Alloplastisches Bandmaterial in der Therapie der Harninkontinenz

Alloplastic material in the treatment of urinary incontinence

Zusammenfassung

Nach Versagen der konservativen Therapieansätze werden operative Verfahren zur Korrektur der Harninkontinenz bei Frauen und Männern empfohlen. Alloplastische Schlingensysteme stellen hierbei bei beiden Geschlechtern die etablierte Therapieoption dar. Standardtherapie in der operativen Behandlung der weiblichen Belastungsinkontinenz ist aktuell in Deutschland die suburethrale spannungsfreie Schlinge. Und auch beim Mann werden v. a. bei leicht bis mittelgradiger Belastungsinkontinenz repositionierende fixierte oder adjustierbare Schlingensysteme eingesetzt. Allerdings stehen operative Techniken mit alloplastischem Fremdmaterial in den letzten Jahren stark in der Diskussion. Zwar bezieht sich die Kritik und die ausgesprochenen Verbote nur auf den Einsatz von Fremdmaterial bei der operativen Behandlung des Genitaldeszensus der Frau, dennoch wird häufig v. a. in der Laienpresse kein Unterschied zwischen Harninkontinenz und Deszensus gemacht. Aufgrund der zunehmenden Kritik an der Implantation von Fremdmaterial bei Frauen könnte die laparoskopische Kolposuspension in Zukunft wieder häufiger durchgeführt werden.

Abstract

Surgery for urinary incontinence is indicated after failure of conservative treatment with pelvic floor therapy. Different sling systems are the established treatment option for urinary incontinence for female and male patients. Tension-free vaginal tapes represent the standard of care in the surgical treatment of female stress urinary incontinence. In male patients with mild or moderate stress urinary incontinence, fixed repositioning slings or adjustable compressive slings represent minimally invasive alternatives to the artificial urinary sphincter. The use of surgical mesh material has been widely discussed within the last years. The current US Food and Drug Administration warning was focused on the use of transvaginal mesh implants in female patients with pelvic organ prolapse. Within the current debate, surgery for stress urinary incontinence and surgery for pelvic organ prolapse have often not been differentiated. With this ongoing discussion about the use of foreign material in reconstructive surgery, laparoscopic colposuspension might be performed more often in the near future.

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Correspondence to Dr. M. Grabbert.

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Interessenkonflikt

M. Grabbert gibt folgende Beziehungen an: Beratungstätigkeit für Boston Scientific (Marlborough, MA, USA) sowie Übernahme von Reisekosten durch Promedon (Cordoba, Argentinien) und Astellas Pharma (München, Deutschland). R.M. Bauer gibt folgende Beziehungen an: Beratungstätigkeit, Vorträge und Mitwirkung an klinischen Studien für Boston Scientific (Marlborough, MA, USA), AMI (Feldkirch, Österreich) und Promedon (Cordoba, Argentinien).

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Grabbert, M., Bauer, R.M. Alloplastisches Bandmaterial in der Therapie der Harninkontinenz. Urologe (2021). https://doi.org/10.1007/s00120-021-01530-8

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Schlüsselwörter

  • Spannungsfreie Schlingen
  • Adjustierbare Schlingen
  • Fremdmaterial
  • Deszensus
  • Komplikationsrate

Keywords

  • Tension-free vaginal tapes
  • Adjustable slings
  • Mesh material
  • Pelvic organ prolapse
  • Postoperative complications