Advertisement

Descensus genitalis

  • T. DimpflEmail author
  • A.-K. von Hobe
  • C. Schiffner
Leitthema
  • 47 Downloads

Zusammenfassung

Die Erkrankungen und Funktionsstörungen des weiblichen Beckenbodens gewinnen aufgrund der demographischen Entwicklung und der steigenden Lebenserwartung der Frau einerseits und aufgrund der Ansprüche an die Erhaltung der Lebensqualität in jedem Alter andererseits stetig an Bedeutung. Die Prävalenz des Descensus genitalis wird in einer schwedischen Studie in einer Subgruppe von Frauen zwischen 20 und 59 Jahren mit 31 % angegeben, die Prävalenz bei Frauen zwischen 50- und 79 Jahren steigt auf bis zu 41 %. Die AGUB (Arbeitsgemeinschaft für Urogynäkologie und plastische Beckenbodenrekonstruktion) hat in den letzten Jahren gemeinsam mit Kollegen aus Österreich und der Schweiz für alle relevanten Erkrankungen des Beckenbodens hochkarätige Leitlinien für den gesamten deutschsprachigen Raum Europas entwickelt. Dargestellt werden die wesentlichen Schritte der Diagnostik sowie die konservative und operative Therapie. Besonders wird dabei auf die unterschiedlichen Zugangswege von vaginal, abdominal und minimal-invasiv per Laparoskopie eingegangen sowie auf die uteruserhaltenden Operationsverfahren. Abschließend erfolgt eine Bewertung der alloplastischen Netzmaterialen im Spiegel der aktuellen Literatur.

Schlüsselwörter

Beckenboden Patientenzufriedenheit Lebensqualität Urininkontinenz Deszensus genitalis Prolaps 

Genital prolapse

Abstract

Diseases and functional disorders of the female pelvic floor are continuously gaining in importance due to the demographic developments with the increasing life expectations of women and the demands on the preservation of the quality of life at all ages. In a Swedish study the prevalence of genital prolapse in a subgroup of women between 20 and 59 years old was given as 31% and the prevalence in women between 50 and 79 years old increased up to 41%. In recent years the German working group for urogynecology and plastic surgical pelvic floor reconstruction (AGUB) together with colleagues from Austria and Switzerland has developed high-quality guidelines for all relevant diseases and for all German-speaking regions in Europe. The principal steps of the diagnostics as well as the conservative and surgical treatment are presented. Special emphasis is placed on the various vaginal, abdominal and minimally invasive access routes by laparoscopy as well as uterus-preserving surgical procedures. Finally, an assessment of alloplastic mesh materials is carried out as reflected in the currently available literature.

Keywords

Pelvic floor Patient satisfaction Quality of life Urinary incontinence Descensus genitalis Prolapse 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

