Zusammenfassung
Ein Deszensus/Prolaps genitalis und die Inkontinenz können bei entsprechendem Leidensdruck konservativ oder operativ behandelt werden. Der Zeitpunkt, die Indikation und die Wahl des geeigneten Verfahrens, eine detaillierte Aufklärung und ausreichende Operationserfahrung sind unabdingbare Vorraussetzungen für eine anatomisch und funktionell erfolgreiche Wiederherstellung des Beckenbodens und damit einer Verbesserung der Lebensqualität.
Grundsätzlich sollte zunächst konservativ behandelt werden. Vermutlich ist es günstiger, erst nach abgeschlossener Familienplanung zu operieren. Die klassischen Operationen mit Eigengewebe sind effektiv, komplikationsarm und lange untersucht. Mesh-gestützte Verfahren werden derzeit nur für die Rezidivsituation empfohlen, sie erhöhen die anatomischen Erfolgsraten um etwa 10–15%, was sich aber derzeit noch nicht in einer höheren Patientenzufriedenheit und einer geringeren Rate an Reoperationen ausdrückt. Ausreichende Langzeitdaten liegen nicht vor, müssen aber gefordert werden. Die Weiterentwicklung der Materialien, operationstechnische Verbesserungen und der stetige Erfahrungszuwachs lassen einen vorsichtigen Optimismus zu.
Abstract
Genital prolapse and urinary incontinence can be treated conservatively and by sugery. The point in time, indication and choice of method, providing patients with detailed information about the surgery and sufficient operative experience are indispensable conditions for an effective anatomic and functional reconstruction of the pelvic floor and improvement of quality of life.
Generally conservative treatment is worth a try. Probably family planning should be completed before surgery. Standard classic procedures with autogenetic tissue are effective, safe and have been investigated for a long time. At this time mesh procedures are recommended for recurrent prolapse only. Effectiveness seems to be enhanced by 10–15%, but does not lead to higher patient satisfaction or lower re-operation rates. Long-term data are missing and should be obtained. Advancements in materials and operative methods and more expert knowledge reduce complications and allow cautious optimism.
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Keim, S., Anthuber, C. Inkontinenz und Deszensus der jungen Frau. Gynäkologe 43, 643–652 (2010). https://doi.org/10.1007/s00129-010-2550-4
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DOI: https://doi.org/10.1007/s00129-010-2550-4