Download PDF
Zentralbl Gynakol 2005; 127(5): 338-345
DOI: 10.1055/s-2005-836868
Übersicht

© Georg Thieme Verlag Stuttgart · New York

Empfehlungen zur Diagnostik und Therapie der Endometriose

Recommendations for Diagnosis and Treatment of EndometriosisU. Ulrich1 [1] , J. Hucke2 [1] , K.-W. Schweppe3 [1]
  • 1Klinik für Gynäkologie und Geburtshilfe, Kaiserswerther Diakonie, Florence-Nightingale-Krankenhaus, Düsseldorf
  • 2Klinik für Frauenheilkunde und Geburtshilfe, Bethesda Krankenhaus, Wuppertal
  • 3Frauenklinik, Ammerland Klinik, Westerstede
Further Information

Publication History

Publication Date:
29 September 2005 (online)

    Permissions and Reprints

Vorwort

Das hier vorgestellte Konsensuspapier der AGE und der SEF zur Diagnostik und Therapie der Endometriose soll als Diskussionsgrundlage für eine geplante DGGG-Leitlinie verstanden werden.

Literatur

  • 1 Abbott J, Hawe J, Hunter D, Halmes M, Finn P, Garry R. Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial.  Fertil Steril. 2004;  82 878-884
    CrossrefPubMedGoogle Scholar
  • 2 Abrao M S, Neme R M, Averbach M, Petta C A, Aldrighi J M. Rectal ultrasound with a radial probe in the assessment of rectovaginal endometriosis.  J Am Assoc Gynecol Laparosc. 2004;  11 50-54
    CrossrefPubMedGoogle Scholar
  • 3 Alborzi S, Momtahan M, Parsanezhad M E, Dehbashi S, Zolghadri J, Alborzi S. A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas.  Fertil Steril. 2004;  82 1633-1637
    CrossrefPubMedGoogle Scholar
  • 4 Albrecht H. Die Endometriose. In: Seitz L, Amreich AI (Hrsg). Biologie und Pathologie des Weibes. Bd. IV. Urban & Schwarzenberg, Berlin, Innsbruck, München, Wien 1955; 190-288
    Google Scholar
  • 5 American Society for Reproductive Medicine . Revised American Society for Reproductive Medicine classification of endometriosis.  Fertil Steril. 1997;  67 817-822
    CrossrefPubMedGoogle Scholar
  • 6 Asher-Walsh C J, Tu J L, Du Y, Blanco J S. Location of adenomyosis in total hysterectomy specimens.  J Am Assoc Gynecol Laparosc. 2003;  10 360-362
    CrossrefPubMedGoogle Scholar
  • 7 Athey P A, Diment D D. The spectrum of sonographic findings in endometriomas.  J Ultasound Med. 1989;  8 487-491
    PubMedGoogle Scholar
  • 8 Barnhart K, Dunsmoor-Su R, Coutifaris C. Effect of endometriosis on in vitro fertilization.  Fertil Steril. 2002;  77 1148-1155
    CrossrefPubMedGoogle Scholar
  • 9 Bazot M, Darai E, Hourani R, Thomassin I, Cortez A, Uzan S, Buy J N. Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease.  Radiology. 2004;  232 379-389
    CrossrefPubMedGoogle Scholar
  • 10 Beretta P, Franchi M, Ghezzi F, Busacca M, Zupi E, Bolis P. Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation.  Fertil Steril. 1998;  70 1176-1180
    CrossrefPubMedGoogle Scholar
  • 11 Brinton L A, Gridley G, Persson I, Baron J, Bergqvist A. Cancer risk after a hospital discharge diagnosis of endometriosis.  Am J Obstet Gynecol. 1997;  176 572-579
    CrossrefPubMedGoogle Scholar
  • 12 Brooks J J, Wheeler J E. Malignancy arising in extragonadal endometriosis.  Cancer. 1977;  40 3065-3073
    CrossrefPubMedGoogle Scholar
  • 13 Busacca M, Fedele L, Bianchi S, Candiani M, Agnoli B, Raffaelli R, Vignali M. Surgical treatment of recurrent endometriosis: laparotomy versus laparoscopy.  Hum Reprod. 1998;  13 2271-2274
    CrossrefPubMedGoogle Scholar
  • 14 Busacca M, Somigliana E, Bianchi S, DeMarinis S, Calia C, Candiani M, Vignali M. Post-operative GnRH analogue treatment after conservative surgery for symptomatic endometriosis stage III-IV: a randomized controlled trial.  Hum Reprod. 2001;  16 2399-2402
    CrossrefPubMedGoogle Scholar