T. Dimpfl, A.-K. von Hobe und C. Schiffner geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Anthuber C, Finas D, Hübner M, Peschers U, Jundt K, Strauss A, Funfgeld C et al (2015) Interdisziplinäre S2-Leitlinie: Deszensus genitalis der Frau – Diagnostik und Therapie. AWMF-Leitlinien Register Nr 015/005Google Scholar
  2. 2.
    Barber MD, Maher CF (2013) Apical prolapse. Int Urogynecol J 24(11):1815–1833CrossRefGoogle Scholar
  3. 3.
    Braekken IH, Majida M, Engh ME, Bo K (2010) Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. Am J Obstet Gynecol 203(2):170–177.  https://doi.org/10.1016/j.ajog.2010.02.037 CrossRefPubMedGoogle Scholar
  4. 4.
    Cayrac M, Warembourg S, le Normand L, Fatton B (2016) Does hysterectomy modifies the anatomical and functional outcomes of prolapse surgery?: clinical practice guidelines. Prog Urol 26(Suppl 1):S73–S88.  https://doi.org/10.1016/S1166-7087(16)30430-4 CrossRefPubMedGoogle Scholar
  5. 5.
    Chapple CR, Cruz F, Deffieux X, Milani AL, Arlandis S, Artibani W, Castro-Diaz D et al (2017) Consensus statement of the European Urology Association and the European Urogynaecological Association on the use of implanted materials for treating pelvic organ prolapse and stress urinary incontinence. Eur Urol 72(3):424–431CrossRefGoogle Scholar
  6. 6.
    Da Siveira S, Haddad J, Jarmy-Di BZ, Nastri F, Kawabata MGM, Da Silva Carramao S, Chada Bacarat E, Flores Auge AP et al (2015) Multicenter, randomized trial comparing native tissue repair and synthetic mesh repair for genital prolpase surgical treatment. Int Urogynecol J 26:335–342CrossRefGoogle Scholar
  7. 7.
    Dias MM, Castro R, Bortolini MAT, Delroy CA, Martins PCF et al (2015) Two-years results of native tissue versus vaginal mesh repair in the tretament of anterior prolapse according to different success criteria: a randomized controlled trail. Neurourol Urodyn.  https://doi.org/10.1002/nau.22740 CrossRefPubMedGoogle Scholar
  8. 8.
    Farthmann J, Watermann D, Erbes T, Roth K, Nanovska P, Gitsch G, Gabriel B (2015) Functional outcome after pelvic floor reconstructive surgery with or without concomitant hysterectomy. Arch Gynecol Obstet 291(3):573–577.  https://doi.org/10.1007/s00404-014-3435-x CrossRefPubMedGoogle Scholar
  9. 9.
    Fialkow MF, Newton KM, Lentz GM, Weiss NS (2008) Lifetime risk of surgical management for pelvic organ prolapse or urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 19(3):437–440.  https://doi.org/10.1007/s00192-007-0459-9 CrossRefPubMedGoogle Scholar
  10. 10.
    Hannestad YS, Rortveit G, Sandvik H, Hunskaar S (2000) A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of Incontinence in the County of Nord-Trondelag. J Clin Epidemiol 53(11):1150–1157.  https://doi.org/10.1016/s0895-4356(00)00232-8 CrossRefPubMedGoogle Scholar
  11. 11.
    Hofmann R, Wagner U (2014) Senkung des mittleren Vaginalkompartiments. In: Szych A, Dimpfl T, Valet A, Hessler P, Kalder M (Hrsg) Inkontinenz- und Deszensuschirurgie der Frau. Springer, Berlin, Heidelberg, S 151–185. ISBN 978-3662436707Google Scholar
  12. 12.
    Hsiao KC, Latchamsetty K, Govier FE, Kozlowski P, Kobashi KC (2007) Comparison of laparoscopic and abdominal sacrocolpopexy for the treatment of vaginal vault prolapse. J Endourol 21(8):926–930.  https://doi.org/10.1089/end.2006.0381 CrossRefPubMedGoogle Scholar
  13. 13.
    Jundt K, Peschers U, Kentenich H (2015) The investigation and treatment of female pelvic floor dysfunction. Dtsch Arztebl Int 112(33–34):564–574.  https://doi.org/10.3238/arztebl.2015.0564 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Kahn MA, Stanton SL (1997) Posterior colporrhaphy: its effects on bowel and sexual function. Br J Obstet Gynaecol 104(1):82–86CrossRefGoogle Scholar
  15. 15.
