Zusammenfassung
Die Urogenitalsonographie spielt seit Jahren eine unverzichtbare Rolle in der urogynäkologischen Diagnostik. Vor allem gute Verfügbarkeit, geringe Kosten und hohe Patientinnenakzeptanz haben für ihre zunehmende klinische Verbreitung gesorgt. Der Ultraschall ermöglicht die gleichzeitige Abbildung aller 3 Kompartimente in Ruhe und in der Dynamik. Neben der Darstellung von Urethra, Blase, Zervix, Analkanal und Rektum können auch Symphyse und Levator ani identifiziert werden. Die Positionen der Strukturen können nicht nur qualitativ, sondern auch innerhalb eines Koordinatensystems qualitativ und reproduzierbar dokumentiert werden. Aufgrund der direkten Darstellung alloplastischer Strukturen wie Bänder, Netze und „bulking agents“ eignet sich die Sonographie auch für das postoperative Komplikationsmanagement. Durch die Einführung der 3‑D-Sonographie können der Verlauf der Levatorschlinge und die Fläche des Hiatus genitalis in der Axialebene bestimmt werden. Für die Abklärung einer Harninkontinenz ist der präoperative Ausschluss von Divertikeln und Restharn obligat. Bei Senkungsbeschwerden kann das Tiefertreten aller Kompartimente während des Valsalva-Manövers bildlich festgehalten und quantitativ dokumentiert werden. Gerade im hinteren Kompartiment lassen sich die verschiedenen Formen wie Rektozele, Enterozele oder Intussuszeption unterscheiden. Ein Levatordefekt oder eine pathologische Aufweitung des Hiatus genitalis stellen Risikofaktoren für postoperative Rezidive nach Deszensusoperationen dar. Auch für die Abklärung einer Analinkontinenz eignen sich konventionelle Vaginal- und Abdominalsonden. Mit der exoanalen Technik können Defekte des internen und externen Sphinkterapparates dargestellt werden.
Abstract
Pelvic floor ultrasound has been an indispensable tool in the urogynecological work-up for several years. Due to easy access, low cost and high patient acceptance, ultrasound has become of increasing clinical importance. Ultrasound enables clinicians to visualize all three compartments at rest and during dynamic activity. Important structures, such as the pubic symphysis, urethra, bladder, cervix, anal canal, rectum and levator ani muscle can be identified. We can now not only describe the position of different structures qualitatively, but also document that position in a coordinate system in a highly reproducible way. Especially because of the ability to directly visualize alloplastic materials, such as slings, meshes and bulking agents, pelvic floor ultrasound plays a major role in postoperative complications. The introduction of 3D technology provides access to the axial plane and thus the evaluation of the levator and genital hiatus. Sonographic work-up for urinary incontinence and pelvic organ prolapse is obligatory. Evaluation of the posterior compartment and the discrimination between rectocele, enterocele and intussusception in particular are crucial. The presence of levator avulsion or abnormal hiatal overdistension represent risk factors for prolapse recurrence. Detailed evaluation of anal incontinence can be performed using regular gynecological ultrasound probes. Defects of the internal and external anal sphincter can also be demonstrated by the application of exoanal ultrasound.
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A. Schröer, Berlin
B.-J. Hackelöer, Hamburg
J. Weichert, Lübeck
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Albrich, S.B. Urogenitalsonographie des weiblichen Beckenbodens. Gynäkologe 51, 208–216 (2018). https://doi.org/10.1007/s00129-018-4200-1
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DOI: https://doi.org/10.1007/s00129-018-4200-1