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Urogynäkologische Diagnostik vor konservativer und operativer Therapie

Urogynaecologic diagnostics for conservative or surgical treatment

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Zusammenfassung

Nationale und internationale Fachgesellschaften haben Leitlinien und Empfehlungen aktualisiert, welche die Diagnostik und Therapie von Harninkontinenz und Deszensus auf dem Boden der Evidenz-Levels und Cochrane-Publikationen beschreiben. Anamnese, Inspektion und Palpation, Harnuntersuchung und Sonographie sind in der Frauenheilkunde die Basisdiagnostik. Bei Diskrepanz zwischen subjektiven Beschwerden und klinischem Befund, beim Versagen der konservativen Therapie, bei Rezidiven und bei geplanter operativer/invasiver Therapie sollte eine urodynamische Funktionsdiagnostik, Perineal- oder Introitussonographie und Urethrozystoskopie erfolgen. Angesichts der nicht unerheblichen Komplikationsrate und der kontroversen bis fehlenden Datenlage zu den Materialien und Zugangswegen bei Einsatz alloplastischer Bänder und Netze wird den traditionellen Rekonstruktionen, der vaginalen oder abdominalen Sakrokolpopexie und der Kolposuspension beim paravaginalen Abriss, wieder ein Stellenwert eingeräumt.

Abstract

National and international societies have up-dated guidelines and recommendations for the diagnosis and treatment of urinary incontinence and urogenital prolapse based on evidence levels and Cochrane publications. The medical history, inspection and palpation physical examinations together with urine culture and sonography are the basic tools in gynaecology. In cases of a discrepancy between the subjective complaints and objective clinical findings, recurrence or a planned invasive/surgical intervention, urodynamic testing together with perineal or introital sonogram and urethrocystoscopy should be performed. In view of the not insubstantial rate of complications and conflicting or lacking data on materials and access routes for alloplastic slings and meshes a more sophisticated approach is again to be recommended with a definitive place for traditional reconstructions, such as vaginal and abdominal sacrocolpopexy and colposuspension for paravaginal defects.

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Literatur

  1. (o A) (2006) National Collaboration Centre For Women’s and Children’s Health. Urinary Incontinence (NICE Guidelines). http://www.nice.org.uk/nicemedia/pdf/CG40fullguideline.pdf. RCOG Press

  2. Baessler K,Reisenauer C et al (2008) Descensus genitalis der Frau – Diagnostik und Therapie. http://www.uni-duesseldorf.de/AWMF/ll/015-006.htm

  3. Delorme E (2001) Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol 11(6):1306–1313

    PubMed  CAS  Google Scholar 

  4. Hay-Smith EJ, Dumoulin C (2006) Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev (1): p. CD005654

    Google Scholar 

  5. Keegan PE, Atiemo K, Cody J et al (2007) Periurethral injection therapy for urinary incontinence in women. Cochrane Database Syst Rev (3):CD003881

    Google Scholar 

  6. Kuuva N, Nilsson CG (2006) Long-term results of the tension-free vaginal tape operation in an unselected group of 129 stress incontinent women. Acta Obstet Gynecol Scand 85(4):482–487

    Article  PubMed  Google Scholar 

  7. Liapis A, Bakas P, Creatsas G (2002) Burch colposuspension and tension-free vaginal tape in the management of stress urinary incontinence in women. Eur Urol 41(4):469–473

    Article  PubMed  CAS  Google Scholar 

  8. Liapis A, Bakas P, Giner M, Creatsas G (2006) Tension-free vaginal tape versus tension-free vaginal tape obturator in women with stress urinary incontinence. Gynecol Obstet Invest 62(3):160–164

    Article  PubMed  Google Scholar 

  9. Meschia M, Pifarotti P, Buonaguidi A et al (2005) Tension-free vaginal tape (TVT) for treatment of stress urinary incontinence in women with low-pressure urethra. Eur J Obstet Gynecol Reprod Biol 122(1):118–121

    Article  PubMed  Google Scholar 

  10. Norton PA, Zinner NR, Yalcin I, Bump RC (2002) Duloxetine versus placebo in the treatment of stress urinary incontinence. Am J Obstet Gynecol 187(1):40–48

