Skip to main content
SpringerLink
Log in

Beckenbodendysfunktion aus chirurgischer Sicht

Pelvic floor disorders from the surgeon’s viewpoint

  • CME Zertifizierte Fortbildung
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Beckenbodenfunktionsstörungen werden individuell höchst unterschiedlich in Ausprägung und Wahrnehmung erlebt. Sie erfordern Erfahrung und interdisziplinäre Zusammenarbeit sowohl hinsichtlich Diagnostik als auch Therapie. Sinnvollerweise stützt sich die primäre Abklärung auf eine Basisdiagnostik. Diese besteht im Wesentlichen aus Anamnese, klinischer Untersuchung und Proktorektoskopie. Die Endosonographie und perineale Sonographie haben zusätzlich große Bedeutung erlangt. In vielen Fällen wird zunächst ein konservativer Therapieversuch indiziert sein, bevor weitere aufwendigere Diagnostik eingesetzt wird. Während bereits die Diagnostik der Beckenbodenfunktionsstörungen sehr vielschichtig und unter Berücksichtigung des organüberschreitenden Charakters der Erkrankung komplex und in der Regel nur interdisziplinär zu lösen ist, gilt dies umso mehr für die Therapie. Jegliche Therapieentscheidung sollte nicht nur befundadaptiert sein, sondern in erster Linie die individuelle Lebenssituation (Alter, Leidensdruck, Risikoprofil des Patienten) sowie dessen Erwartungshorizont berücksichtigen. Insgesamt steht einer breiten Symptompalette der Beckenbodenfunktionsstörungen eine nicht minder große Auswahl verschiedener Therapieverfahren gegenüber. Die definitive Entscheidung, welches Verfahren zu bevorzugen ist, hängt neben den individuellen Wünschen und dem Beschwerdebild bzw. Leidensdruck des Patienten nicht zuletzt auch von der klinischen und operativen Erfahrung des Arztes ab.

Abstract

Pelvic floor disorders present very differently with regard to symptoms and manifestation. Both diagnostic and treatment options require specific experience and an interdisciplinary approach. Diagnostic work-up is primarily based on medical history, physical examination and procto-rectoscopy. Furthermore, endosonography and perineal sonography have also gained importance. In almost all cases following these basic examinations conservative therapy options should be considered. As the interdisciplinary concept is very important, for careful diagnosis of pelvic floor disorders it became crucial to find an adequate form of treatment. Every decision for surgical therapy should not only focus on the results of previous examinations but should also consider the individual situation of each patient. In pelvic floor disorders a large variety of symptoms are confronted with a vast number of different and often highly specific procedures. The decisions on who to treat and how to treat are not only based on individual patient requests and desires but also on the experience and preference of the surgeon.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8

Literatur

  1. Roos AM, Thakar R, Sultan AH et al (2013) Pelvic floor dysfunction: women’s sexual concerns unraveled. J Sex Med

  2. Stadelmaier U, Bittorf B, Meyer M et al (2000) Can continence function after rectal resection be prognostically estimated?. Chirurg 71:932–938

    Article  PubMed  CAS  Google Scholar 

  3. Freys SM, Fuchs KH, Fein M et al (1998) Inter- and intraindividual reproducibility of anorectal manometry. Langenbecks Arch Surg 383:325–329

    Article  PubMed  CAS  Google Scholar 

  4. Santoro GA, Wieczorek AP, Dietz HP et al (2011) State of the art: an integrated approach to pelvic floor ultrasonography. Ultrasound Obstet Gynecol 37:381–396

    Article  PubMed  CAS  Google Scholar 

  5. Kim M, Isbert C (2013) Anorectal functional diagnostics. Therapy algorithm for obstruction and incontinence. Chirurg 84:7–14

    Article  PubMed  CAS  Google Scholar 

  6. Herold A (2007) Treatment of anorectal diseases. Praxis 96:249–255

    Article  PubMed  CAS  Google Scholar 

  7. Herold A, Muller-Lobeck H, Jost WH et al (1999) Diagnostic evaluation of the rectum and pelvic floor in chronic constipation. Zentralbl Chir 124:784–795

    PubMed  CAS  Google Scholar 

  8. Siegmann KC, Reisenauer C, Speck S et al (2011) Dynamic magnetic resonance imaging for assessment of minimally invasive pelvic floor reconstruction with polypropylene implant. Eur J Radiol 80:182–187

    Article  PubMed  Google Scholar 

  9. Withagen MI, Vierhout ME, Mannaerts GH, Weiden RM van der (2012) Laparoscopic sacrocolpopexy with bone anchor fixation: short-term anatomic and functional results. Int Urogynecol J 23:481–486

