Download PDF
CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2021; 81(02): 183-190
DOI: 10.1055/a-1302-7803
GebFra Science
Review/Übersicht

Quo vadis Urogynäkologie 2020 – innovative Behandlungskonzepte von Harninkontinenz und Genitalprolaps

Article in several languages: English | deutsch
Gert Naumann
Frauenklinik, Helios Klinikum Erfurt, Universitätsfrauenklinik, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Zusammenfassung

Die aktuelle Behandlung von Harninkontinenz und Genitalprolaps umfasst vielfältige innovative Möglichkeiten konservativer und operativer Therapien. Eine angepasste lokale Estrogenisierung und professionelle Techniken des passiven und aktiven Beckenbodentrainings mit Biofeedback, Rüttelplatte und verschiedenen Vaginaldevices stellen den Behandlungsbeginn bei Beckenbodenfunktionsstörungen dar. Methode der Wahl zur operativen Sanierung der Belastungsinkontinenz ist die Einlage einer suburethralen Schlinge. Die operative Behandlung des Genitalprolaps bietet verschiedene Methoden auf vaginalem oder abdominal/endoskopischem Weg unter Eigengewebsrekonstruktion oder Nutzung von alloplastischem Material. So gelingt eine individuelle optimale Rekonstruktion sowohl bei der jungen Frau mit zumeist postpartalen Schädigungen bis hin zur betagten Patientin in der letzten Lebensphase. Dazu gehört die Einschätzung des gesundheitlichen Zustandes der Patientin und dem bestehenden anästhesiologischen Risikoprofil. Wichtig ist die Ermittlung des realistischen Patientenwunsches nach Erläuterung eines individuellen Konzeptes und Darstellung auch alternativer operativer Möglichkeiten.

Schlüsselwörter

Belastungsinkontinenz - suburethrale Schlinge - Genitaldeszensus - Sakrokolpopexie - vaginale Uterusfixation


Publication History

Received: 29 July 2020

Accepted: 01 November 2020

Article published online:
08 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References/Literatur

