary flow rate in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. J Urol 191:1045–1050PubMed
45.
Zurück zum Zitat Roehrborn CG, Siami P, Barkin J et al (2010) The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4‑year results from the CombAT study. Eur Urol 57:123–131PubMed Roehrborn CG, Siami P, Barkin J et al (2010) The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4‑year results from the CombAT study. Eur Urol 57:123–131PubMed
46.
Zurück zum Zitat Sakalis V, Gkotsi A, Charpidou D et al (2021) The effect of pharmacotherapy on prostate volume, prostate perfusion and prostate-specific antigen (prostate morphometric parameters) in patients with lower urinary tract symptoms and benign prostatic obstruction. A systematic review and meta-analysis. Cent Eur J Urol 74:388–421 Sakalis V, Gkotsi A, Charpidou D et al (2021) The effect of pharmacotherapy on prostate volume, prostate perfusion and prostate-specific antigen (prostate morphometric parameters) in patients with lower urinary tract symptoms and benign prostatic obstruction. A systematic review and meta-analysis. Cent Eur J Urol 74:388–421
47.
Zurück zum Zitat Sun Y, Peng B, Lei GL et al (2020) Study of phosphodiesterase 5 inhibitors and α‑adrenoceptor antagonists used alone or in combination for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Minerva Urol Nefrol 72:13–21PubMed Sun Y, Peng B, Lei GL et al (2020) Study of phosphodiesterase 5 inhibitors and α‑adrenoceptor antagonists used alone or in combination for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Minerva Urol Nefrol 72:13–21PubMed
48.
Zurück zum Zitat Thomas AW, Cannon A, Bartlett E et al (2005) The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic follow-up of untreated bladder outlet obstruction. BJU Int 96:1301–1306PubMed Thomas AW, Cannon A, Bartlett E et al (2005) The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic follow-up of untreated bladder outlet obstruction. BJU Int 96:1301–1306PubMed
49.
Zurück zum Zitat Wang X, Wang X, Li S et al (2014) Comparative effectiveness of oral drug therapies for lower urinary tract symptoms due to benign prostatic hyperplasia: a systematic review and network meta-analysis. PLoS ONE 9:e107593PubMedPubMedCentral Wang X, Wang X, Li S et al (2014) Comparative effectiveness of oral drug therapies for lower urinary tract symptoms due to benign prostatic hyperplasia: a systematic review and network meta-analysis. PLoS ONE 9:e107593PubMedPubMedCentral
50.
Zurück zum Zitat Wang XH, Wang X, Shi MJ et al (2015) Systematic review and meta-analysis on phosphodiesterase 5 inhibitors and α‑adrenoceptor antagonists used alone or combined for treatment of LUTS due to BPH. Asian J Androl 17:1022–1032PubMedPubMedCentral Wang XH, Wang X, Shi MJ et al (2015) Systematic review and meta-analysis on phosphodiesterase 5 inhibitors and α‑adrenoceptor antagonists used alone or combined for treatment of LUTS due to BPH. Asian J Androl 17:1022–1032PubMedPubMedCentral
51.
Zurück zum Zitat Wei L, Lai EC, Kao-Yang YH et al (2019) Incidence of type 2 diabetes mellitus in men receiving steroid 5α-reductase inhibitors: population based cohort study. BMJ 365:l1204PubMedPubMedCentral Wei L, Lai EC, Kao-Yang YH et al (2019) Incidence of type 2 diabetes mellitus in men receiving steroid 5α-reductase inhibitors: population based cohort study. BMJ 365:l1204PubMedPubMedCentral
52.