    Article  PubMed  CAS  Google Scholar 

  11. Peschers U, Dimpfl T, Kölbl H, Petri E et al (2008) Belastungsinkontinenz der Frau. http://www.uni-duesseldorf.de/AWMF/ll/015/005.htm

  12. Petri E, Niemeyer R, Martan A et al (2006) Reasons for and treatment of surgical complications with alloplastic slings. Int Urogynecol J 17:3–13

    Article  Google Scholar 

  13. Porena M, Costantini E, Frea B et al (2007) Tension-free vaginal tape versus transobturator tape as surgery for stress urinary incontinence: results of a multicentre randomised trial. Eur Urol 52(5):1481–1490

    Article  PubMed  Google Scholar 

  14. Schraffordt Koops SE, Bisseling TM, van Brummen HJ et al (2007) Result of the tension-free vaginal tape in patients with concomitant prolapse surgery: a 2-year follow-up study. An analysis from the Netherlands TVT database. Int Urogynecol J Pelvic Floor Dysfunct 18(4):437–442

    Article  Google Scholar 

  15. Shaikh S, Ong EK, Glavind K et al (2006) Mechanical devices for urinary incontinence in women. Cochrane Database Syst Rev 3:CD001756

    PubMed  CAS  Google Scholar 

  16. Smith AR, Daneshgari F, Milani R et al (2004) Surgery for Urinary Incontinence (in: Incontinence). Plymouth UK: Mass: Health Publication Ltd., 2005. Ward KL, Hilton P (eds) A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: two-year follow-up. Am J Obstet Gynecol 190(2):324–331

    Article  Google Scholar 

  17. Strasser H, Marksteiner R, Margreiter E et al (2007) Transurethral ultrasonography-guided injection of adult autologous stem cells versus transurethral endoscopic injection of collagen in treatment of urinary incontinence. World J Urol 25(4):385–392

    Article  PubMed  CAS  Google Scholar 

  18. Subak LL, Whitcomb E, Shen H et al (2005) Weight loss: a novel and effective treatment for urinary incontinence. J Urol 174(1):190–195

    Article  PubMed  Google Scholar 

  19. Swift S, Morris S, McKinnie, Petri E et al (2006) Validation of a simplified technique for using the POPQ pelvic organ prolapsed classification system. Int Urogynecol J 17:615–620

    Article  Google Scholar 

  20. Tamussino K, Hanzal E, Kolle D et al (2001) Tension-free vaginal tape operation: results of the Austrian registry. Obstet Gynecol 98:732–736

    Article  PubMed  CAS  Google Scholar 

  21. Tunn R, Schaer G, Petri E, Riss P et al (2005) Updated recommendationson ultrasonography in urogynecology. Int Urogynecol J 16:236–241

    Article  CAS  Google Scholar 

  22. Ulmsten U, Johnson P, Rezapour M (1999) A three-year follow up of tension free vaginal tape for surgical treatment of female stress urinary incontinence. J Obstet Gynaecol 106(4):345–350

    CAS  Google Scholar 

  23. Venn SN, Greenwell TJ, Mundy AR (2000) The long-term outcome of artificial urinary sphincters. J Urol 164(3 Pt 1):702–706

    Article  PubMed  CAS  Google Scholar 

  24. Ward K, Hilton P (2002) Prospective multicentre randomised trial of tension-free vaginal tape and colposuspension as primary treatment for stress incontinence. BMJ 325(7355):67

    Article  PubMed  Google Scholar 

  25. Zhu L, Lang J (2006) A prospective randomized trial comparing TVT and TOT for surgical treatment of slight and moderate stress urinary incontinence (abstract). Int Urogynecol J Pelvic Floor Dysfunct 17(Suppl 2):S307

    Google Scholar 

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  1. Frauenklinik der Helios-Kliniken Schwerin, Wismarsche Straße 393-397, 19049, Schwerin, Deutschland

    E. Petri

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  1. E. Petri
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Correspondence to E. Petri.

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Unter Verwendung der aktuellen Leitlinien der Arbeitsgemeinschaften der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe und der Deutschen Gesellschaft für Urologie, der Arbeitsgemeinschaften in Österreich und der Arbeitsgemeinschaft Urogynäkologie der Schweiz.

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Petri, E. Urogynäkologische Diagnostik vor konservativer und operativer Therapie. Gynäkologe 42, 365–377 (2009). https://doi.org/10.1007/s00129-009-2369-z

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