  • 1 Crean-Tate KK, Faubion SS, Pederson HJ. et al. Management of genitourinary syndrome of menopause in female cancer patients: a focus on vaginal hormonal therapy. Am J Obstet Gynecol 2020; 222: 103-113
    CrossrefPubMedGoogle Scholar
  • 2 Ford AA, Taylor V, Ogah J. et al. Midurethral slings for treatment of stress urinary incontinence review. Neurourol Urodyn 2019; 38: S70-S75
    PubMedGoogle Scholar
  • 3 Leone Roberti Maggiore U, Finazzi Agrò E, Soligo M. et al. Long-term outcomes of TOT and TVT procedures for the treatment of female stress urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J 2017; 28: 1119-1130
    CrossrefPubMedGoogle Scholar
  • 4 Kim A, Kim MS, Park YJ. et al. Clinical outcome of single-incision slings, excluding TVT-Secur, vs. standard slings in the surgical management of stress incontinence: an updated systematic review and meta-analysis. BJU Int 2019; 123: 566-584
    CrossrefPubMedGoogle Scholar
  • 5 Huebner M, Tunn R, Reisenauer C. et al. Surgical procedures for the treatment of stress urinary incontinence (SUI) in the light of the updated FDA-warning and its effects on practise patterns in Germany between 2010 and 2018. Abstract 63. EUGA 2020 Interactive Meeting 11. – 12.12.2020 Dublin.
    PubMedGoogle Scholar
  • 6 Veit-Rubin N, Dubuisson J, Ford A. et al. Burch colposuspension. Neurourol Urodyn 2019; 38: 553-562
    CrossrefPubMedGoogle Scholar
  • 7 Freites J, Stewart F, Omar MI. et al. Laparoscopic colposuspension for urinary incontinence in women. Cochrane Database Syst Rev 2019; (12) CD002239
    PubMedGoogle Scholar
  • 8 Leone Roberti Maggiore U, Bogani G, Meschia M. et al. Urethral bulking agents versus other surgical procedures for the treatment of female stress urinary incontinence: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2015; 189: 48-54
    CrossrefPubMedGoogle Scholar
  • 9 Itkonen Freitas AM, Mentula M, Rahkola-Soisalo P. et al. Tension-Free Vaginal Tape Surgery versus Polyacrylamide Hydrogel Injection for Primary Stress Urinary Incontinence: A Randomized Clinical Trial. J Urol 2020; 203: 372-378
    CrossrefPubMedGoogle Scholar
  • 10 Peyronnet B, OʼConnor E, Khavari R. et al. AMS-800 Artificial urinary sphincter in female patients with stress urinary incontinence: A systematic review. Neurourol Urodyn 2019; 38 (Suppl. 04) S28-S41
    PubMedGoogle Scholar
  • 11 Cui Y, Zhou X, Zong H. et al. The efficacy and safety of onabotulinumtoxinA in treating idiopathic OAB: A systematic review and meta-analysis. Neurourol Urodyn 2015; 34: 413-419
    CrossrefPubMedGoogle Scholar
  • 12 Lozano-Ortega G, Walker D, Rogula B. et al. The Relative Efficacy and Safety of Mirabegron and OnabotulinumtoxinA in Patients With Overactive Bladder who Have Previously Been Managed With an Antimuscarinic: A Network Meta-analysis. Urology 2019; 127: 1-8
    CrossrefPubMedGoogle Scholar
  • 13 Tutolo M, Ammirati E, Heesakkers J. et al. Efficacy and Safety of Sacral and Percutaneous Tibial Neuromodulation in Non-neurogenic Lower Urinary Tract Dysfunction and Chronic Pelvic Pain: A Systematic Review of the Literature. Eur Urol 2018; 73: 406-418
    CrossrefPubMedGoogle Scholar
  • 14 Coolen AWM, Bui BN, Dietz V. et al. The treatment of post-hysterectomy vaginal vault prolapse: a systematic review and meta-analysis. Int Urogynecol J 2017; 28: 1767-1783
    CrossrefPubMedGoogle Scholar
  • 15 Barber MD, Brubaker L, Burgio KL. et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA 2014; 311: 1023-1034 [published correction in JAMA 2015; 313: 2287]
    CrossrefPubMedGoogle Scholar
  • 16 Sutkin G, Zyczynski HM, Sridhar A. et al. Association between adjuvant posterior repair and success of native tissue apical suspension. Am J Obstet Gynecol 2020; 222: 161.e1-161.e8
    CrossrefPubMedGoogle Scholar
  • 17 Neis KJ, Zubke W, Römer T. et al. Indications and Route of Hysterectomy for Benign Diseases. Guideline of the DGGG, OEGGG and SGGG (S3 Level, AWMF Registry No. 015/070, April 2015). Geburtshilfe Frauenheilkd 2016; 76: 350-364
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Gutman R, Maher C. Uterine-preserving POP surgery. Int Urogynecol J 2013; 24: 1803-1813
    CrossrefPubMedGoogle Scholar
  • 19 Schulten SFM, Detollenaere RJ, Stekelenburg J. et al. Sacrospinous hysteropexy versus vaginal hysterectomy with uterosacral ligament suspension in women with uterine prolapse stage 2 or higher: observational follow-up of a multicentre randomised trial. BMJ 2019; 366: l5149
    CrossrefPubMedGoogle Scholar
  • 20 Meriwether KV, Antosh DD, Olivera CK. et al. Uterine preservation vs. hysterectomy in pelvic organ prolapse surgery: a systematic review with meta-analysis and clinical practice guidelines. Am J Obstet Gynecol 2018; 219: 129-146.e2
    CrossrefPubMedGoogle Scholar
  • 21 Baessler K, Aigmüller T, Albrich S. et al. Diagnosis and therapy of female pelvic organ prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e- Level, AWMF Registry Number 015/006, April 2016). Geburtshilfe Frauenheilkd 2016; 76: 1287-1301
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Maher C, Feiner B, Baessler K. et al. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev 2016; (02) CD012079
    PubMedGoogle Scholar
  • 23 Chapple CR, Cruz F, Deffieux X. et al. Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence. Eur Urol 2017; 72: 424-431
    CrossrefPubMedGoogle Scholar
  • 24 Wong V, Shek KL, Goh J. et al. Cystocele recurrence after anterior colpor-rhaphy with and without mesh use. Eur J Obstet Gynecol 2014; 172: 131-135
    CrossrefPubMedGoogle Scholar
  • 25 Collinet P, Belot F, Debodinance P. et al. Transvaginal mesh technique for pelvic organ prolapse repair: mesh exposure management and risk factors. Int Urogynecol J 2006; 17: 315-320
    CrossrefPubMedGoogle Scholar
  • 26 Naumann G, Hüsch T, Mörgeli C. et al. Mesh-augmented transvaginal repair of recurrent or complex anterior pelvic organ prolapse in accordance with SCENIHR-opinion. Int Urogynecol J 2020; DOI: 10.1007/s00192-020-04525-9.
    CrossrefPubMedGoogle Scholar
  • 27 Wattiez A, Nasir R, Al Maamari B. et al. Laparoscopic prolapse surgery: types and evidence. Curr Opin Obstet Gynecol 2016; 28: 430-434
    CrossrefPubMedGoogle Scholar
  • 28 Ganatra AM, Rozet F, Sanchez-Salas R. et al. The current status of laparoscopic sacrocolpopexy: a review. European Urol 2009; 55: 1089-1105
    CrossrefPubMedGoogle Scholar
  • 29 Coolen AWM, van Oudheusden AMJ, Mol BWJ. et al. Laparoscopic sacro-colpopexy compared with open abdominal sacrocolpopexy for vault prolapse repair: a randomised controlled trial. Int Urogynecol J 2017; 28: 1469-1479
    CrossrefPubMedGoogle Scholar
  • 30 Maher C, Feiner B, Baessler K. et al. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2013; (04) CD004014
    PubMedGoogle Scholar
  • 31 Noé KG, Schiermeier S, Alkatout I. et al. Laparoscopic pectopexy: a prospective, randomized, comparative clinical trial of standard laparoscopic sacral colpocervicopexy with the new laparoscopic pectopexy-postoperative results and intermediate-term follow-up in a pilot study. J Endourol 2015; 29: 210-215
    CrossrefPubMedGoogle Scholar
  • 32 Rexhepi S, Rexhepi E, Stumm M. et al. Laparoscopic bilateral cervico-sacropexy and vaginosacropexy: new surgical treatment option in women with pelvic organ prolapse and urinary incontinence. J Endourol 2018; 32: 1058-1064
    CrossrefPubMedGoogle Scholar
  • 33 De Gouveia De Sa M, Claydon LS. et al. Robotic versus laparoscopic sacrocolpopexy for treatment of prolapse of the apical segment of the vagina: a systematic review and meta-analysis. Int Urogynecol J 2016; 27: 355-366
    CrossrefPubMedGoogle Scholar