Zusammenfassung
Die Beckenbodeninsuffizienz als Erkrankungsbild zeichnet sich durch mannigfaltige Symptome, wie z. B. Druckgefühl, Entleerungsstörungen oder Inkontinenzbeschwerden, aus. Bedingt durch die hohe Inzidenz und die breitgefächerte Symptomatik, befassen sich unterschiedliche medizinische Fachrichtungen, darunter Gynäkologie, Chirurgie, Koloproktologie und Urologie mit diesem Krankheitsbild. Alle diese Fachrichtungen haben im Laufe der Zeit verschiedene diagnostische Techniken hervorgebracht und bieten den Betroffenen zahlreiche konservative und operative Behandlungsstrategien. In der heutigen Zeit zeigt sich jedoch zunehmend, dass ein Behandlungsansatz, welcher nur auf einen Teil des Beckenbodens fokussiert, nicht mehr ausreicht, um dessen kombinierte Pathologien zu behandeln. In diesem Zusammenhang stellt die Diagnostik einen zentralen Punkt dar, da sie am Anfang eines jeden Behandlungspfades steht und keine Fehler zulässt. In diesem Beitrag werden die einzelnen fachspezifischen diagnostischen Tools beschrieben. Ein besonderes Augenmerk wird auf die Sonographie gelegt, die einige entscheidende Vorteile bei der Beurteilung des Beckenbodens bietet. Aktuell weichen die Messmethoden und die Einteilung der Schweregrade von Fakultät zu Fakultät ab. Daraus resultieren unterschiedliche und zum Teil gegensätzliche Behandlungsvorschläge. Durch eine alternative Messmethode können alle Beckenbodenveränderungen quantifiziert werden. Diese Methode kann fachübergreifend für die prä- und postoperative Beurteilung des gesamten Beckenbodens eingesetzt werden, was wiederum einer kontinuierlichen Verbesserung der Behandlung dient.
Abstract
Pelvic floor insufficiency as a disease is characterized by various symptoms, such as feeling of pressure, voiding disorders, or incontinence. Due to the high incidence and the wide range of symptoms, various medical specialties, including gynecology, surgery, coloproctology, and urology, have patients who present with this clinical picture. Each specialty has developed various diagnostic techniques over time and offer those affected numerous conservative and surgical treatment strategies. Today, however, it is becoming increasingly apparent that a treatment approach focused on part of the pelvic floor is no longer sufficient to treat the combined pathologies of the pelvic floor. In this context, diagnosis is a central point, as it is at the beginning of each treatment path and does not allow errors. This article describes the individual specialty-specific diagnostic tools. Particular attention is paid to sonography, which offers several decisive advantages in the assessment of the pelvic floor. Currently, the measurement methods and the classification of the severity levels differ from specialty to specialty, which results in different and sometimes contradictory treatment options. Using an alternative diagnostic approach can quantify all pelvic floor changes. This alternative approach can be used interdisciplinary for pre- and postoperative assessment of the entire pelvic floor, which in turn serves a continuous improvement of treatment.
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Kowallik, M. Diagnostik der Beckenbodeninsuffizienz. coloproctology 43, 321–327 (2021). https://doi.org/10.1007/s00053-021-00551-3
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DOI: https://doi.org/10.1007/s00053-021-00551-3