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Komplikationsmanagement bei der Deszensus- und Inkontinenzchirurgie

Complication management in prolapse and incontinence surgery

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Zusammenfassung

Seit 20 Jahren haben spannungsfreie alloplastische Schlingenplastiken (SFAS) die Chirurgie der weiblichen Belastungsinkontinenz revolutioniert. Das Verfahren hat sich in großen Vergleichsstudien bei einfacher Erlernbarkeit, minimaler Invasivität mit entsprechend kurzen Operationszeiten und prinzipiell ambulanter Durchführbarkeit in Bezug auf Langzeiteffektivität der Kolposuspension als ebenbürtig erwiesen und flächendeckend durchgesetzt. Die Zahl der Inkontinenzoperationen hat sich verdreifacht, was auch einen zwangsläufigen Einfluss auch die Komplikationszahlen haben muss. Demgegenüber ist die Sakrokolpopexie nach wie vor die Standardoperation des weiblichen Deszensus in urologischer Hand geblieben, da sämtliche neuen Verfahren nicht an die Effektivität und Komplikationsarmut dieser Operation heranreichen. Gleichwohl müssen Komplikationsmöglichkeiten benannt und ihre Ursachen erkannt werden, um auch zukünftig höchsten Qualitätsansprüchen genügen zu können. Mögliche SFAS-Komplikationen werden sowohl in ihrer Häufigkeit als auch in ihrer Beherrschbarkeit unterschätzt. Komplikationsmöglichkeiten der Inkontinenz- und Deszensuschirurgie werden vorgestellt und möglichen Ursachen zugeordnet. Aus der Kenntnis der Pathophysiologie und der Komplikationsursache kann dann unter Hinzuziehung einer postoperativen Komplikationsdiagnostik ein patientenindividualisiertes Komplikationsmanagement erfolgen. Zur Vermeidung von Komplikationen sollte der Patient präoperativ konservativ ausbehandelt und vollständig (auch urodynamisch) untersucht werden. Eine postoperative Urodynamikkontrolle hilft bei der Dokumentation des Operationserfolges genauso wie bei der Identifizierung und Graduierung von Komplikationen.

Abstract

Tension-free alloplastic slings (TFAS) have revolutionized surgery for female stress urinary incontinence for more than 20 years. The procedure is easy to perform, minimally invasive with a short operating time in an outpatient setting and has proven efficacy comparable to retropubic colposuspension. The frequency of surgery for female stress incontinence has tripled within one decade which has to have an impact on the number of complications. In contrast, sacrocolpopexy has remained the gold standard in urological prolapse surgery as none of the new techniques has reached similar efficacy or safety; however, possible complications have to be named and their causes have to be understood to maintain the highest quality of care in the future. Possible complications of TFAS are potentially underestimated with respect to prevalence and manageability. Possible complications of prolapse and incontinence surgery are presented and the underlying causes are identified. Knowledge of the pathophysiology and the cause of complications together with the results of a postoperative diagnostic work-up, allow complication management to be tailored to each individual patient. To prevent complications all conservative treatment options should have been tried preoperatively and a complete evaluation (including urodynamics) should have been carried out for every patient. Postoperative urodynamics may help to document treatment success and to identify and quantify complications.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. C. Hampel, F. Roos, A. Neisius, J.W. Thüroff und C. Thomas geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Urologische Klinik und Poliklinik, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland

    C. Hampel, F. Roos, A. Neisius, J.W. Thüroff & C. Thomas

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  1. C. Hampel
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  2. F. Roos
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  3. A. Neisius
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  4. J.W. Thüroff
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  5. C. Thomas
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Correspondence to C. Hampel.

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Hampel, C., Roos, F., Neisius, A. et al. Komplikationsmanagement bei der Deszensus- und Inkontinenzchirurgie. Urologe 53, 1017–1029 (2014). https://doi.org/10.1007/s00120-014-3496-2

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