Die Harnröhrenenge und Blasenhalsstenose der Frau – Fakt oder Mythos – Was ist zu tun?

 

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Zusammenfassung

Die weibliche Harnröhre ist das wahrscheinlich am wenigsten beachtete Organ der Frau. Die Harnröhrenstriktur und die primäre Blasenhalsenge bei Frauen sind seltene klinische Krankheitsbilder.

Zur Behandlung der weiblichen Harnröhrenstriktur werden traditionelle und neuere chirurgische Techniken beschrieben. Diese beruhen allerdings auf einer schwachen Datenlage. Ein Konsens über das beste Vorgehen fehlt. Die Techniken der Harnröhrenplastiken haben bei kürzerer Nachbeobachtungszeit eine höhere Erfolgsquote (80–94%) als die Harnröhrendilatation (< 50%). Die Harnröhrenplastik in erfahrenen Händen erscheint als machbare Option bei Dilatationsversagen, obgleich es auch hier an hoher Evidenz für die jeweilige Technik der Harnröhrenplastik mangelt.

Die primäre Blasenhalsenge ist ein Zustand, in dem sich der Blasenhals während der Miktion nicht adäquat öffnet. Diese führt zu einer erhöhten Aktivität der quergestreiften Sphinktermuskulatur oder zu einer Behinderung des Uroflows ohne Vorliegen einer anderen anatomischen Ursache wie z. B. ein Genitalprolaps.

Watchful waiting, Pharmakotherapie oder eine chirurgische Intervention sind mögliche Behandlungsoptionen.

Summary

The female urethra is probably the most neglected organ in women. Female urethral stricture and primary bladder neck obstruction are rare clinical entities. Traditional and new surgical techniques have been described for the treatment of female urethral stricture. However, they are based on limited data. There is no consensus on best management. The techniques of urethroplasty all have a higher mean success rate (80–94%) than urethral dilatation (< 50%), albeit with shorter mean follow-up. Urethroplasty performed by experienced surgeons appears to be a feasible option in women who have failed urethral dilatation, although there is a lack of high-level evidence to recommend one technique over another.

Primary bladder neck obstruction (PBNO) is a condition in which the bladder neck fails to open adequately during voiding. This leads to increased striated sphincter activity or obstruction of urinary flow without another anatomic cause being present, for example an obstruction caused by genitourinary prolapse in women. Watchful waiting, pharmacotherapy and surgical intervention are possible treatments.

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