Abakterielle Zystitis: Grundlagen, Diagnostik und kausale Therapiemöglichkeiten

 

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Zusammenfassung

Die Therapie abakterieller Zystitiden stützt sich oft auf rein symptomorientierte Maßnahmen, die den Patienten zwar in vielen Fällen Linderung bringen, das chronische Fortschreiten ihrer Erkrankung jedoch nicht verhindern können. Diese Arbeit skizziert die häufigsten Formen der abakteriellen Zystitiden (interstitielle, radiogene und chemotherapieinduzierte Zystitis) und ihre gemeinsame Pathophysiologie und stellt im Anschluss daran die gängigen therapeutischen Maßnahmen dar. In Bezug auf die radiogene und die chemotherapieinduzierte Zystitis ist zu berücksichtigen, dass durch optimierte präventive Maßnahmen die Entstehung des Entzündungsprozesses oft deutlich verzögert oder sogar verhindert werden kann. Die in diesem Beitrag genannten Präventionsmaßnahmen sollten deshalb zur festen Begleittherapie im Rahmen der tumorbedingten Behandlung gehören. Alternativ oder ergänzend zu den symptomatischen Therapien zeigen kausale Behandlungsansätze gute Ansprechraten. Neben der erfolgreichen hyperbaren Sauerstofftherapie gilt dies auch für das Hyaluronan, das mit dem Ziel des Wiederaufbaus der geschädigten Glykosaminoglukan-Schicht im Harnblasenendothel instilliert wird und eröffnet in bislang als therapieresistent geltenden Fällen neue Heilungsoptionen. Ein vorangehender Kaliumsensitivitätstest ist zu empfehlen, da sich durch ihn der mutmaßliche Erfolg der Therapie mit hoher Wahrscheinlichkeit abschätzen lässt. Mindestens ebenso wichtig ist allerdings, dass insbesondere bei interstitieller Zystitis überhaupt eine frühzeitigere Diagnostik stattfindet, als dies bisher oft der Fall ist. 

Abstract

The therapy for non-bacterial cysitides is often based on purely symptom-oriented measures which in many cases relieve the patient’s symptoms but cannot stop the chronic progression of the disease. The present article summarises the most common forms of non-bacterial cystitis (interstitial, radiogenic, chemotherapy-induced) with their common pathophysiology and then introdcuces the most common therapeutic procedures. With regard to radiogenic and chemotherapy-induced cystitis it must be considered that optimal preventative measures can often markedly delay or even prevent the development of the inflammatory processes. The preventative therapeutic measures mentioned in this article should thus constitute a fixed part of the accompanying therapy within the framework of tumour-related treatment. As alternatives or supplements to symptomatic therapy, causal therapy options show good response rates. Besides successful hyperbaric oxygen therapy, this also holds for hyalurane that is instilled with the aim of repairing the damaged glycosamine layer in the endothelium of the urinary bladder and so opens new curative options in cases that were previously considered as therapy resistant. A prior potassium-sensitivity test is recommended as this allows the putative success of the therapy to be predicted with a high probability. However. It is equally important, especially in cases of interstitial cystitis, that the diagnosis is made as early as possible which was often not done in the past. 

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Priv.-Doz. Dr. med. M. J. Mathers

Urologische Gemeinschaftspraxis Remscheid · Kooperationspraxis der Klinik für Urologie und Kinderurologie · Helios Klinikum Wuppertal · Universität Witten / Herdecke

Fastenrathstr. 1

42853 Remscheid

Email: M.J.Mathers@t-online.de

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