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Prolapschirurgie

Endgültiger Abschied von Gesamtkonzepten?

Prolapse surgery: Farewell to general concepts?

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

„Rundum-glücklich-Konzepte“ bei der Rekonstruktion von Beckenbodendefekten mit Deszensus, Prolaps und Störungen der urethralen und analen Kontinenzmechanismen sind mangels überzeugender Langzeitergebnisse und aufgrund der ökonomischen Zwänge spätestens seit Einführung der DRG zu Gunsten einer individualisierten, symptombezogenen operativen Strategie verlassen worden. Die routinemäßige Hysterektomie ist ohne relevanten Descensus uteri spätestens beim senil atrophen Organ nicht gerechtfertigt. Eine mögliche larvierte Stressinkontinenz sollte in der Aufklärung erwähnt werden, wegen der potenziellen Nebenwirkungen und Risiken jedoch nicht routinemäßig zu einem zusätzlichen Inkontinenzeingriff Anlass sein. Fremdmaterialien sollen nur bei mehrfachem Rezidiv oder bei Risikofaktoren mit vorhersehbar hohem Rezidivrisiko eingesetzt werden, ihr Einsatz bedarf strenger Indikationsstellung und einer subtilen Aufklärung über die möglichen erheblichen Nebenwirkungen und Komplikationen. Eine allgemein akzeptierte Klassifizierung von Descensus und Prolaps ist ebenso dringend erforderlich wie Vergleichstudien, um den Stellenwert der einzelnen Strategien zu belegen: Die Datenlage ist absolut unbefriedigend.

Abstract

Abdominal or vaginal complex surgical strategies did not show convincing success rates. They have been replaced by individualized symptom orientated approaches. Economic factors have contributed to this change of strategies. Routine hysterectomy without marked organ prolapse, especially in atrophic small uteri in postmenopause is not justified. Masked urinary incontinence should be discussed during the informed consent, but, should not be indication for routine prophylactic anti-incontinence procedures because of the risk of functional obstruction and other side effects. As there is a lack of reliable prospective studies with at least mid-term experience the use of alloplastic materials should be restricted to recurrences, needing extensive information about possible side effects and complications. We need a generally accepted clinical classification of descent and prolapse, at the same time waiting for prospective randomized studies proving the effect of different materials and strategies.

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

    E. Petri

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Petri, E. Prolapschirurgie. Gynäkologe 40, 702–709 (2007). https://doi.org/10.1007/s00129-007-2033-4

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  • DOI: https://doi.org/10.1007/s00129-007-2033-4

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