Zurück zum Zitat Xin Z, Huang Y, Lu J et al (2013) Addition of antimuscarinics to alpha-blockers for treatment of lower urinary tract symptoms in men: a meta-analysis. Urology 82:270–277PubMed Xin Z, Huang Y, Lu J et al (2013) Addition of antimuscarinics to alpha-blockers for treatment of lower urinary tract symptoms in men: a meta-analysis. Urology 82:270–277PubMed
53.
Zurück zum Zitat Yokoyama T, Uematsu K, Watanabe T et al (2009) Naftopidil and propiverine hydrochloride for treatment of male lower urinary tract symptoms suggestive of benign prostatic hyperplasia and concomitant overactive bladder: a prospective randomized controlled study. Scand J Urol Nephrol 43:307–314PubMed Yokoyama T, Uematsu K, Watanabe T et al (2009) Naftopidil and propiverine hydrochloride for treatment of male lower urinary tract symptoms suggestive of benign prostatic hyperplasia and concomitant overactive bladder: a prospective randomized controlled study. Scand J Urol Nephrol 43:307–314PubMed
54.
Zurück zum Zitat Yuan JQ, Mao C, Wong SY et al (2015) Comparative effectiveness and safety of monodrug therapies for lower urinary tract symptoms associated with benign prostatic hyperplasia: a network meta-analysis. Medicine (Baltimore) 94:e974PubMed Yuan JQ, Mao C, Wong SY et al (2015) Comparative effectiveness and safety of monodrug therapies for lower urinary tract symptoms associated with benign prostatic hyperplasia: a network meta-analysis. Medicine (Baltimore) 94:e974PubMed
55.
Zurück zum Zitat Zong HT, Peng XX, Yang CC et al (2011) A systematic review of the effects and mechanisms of preoperative 5α-reductase inhibitors on intraoperative haemorrhage during surgery for benign prostatic hyperplasia. Asian J Androl 13:812–818PubMedPubMedCentral Zong HT, Peng XX, Yang CC et al (2011) A systematic review of the effects and mechanisms of preoperative 5α-reductase inhibitors on intraoperative haemorrhage during surgery for benign prostatic hyperplasia. Asian J Androl 13:812–818PubMedPubMedCentral
Metadaten
Titel
Konservative und medikamentöse Therapie des benignen Prostatasyndroms
Die deutsche S2e-Leitlinie 2023 – Teil 2
verfasst von
Prof. Dr. med. Dr. phil. Dr. h.c. Thomas Bschleipfer, F.E.B.U.
S. Dominik Abt
Klaus F. Becher
Kurt Dreikorn
Klaus Höfner
Stephan Madersbacher
Guiseppe Magistro
Rolf Muschter
Matthias Oelke
Oliver Reich
Malte Rieken
Johannes Salem
Martin C. Michel
Sandra Schönburg
Publikationsdatum
04.10.2023
Verlag
Springer Medizin
Erschienen in
Die Urologie / Ausgabe 10/2023
Print ISSN: 2731-7064
Elektronische ISSN: 2731-7072
DOI
https://doi.org/10.1007/s00120-023-02183-5

Weitere Artikel der Ausgabe 10/2023

Die Urologie 10/2023 Zur Ausgabe

GeSRU

GeSRU

Das könnte Sie auch interessieren

03.07.2023 | Benigne Prostatahyperplasie | Leitlinien der DGU

S2e-Leitlinie Teil 1: Diagnostik des benignen Prostatasyndroms

Die deutsche S2e-Leitlinie 2023 Teil 1

11.10.2023 | Benigne Prostatahyperplasie | Leitlinien der DGU

Leitlinien-Update: Operative Therapie des benignen Prostatasyndroms

Die deutsche S2e-Leitlinie 2023 – Teil 3

Passend zum Thema

ANZEIGE
OnSite Advertorial Prostatitis
Phytotherapie bei CPPS

Pollstimol®: Leitliniengerechte Prostatitis-Therapie

In 90 % der Prostatitis-Fälle handelt es sich um eine chronische abakterielle Prostatitis (chronic pelvic pain syndrome, CPPS) mit anhaltender Entzündungsreaktion und Schwellung der Prostata. Als leitliniengerechte Behandlungsoption mit guter Evidenz hat sich das Phytotherapeutikum Pollstimol® etabliert.