    Kashyap R, Jain V, Singh A (2013) Comparative effect of 2 packages of pelvic floor muscle training on the clinical course of stage I–III pelvic organ prolapse. Int J Gynaecol Obstet 121(1):69–73.  https://doi.org/10.1016/j.ijgo.2012.11.012 CrossRefPubMedGoogle Scholar
  16. 16.
    Kaufmann M, Costa SD, Scharl A (2013) Kapitel Lageveränderungen des weiblichen Genitale. In: Skala C, Scharl A, Göhring U‑J (Hrsg) Die Gynäkologie. Springer, Berlin, Heidelberg, S 233–250. ISBN 978-3642209222CrossRefGoogle Scholar
  17. 17.
    Lim YN, Muller R, Corstiaans A, Hitchins S, Barry C, Rane A (2007) A long-term review of posterior colporrhaphy with Vypro 2 mesh. Int Urogynecol J Pelvic Floor Dysfunct 18(9):1053–1057.  https://doi.org/10.1007/s00192-006-0290-8 CrossRefPubMedGoogle Scholar
  18. 18.
    Maher C, Feiner B, Baessler K, Christmann-Schmid C (2016) Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.cd012079 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J (2016) Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.cd012376 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Maher CF, Feiner B, Baessler K, Schmid C (2013) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.cd004014.pub5 CrossRefPubMedGoogle Scholar
  21. 21.
    Maito JM, Quam ZA, Craig E, Danner KA, Rogers RG (2006) Predictors of successful pessary fitting and continued use in a nurse-midwifery pessary clinic. J Midwifery Womens Health 51(2):78–84.  https://doi.org/10.1016/j.jmwh.2005.09.003 CrossRefPubMedGoogle Scholar
  22. 22.
    Morling JR, McAlister A, Agur W (2017) Adverse events after first, single, mesh and non-mesh surgical procederes for stress urinary incontinence and pelvic organ prolpase in scotland, 1997–2016: a population-based study. Lancet 389:629–640CrossRefGoogle Scholar
  23. 23.
    Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H (2013) Long-term Outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA 309:2016–2024CrossRefGoogle Scholar
  24. 24.
    Paraiso MF, Barber MD, Muir TW, Walters MD (2006) Rectocele repair: a randomized trial of three surgical techniques including graft augmentation. Am J Obstet Gynecol 195(6):1762–1771.  https://doi.org/10.1016/j.ajog.2006.07.026 CrossRefPubMedGoogle Scholar
  25. 25.
    Raz S (2015) The anatomy of pelvic support. In: Raz S (Hrsg) Atlas of vaginal reconstructive surgery. Springer, NewYork, S 1–26. ISBN 978-1493929405 CrossRefGoogle Scholar
  26. 26.
    Richter K (1999) Die chirurgische Anatomie der Vagiaefixatio sacrospinalis vaginalis. Ein Beitrag zur operativen Behandlung des Scheidenblindsackprolapses. Geburtshilfe Frauenheilkd 28(4):321–327Google Scholar
  27. 27.
    Samuelsson EC, Victor FT, Tibblin G, Svardsudd KF (1999) Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol 180(2 Pt 1):299–305CrossRefGoogle Scholar
  28. 28.
    Sandvik H, Hunskaar S, Seim A, Hermstad R, Vanvik A, Bratt H (1993) Validation of a severity index in female urinary incontinence and its implementation in an epidemiological survey. J Epidemiol Community Health 47(6):497–499CrossRefGoogle Scholar
  29. 29.
    Smith FJ, Holman CD, Moorin RE, Tsokos N (2010) Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol 116(5):1096–1100.  https://doi.org/10.1097/AOG.0b013e3181f73729 CrossRefPubMedGoogle Scholar
  30. 30.
    Spanknebel B, Dimpfl T (2013) Descensus genitalis – klassische operative Konzepte. Gynäkologe 46:458–462.  https://doi.org/10.1007/s00129-012-3125-3 CrossRefGoogle Scholar
  31. 31.
    Stupp L, Resende AP, Oliveira E, Castro RA, Girao MJ, Sartori MG (2011) Pelvic floor muscle training for treatment of pelvic organ prolapse: an assessor-blinded randomized controlled trial. Int Urogynecol J 22(10):1233–1239.  https://doi.org/10.1007/s00192-011-1428-x CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.FrauenklinikKlinikum KasselKasselDeutschland

Personalised recommendations