Combined therapy of benign prostatic syndrome (BPS) with α1-blockers and 5α-reductase (5AR)-inhibitors is recommended according to two leading studies on doxazosin/finasteride and tamsulosin/dutasteride for all 10 in Germany possible combinations (five α1-blockers and two 5AR inhibitors). Because tamsulosin and finasteride predominate in the treatment of BPS in Germany, the role of the combination tamsulosin/finasteride and its scientific basis from clinical studies has been investigated. A pharmacoepidemiological extrapolation from receipts of pharmacy data centres showed a strong increase of the combination tamsulosin/finasteride since 2003. As a free combination, tamsulosin/finasteride beside the fixed combination tamsulosin/dutasteride accounts to about 50% of all α1-blocker/5AR-inhibitor combinations today. Clinical studies on tamsulosin/finasteride have been published including controlled studies of the combination and both monotherapies. The results of improvement of lower urinary tract symptoms (LUTS), maximum urinary flow rate (Qmax), prostate volume (PV) and prostate-specific antigen (PSA) as well as adverse events and drug safety are in agreement with the leading studies. However, results due to chance cannot be excluded because of deficiencies in study design. A reliable comparison of the risk of progression between tamsulosin/finasteride and both monotherapies is lacking completely. Because of the great coherence and continuous evaluation of available data of all combinations, and with the established strong class effect of monotherapies, a continuation of the therapeutic practice with the combination tamsulosin/finasteride is possible.

This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the instrumental treatment of the lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding open and transurethral procedures (TUR-P, bipolar TUR-P, TUI-P, HE-TUMT, TUNA, and the different Laser techniques). Recommendations are also given concerning intraprostatic stents and injection therapies. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.

Diese Übersicht fasst die relevanten Aspekte der S2e-Leitlinie der Deutschen Urologen zur instrumentellen Therapie des benignen Prostatasyndroms (BPS) zusammen. Empfehlungen zu offenen und transurethralen Verfahren (TUR-P, bipolare TUR-P, TUI-P, HE-TUMT, TUNA und den unterschiedlichen Laserverfahren) werden gegeben. Darüber hinaus finden sich Empfehlungen zu intraprostatischen Stents und Injektionstherapien. Die Arbeit stellt zudem detailliert den Einfluss der unterschiedlichen Therapieoptionen auf die Blasenauslassobstruktion (BOO) dar.

This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the instrumental treatment of the lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding open and transurethral procedures (TUR-P, bipolar TUR-P, TUI-P, HE-TUMT, TUNA, and the different Laser techniques). Recommendations are also given concerning intraprostatic stents and injection therapies. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.

This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the conservative and pharmacological treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding watchful waiting, behavioral therapy, phytotherapy and pharmacological mono- and combination therapy. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.

J. Altwein*, München G. Aumüller*, Marburg R. Berges*, Herne K. Dreikorn*, Bremen U. Eickenberg, Bielefeld U. Engelmann, Köln P. Gratzke, Rosenheim R. Harzmann, Augsburg G. Haupt, Herne K. Höfner*, Hannover D. Jonas,Frankfurt U. Jonas*, Hannover M. Krieg, Bochum R.Muschter*, Rothenburg/Wümme L. Pientka*, Bochum R. Ringert, Göttingen J. Schabel†, Halle H. Schuldes, Frankfurt/M U. Schweikert*,Bonn A. Semjonow, Münster T. Senge*, Herne U. Tunn*, Offenbach C. Tschuschke, Münster J. Vogel, Ludwigshafen L. Weißbach*, Berlin H. Weisser, Bochum M. Wirth, Dresden T. Zwergel, Homburg/Saar J. Zumbé, Gelsenkirchen

There have been function and organ-related certification systems in urology for a long time. The aim of such certificates is the optimization of patient care above the defined minimum standards and intensification of interdisciplinary cooperation. Whether such certificates have led to better patient care has not been proven. The obligatory documentation in epidemiological cancer registries, which has been taken up by legislature, will in future lead to so-called clinical cancer registries in which the complete course of treatment must be entered. With these registries the quality of healthcare can be compared between individual institutions. Until now, quality of care data outside oncology are lacking. Urology would also benefit from a registry with quality of care data for these patients.

Seit längerem gibt es in der Urologie funktions- und organbezogene Zertifizierungssysteme. Ziel dieser Zertifikate ist die Optimierung der Patientenversorgung über die Definition von Mindeststandards und die Intensivierung der interdisziplinären Kooperation. Ob solche Zertifikate zu einer besseren Patientenversorgung geführt haben, blieb bisher unbewiesen. Die in diesen Zertifikaten bestehende Pflicht zur Verlaufsdokumentation wurde inzwischen durch den Gesetzgeber aufgegriffen und wird über die in Zukunft entstehenden klinischen Krebsregister abgebildet werden. Mit diesen Registern kann dann die Qualität der onkologischen Versorgung zwischen den einzelnen Einrichtungen verglichen werden. Eine Abbildung der Versorgungsdaten außerhalb der Onkologie wurde bisher vernachlässigt. Die Urologie täte gut daran, auch für diese Patienten die Versorgungsqualität abzubilden.