Rezidivierende Zystitis der Frau

Zusammenfassung

Chronisch rezidivierende Infektionen der Harnblase sind bei Frauen häufig und können eine erhebliche Belastung darstellen. Ihr Auftreten ist mit im Alter häufiger vorkommenden Risikofaktoren assoziiert. Diese umfassen anatomische und funktionelle Veränderungen, welche die lokale Abwehrlage des Urogenitaltraktes beeinträchtigen (z. B. Atrophie der Schleimhäute, Zystozelen, Restharn, Oligurie). Eine weitere Ursache kann die Besiedelung mit einem besonders virulenten, persistierenden Erreger sein.

Die Diagnose wird anhand der typischen Klinik und mithilfe von Streifentests und Urinkultur gestellt.

Die Therapie und Prophylaxe des chronisch rezidivierenden Harnwegsinfektes beinhaltet die Elimination von Risikofaktoren. Die kontinuierliche oder intermittierende Antibiotikatherapie hat eine besondere Bedeutung. Zur Prophylaxe von rezidivierenden Harnwegsinfektionen stellt Trimethoprim die Substanz der ersten Wahl dar. Die Beeinflussung der Rezidivhäufigkeit ist auch durch Verhaltensänderung und unterstützende Maßnahmen wie lokale Hormonsubstitution und Ansäuern des Urins möglich. Alternative Therapien, vor allem mit pflanzlichen Präparaten, Bakterienextrakten und Akupunktur, zeigen viel versprechende Ergebnisse. Sie sind zurzeit aber noch nicht ausreichend untersucht, um eine Empfehlung auf einer rationalen Basis aussprechen zu können.

Abstract

Recurrent urinary tract infections (RUTI) are very common in women and substantially affect the quality of life of these patients. RUTI is strongly associated with predisposing risk factors occurring especially in elderly women, including functional or anatomical changes such as mucosal atrophy, cystocele, increased post-void residual volume and oliguria. The colonization of the vaginal and periurethral mucosa with virulent, persistent bacteria represents an additional cause for RUTI.

The clinical symptoms together with dipstick urine analysis and urine culture lead to the diagnosis.

Therapy and prophylaxis of RUTI are based on the elimination of the mentioned risk factors. Long-term or intermittent antibiotic treatment are pertinent therapeutic options. The first choice antibiotic regimen for prophylaxis of RUTI is trimethoprim. Behavioral changes and supportive measures such as acidification of the urine or local hormone therapy also reduce the incidence rates of RUTI. In addition, alternative therapeutic approaches including herbal or bacterial extracts and acupuncture showed promising effects, but need further evaluation.

Schlüsselwörter

Chronische rezidivierende Harnwegsinfektion - Zystitis

Key words

Recurrent urinary tract infection

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