Nykturie – ein oft verkanntes Problem

Zusammenfassung

Die Nykturie – darunter versteht man das Gewecktwerden durch Harndrang mit anschließender Blasenentleerung – stellt für die Betroffenen ein ernstes Problem dar. In den letzten Jahrzehnten ist die Nykturie hauptsächlich als irritatives Symptom der benignen Prostatahyperplasie (BPH) betrachtet worden. Häufig jedoch wird das Symptom wenig durch die verschiedenen Behandlungen der BPH beeinflusst. Erst seit einigen Jahren hat man erkannt, dass die Prostata weniger an der Symptomatik beteiligt ist, als man vorher geglaubt hatte, denn von der Nykturie sind ebenso viele Frauen betroffen. Aus diesem Grund wird die Nykturie heutzutage anders betrachtet. Es ist ein hoch prävalentes Symptom, das sich bei Männern und Frauen weder quantitativ noch qualitativ unterscheidet. Viele Faktoren führen zu einer Nykturie. Unter anderem sind folgende Erkrankungen daran beteiligt: koronare Herzkrankheit, Diabetes mellitus oder insipidus, Lower Urinary Tract Symptoms (LUTS), Angstzustände oder primäre Schlafstörungen sowie Verhaltens- und Umweltfaktoren. Im Wesentlichen handelt es sich bei der Nykturie entweder um eine nächtliche Polyurie (nächtliche Urinüberproduktion) oder eine verringerte nächtliche Blasenkapazität bzw. eine Kombination aus beidem. Eine Unterscheidung dieser Entitäten kann durch einfache arithmetische Analyse z. B. eines 48-stündigen Miktionstagebuchs bestimmt werden. Erst seit Kurzem ist die Nykturie gemäß der Ätiologie und Pathogenese klassifiziert worden, sodass jetzt eine differenzierte Behandlung möglich ist. In Fällen, in denen die zugrunde liegende Ursache nicht gefunden werden kann, können zwar Verhaltensmaßnahmen helfen, oft sind jedoch medikamentöse Therapien notwendig. Die medikamentöse Behandlung umfasst: Desmopressin, antimuskarinerge Substanzen, allgemeinmedizinische Maßnahmen wie Stützstrümpfe der Beine, zeitliche Veränderung der Diuretikaeinnahme oder in speziellen Fällen die nasale CPAP-Beatmung (Continuous Positive Airway Pressure). Trotz der z. T. hohen Effektivität der Maßnahmen sollte aufgrund der möglichen Nebenwirkungen individuell ein Therapiekonzept erarbeitet werden.

Abstract

Nocturia – waking up during the night due to the urge to urinate and empty the bladder – is a serious problem for affected patients. In the past decades, nocturia has been primarily regarded as an irritative symptom of benign prostate hyperplasia (BPH). This symptom is however frequently not influenced by different BPH treatments. In the last couple of years one has come to the conclusion that the prostate is less involved and in part responsible for the symptoms since women are also frequently affected. For these reasons nocturia is looked at differently. It is a highly prevalent symptom which neither qualitatively nor quantitative differs between men and women. Many factors lead to nocturia. The following diseases are involved: coronary heart disease, diabetes mellitus or insipidus, lower urinary tract symptoms (LUTS), states of anxiety or insomnia as well as behavioural and environmental factors. Nocturia can be categorised in nocturnal polyuria (overproduction of nightly urine) or a diminished bladder capacity or a combination of both. These entities can be easily differentiated by arithmetic analysis, e.g., a 48-hour voiding diary. Only recently nocturia has been classified according to the aetiology and pathogenesis, making a differentiated treatment possible. However, even in the cases in which the underlying cause cannot be found behavioural changes can help. Nevertheless, pharmacological treatments are inevitable. Medical treatments include: desmopressin, anticholinergics and antimuscarinics, general-medical measures like support stockings, different time for the intake of diuretics or in specific cases the nasal CPAP artificial respiration (continuous positive airway pressure). In spite of the partly high effectiveness of these measures, treatment should be customised taking possible side effects in account.

Key words

Nykturie - Polyurie - nächtliche Polyurie - verminderte Blasenkapazität - Desmopressin

Key words

nocturia - polyuria - nocturnal polyuria - diminished bladder capacity - desmopressin

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