Neuro-urologische Diagnostik und Therapie nicht traumatischer/degenerativ bedingter neurogener Dysfunktion des unteren Harntraktes am Beispiel der Multiplen Sklerose

Zusammenfassung

Die neurogene Dysfunktion des unteren Harntrakts bei Multipler Sklerose wird häufig unterschätzt, unterdiagnostiziert und unzureichend behandelt. Sie tritt in Abhängigkeit vom Krankheitsverlauf und der Lokalisation der nervalen Schädigung in unterschiedlicher Häufigkeit und in Form verschiedenster Störungen von Harnspeicherung und Harnentleerung auf. Symptome wie Harninkontinenz, rezidivierende Harnwegsinfektionen, Drangsymptomatik, Pollakisurie, abgeschwächter Harnstrahl, Startverzögerung sowie Restharnbildung sind möglich. Jedoch erlaubt die Symptomatik keinen Rückschluss auf die zugrunde liegende Art der neurogenen Dysfunktion des unteren Harntrakts.

Zwar liegen heute zahlreiche Daten, Publikationen und Leitlinien zu diesem Thema vor; einheitliche, in prospektiven Studien überprüfte Screeningparameter und Algorithmen stehen für die Multiple Sklerose jedoch aus.

Diese Übersicht stellt die aktuellen diagnostischen und therapeutischen Möglichkeiten der neurogenen Dysfunktion des unteren Harntrakts bei Multipler Sklerose dar. Problematisch ist hierbei die initial deutlich verzögerte Diagnosestellung, welche nicht zuletzt auf eine mangelnde Kommunikation zwischen Neurolog/innen und Urolog/innen zurückzuführen ist. Erste Hinweise auf das Vorhandensein einer neurogenen Dysfunktion des unteren Harntrakts ergeben sich aus aktivem Fragen nach subjektivem Vorhandensein von Symptomen wie Harninkontinenz oder Auftreten von Harnwegsinfekten. Allerdings schließt eine subjektive Symptomlosigkeit eine neurogene Dysfunktion des unteren Harntrakts nicht aus.

Unabhängig vom Krankheitsstadium soll frühzeitig und individualisiert eine neuro-urologische Diagnostik und Therapie erfolgen. Bei der neuro-urologischen Therapieentscheidung sind alle Schädigungsaspekte und der Umfang der Funktionsdefizite anderer Organsysteme im Rahmen der Grunderkrankung der Multiplen Sklerose zu berücksichtigen.

Letztlich ist der enge und konsequente interdisziplinäre Austausch zwischen Neurologie, Allgemeinmedizin und Urologie unerlässlich. Dieses interdisziplinäre und interprofessionelle Denken und Handeln ist Voraussetzung, um die zahlreichen konservativen und invasiven therapeutischen Maßnahmen optimal zur Anwendung bringen zu können. Eine lebenslange, individuelle, risikoadaptierte urologische Betreuung zur Früherkennung und Prävention neuro-urologischer Komplikationen soll Betroffenen mit Multipler Sklerose angeboten werden.

Abstract

Neurogenic lower urinary tract dysfunction in multiple sclerosis is often underestimated, underdiagnosed, and inadequately treated. Depending on the course of the disease and the location of neural damage, it occurs with varying frequency and types of impairment of urine storage and voiding function. Symptoms such as urinary incontinence, recurrent urinary tract infections, urgency, pollakiuria, reduced urinary flow, hesitancy as well as postvoid residual urine may occur. However, the symptoms do not allow any conclusions to be drawn about the underlying type of neurogenic lower urinary tract dysfunction. Although numerous data, publications, and guidelines are available on this topic today, there continues to be a lack of standardized screening parameters and algorithms that have been tested in prospective studies for multiple sclerosis. This article presents the current diagnostic and therapeutic options of neurogenic lower urinary tract dysfunction in multiple sclerosis. A crucial issue is the initial delay in diagnosis, not least due to a lack of communication between neurologists and urologists. Initial indicators of the presence of neurogenic lower urinary tract dysfunction can be obtained by actively asking about the subjective presence of symptoms such as urinary incontinence or the occurrence of urinary tract infections. However, a subjective lack of symptoms does not rule out a neurogenic lower urinary tract dysfunction.

Regardless of the stage of the disease, an early and individualized neuro-urological diagnosis and treatment should be implemented. All aspects of the damage and the extent of functional deficits in other organ systems caused by multiple sclerosis must be included in this neuro-urological treatment decision, which requires a consistent interdisciplinary exchange between neurologists, general practitioners, and urologists.

This interdisciplinary and interprofessional way of thinking and acting is key for an optimal treatment using the numerous therapeutic procedures. Lifelong, individual, risk-adapted urological care for the early detection and prevention of neuro-urological complications should be offered to persons with multiple sclerosis.

Schlüsselwörter

Multiple Sklerose - neurogene Dysfunktion des unteren Harntrakts - Harnwegsinfekt - Neuro-Urologie

Keywords

multiple sclerosis - neurogenic lower urinary tract dysfunction - urinary tract infection - neuro-urology

Publication History

Received: 12 January 2024

Accepted after revision: 28 February 2024

Article published online:
23 April 2024

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