    Article  PubMed  Google Scholar 

  10. Vierhout ME, Withagen MI, Futterer JJ (2011) Rectal obstruction after a vaginal posterior compartment polypropylene mesh fixed to the sacrospinous ligaments. Int Urogynecol J 22:1035–1037

    Article  PubMed  Google Scholar 

  11. Roos AM, Thakar R, Sultan AH (2010) Outcome of primary repair of obstetric anal sphincter injuries (OASIS): does the grade of tear matter? Ultrasound Obstet Gynecol 36:368–374

    Article  PubMed  Google Scholar 

  12. Oom DM, Steensma AB, Zimmerman DD, Schouten WR (2010) Anterior sphincteroplasty for fecal incontinence: is the outcome compromised in patients with associated pelvic floor injury? Dis Colon Rectum 53:150–155

    Article  PubMed  Google Scholar 

  13. Farrell SA, Gilmour D, Turnbull GK et al (2010) Overlapping compared with end-to-end repair of third- and fourth-degree obstetric anal sphincter tears: a randomized controlled trial. Obstet Gynecol 116:16–24

    Article  PubMed  Google Scholar 

  14. Matzel KE, Lux P, Heuer S et al (2009) Sacral nerve stimulation for faecal incontinence: long-term outcome. Colorectal Dis 11:636–641

    Article  PubMed  CAS  Google Scholar 

  15. Schiedeck TH (2008) Diagnosis and therapy of stool incontinence. Chirurg 79:379–388 (quiz 89)

    Article  PubMed  CAS  Google Scholar 

  16. Jarrett ME, Matzel KE, Stosser M et al (2005) Sacral nerve stimulation for fecal incontinence following surgery for rectal prolapse repair: a multicenter study. Dis Colon Rectum 48:1243–1248

    Article  PubMed  Google Scholar 

  17. Baumgartner U (2012) The artificial sphincter: therapy for faecal incontinence. Zentralbl Chir 137:340–344

    Article  PubMed  CAS  Google Scholar 

  18. Kersting S, Berg E (2012) Anal sphincter repair in the treatment of anal incontinence – when and how to do it? Zentralbl Chir 137:328–334

    Article  PubMed  CAS  Google Scholar 

  19. El-Gazzaz G, Zutshi M, Hannaway C et al (2012) Overlapping sphincter repair: does age matter? Dis Colon Rectum 55:256–261

    Article  PubMed  CAS  Google Scholar 

  20. Kneist W, Kauff DW, Naumann G, Lang H (2013) Resection rectopexy–laparoscopic neuromapping reveals neurogenic pathways to the lower segment of the rectum: preliminary results. Langenbecks Arch Surg 398:565–570

    Article  PubMed  Google Scholar 

  21. Kienle P, Horisberger K (2013) Transabdominal procedures for functional bowel diseases. Chirurg 84:21–29

    Article  PubMed  CAS  Google Scholar 

  22. Faucheron JL, Voirin D, Riboud R et al (2012) Laparoscopic anterior rectopexy to the promontory for full-thickness rectal prolapse in 175 consecutive patients: short- and long-term follow-up. Dis Colon Rectum 55:660–665

    Article  PubMed  Google Scholar 

  23. Cadeddu F, Sileri P, Grande M et al (2012) Focus on abdominal rectopexy for full-thickness rectal prolapse: meta-analysis of literature. Tech Coloproctol 16:37–53

    Article  PubMed  CAS  Google Scholar 

  24. Otto SD, Ritz JP, Grone J et al (2010) Abdominal resection rectopexy with an absorbable polyglactin mesh: prospective evaluation of morphological and functional changes with consecutive improvement of patient’s symptoms. World J Surg 34:2710–2716

    Article  PubMed  CAS  Google Scholar 

  25. Milito G, Cadeddu F, Selvaggio I, Grande M (2010) The Delorme repair for full-thickness rectal prolapse: a retrospective review. Am J Surg 199:581–582

    Article  PubMed  Google Scholar 

  26. Laubert T, Kleemann M, Schorcht A et al (2010) Laparoscopic resection rectopexy for rectal prolapse: a single-center study during 16 years. Surg Endosc 24(10):2401–2406

    Article  PubMed  Google Scholar 

  27. Kim M, Reibetanz J, Boenicke L et al (2010) Quality of life after transperineal rectosigmoidectomy. Br J Surg 97:269–272

    Article  PubMed  CAS  Google Scholar 

  28. Hetzer FH, Roushan AH, Wolf K et al (2010) Functional outcome after perineal stapled prolapse resection for external rectal prolapse. BMC Surg 10:9

    Article  PubMed  Google Scholar 

  29. Brazzelli M, Bachoo P, Grant A (2005) Surgery for complete rectal prolapse in adults (Review). Cochrane Database Syst Rev

  30. Samaranayake CB, Luo C, Plank AW et al (2010) Systematic review on ventral rectopexy for rectal prolapse and intussusception. Colorectal Dis 12:504–512

    Article  PubMed  CAS  Google Scholar 

  31. Sailer M, Bonicke L, Petersen S (2007) Surgical options in the treatment of rectal prolapse: indications, techniques and results. Zentralbl Chir 132:350–357

    Article  PubMed  CAS  Google Scholar 

  32. Pescatori M, Spyrou M, Pulvirenti d’Urso A (2007) A prospective evaluation of occult disorders in obstructed defecation using the ‚iceberg diagram’. Colorectal Dis 9:452–456

    Article  PubMed  CAS  Google Scholar 

  33. Schreyer AG, Paetzel C, Furst A et al (2012) Dynamic magnetic resonance defecography in 10 asymptomatic volunteers. World J Gastroenterol 18:6836–6842

    Article  PubMed  Google Scholar 

  34. Wijffels NA, Jones OM, Cunningham C et al (2013) What are the symptoms of internal rectal prolapse? Colorectal Dis 15:368–373

    Article  PubMed  CAS  Google Scholar 

  35. Adams K, Papagrigoriadis S (2013) Stapled transanal rectal resection (STARR) for obstructive defaecation syndrome: patients with previous pelvic floor surgery have poorer long-term outcome. Colorectal Dis 15:477–480

    Article  PubMed  CAS  Google Scholar 

  36. Isbert C, Kim M, Reibetanz J, Germer CT (2012) Stapled transanal resection for the treatment of obstructed defaecation syndrome. Zentralbl Chir 137:364–370

    Article  PubMed  CAS  Google Scholar 

  37. Lang RA, Buhmann S, Lautenschlager C et al (2010) Stapled transanal rectal resection for symptomatic intussusception: morphological and functional outcome. Surg Endosc 24(8):1969–1975

    Article  PubMed  Google Scholar 

  38. Isbert C, Reibetanz J, Jayne DG et al (2010) Comparative study of Contour Transtar and STARR procedure for the treatment of obstructed defecation syndrome (ODS) – feasibility, morbidity and early functional results. Colorectal Dis 12:901–908

    Article  PubMed  CAS  Google Scholar 

  39. Gagliardi G, Pescatori M, Altomare DF et al (2008) Results, outcome predictors, and complications after stapled transanal rectal resection for obstructed defecation. Dis Colon Rectum 51:186–195 (discussion 95)

    Article  PubMed  Google Scholar 

  40. Schwandner O, Stuto A, Jayne D et al (2008) Decision-making algorithm for the STARR procedure in obstructed defecation syndrome: position statement of the group of STARR Pioneers. Surg Innov 15:105–109

    Article  PubMed  Google Scholar 

  41. Laubert T, Kleemann M, Roblick UJ et al (2013) Obstructive defecation syndrome: 19 years of experience with laparoscopic resection rectopexy. Tech Coloproctol 17:307–314

    Article  PubMed  CAS  Google Scholar 

  42. Schey R, Cromwell J, Rao SS (2012) Medical and surgical management of pelvic floor disorders affecting defecation. Am J Gastroenterol 107:1624–1633 (quiz p 34)

    Article  PubMed  Google Scholar 

  43. Laubert T, Kleemann M, Roblick UJ et al (2012) Laparoscopic resection rectopexy as treatment for obstructive defecation syndrome. Zentralbl Chir 137:357–363

    Article  PubMed  CAS  Google Scholar 

  44. Baessler K (2012) Do we need meshes in pelvic floor reconstruction? World J Urol 30:479–486

    Article  PubMed  Google Scholar 

  45. Maher C, Feiner B, Baessler K et al (2010) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 4:CD004014

    PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. T.H. Schiedeck gibt an, dass kein Interessenkonflikt besteht. Das vorliegende Manuskript enthält keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Klinik für Allgemein- und Viszeralchirurgie, Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Deutschland

    T.H. Schiedeck

Authors
  1. T.H. Schiedeck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T.H. Schiedeck.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schiedeck, T. Beckenbodendysfunktion aus chirurgischer Sicht. Chirurg 84, 909–918 (2013). https://doi.org/10.1007/s00104-012-2387-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-012-2387-6

Schlüsselwörter

Keywords

Search

Navigation