  • 15 Camagna O, Dhainaut C, Dupuis O, Soncini E, Martin B, Palazzo L, Chosidow D, Madelenat P. Chirurgisches Vorgehen bei Endometriose des Septum rectovaginale in einer konsekutiven Serie von 50 Fällen [auf Französisch].  Gynecol Obstet Fertil. 2004;  32 199-209
    CrossrefPubMedGoogle Scholar
  • 16 Chapron C, Fritel X, Dubuisson J B. Fertility after laparoscopic management of deep endometriosis infiltrating the uterosacral ligaments.  Hum Reprod. 1999;  14 329-332
    CrossrefPubMedGoogle Scholar
  • 17 Chapron C, Dumontier I, Dousset B, Fritel X, Tardif D, Roseau G, Chaussade S, Couturier D, Dubuisson J B. Results of rectal endoscopic ultrasonography for patients with deep pelvic endometriosis.  Hum Reprod. 1998;  13 2266-2270
    CrossrefPubMedGoogle Scholar
  • 18 Chopin N, Vieira M, Borghese B, Foulot H, Dousset B, Coste J, Mignon A, Fauconnier A, Chapron C. Operative management of deeply infiltrating endometriosis: Results on pelvic pain symptoms according to a surgical classification.  J Min Invas Gynecol. 2005;  12 106-112
    PubMedGoogle Scholar
  • 19 Cosson M, Querleu D, Donnez J. Dienogest is as effective as triptorelin in the treatment of endometriosis after laparoscopic surgery: results of a prospective, multicenter, randomized study.  Fertil Steril. 2002;  77 684-692
    CrossrefPubMedGoogle Scholar
  • 20 Darai E, Thomassin I, Barranger E, Detchev R, Cortez A, Houry S, Bazot M. Feasibility and clinical outcome of laparoscopic colorectal resection for endometriosis.  Am J Obstet Gynecol. 2005;  192 394-400
    CrossrefPubMedGoogle Scholar
  • 21 Deaton J L, Gibson M, Blackmer K M, Nakajima S T, Badger G J, Brumsted J R. A randomized, controlled trial of clomiphene citrate and intrauterine insemination in couples with unexplained infertility or surgically corrected endometriosis.  Fertil Steril. 1990;  54 1083-1088
    PubMedGoogle Scholar
  • 22 Decker D, König J, Wardelmann E, Richter O, Popat S, Wolff M, Hirner A, Ulrich U. Terminal ileitis with sealed perforation - a rare complication of intestinal endometriosis.  Arch Gynecol Obstet. 2004;  270 230-234
    CrossrefPubMedGoogle Scholar
  • 23 Donnez J, Nisolle M, Casanas-Roux F. Peritoneal endometriosis: two-dimensional and three dimensional evaluation of typical and subtle lesions.  Ann NY Acad Sc. 1994;  734 324-351
    PubMedGoogle Scholar
  • 24 Donnez J, Nisolle M, Gillet N, Smets M, Bassil S, Casanas-Roux F. Large ovarian endometriomas.  Hum Reprod. 1996;  11 641-646
    CrossrefPubMedGoogle Scholar
  • 25 Egger H, Turnwald W, Weiß S. Radikale operative Behandlung der Endometriose mit Darmteilresektion.  Geburtsh Frauenheilkd. 1998;  58 415-419
    PubMedGoogle Scholar
  • 26 Fedele L, Bianchi S, Raffaelli R, Portuese A, Dorta M. Treatment of adenomyosis-associated menorrhagia with a levonorgestrel-releasing intrauterine device.  Fertil Steril. 1997;  68 426-429
    CrossrefPubMedGoogle Scholar
  • 27 Fedele L, Bianchi S, Zanconato G, Portuese A, Raffaelli R. Use of a levonorgestrel-releasing intrauterine device in the treatment of rectovaginal endometriosis.  Fertil Steril. 2001;  75 485-488
    CrossrefPubMedGoogle Scholar
  • 28 Ford J, English J, Miles W A, Giannopoulos T. Pain, quality of life and complications following the radical resection of rectovaginal endometriosis.  Br J Obstet Gynaecol. 2004;  111 353-356
    CrossrefPubMedGoogle Scholar
  • 29 Garrido N, Navarro J, Garcia Velasco J. The endometrium versus embryonic quality in endometriosis-related infertility.  Hum Reprod Update. 2002;  8 95-103
    CrossrefPubMedGoogle Scholar
  • 30 Garry R. The effectiveness of laparoscopic excision of endometriosis.  Curr Opin Obstet Gynecol. 2004;  16 299-303
    CrossrefPubMedGoogle Scholar
  • 31 Giudice L C, Kao L C. Endometriosis.  Lancet. 2004;  364 1789-1799
    CrossrefPubMedGoogle Scholar
  • 32 Gruppo Italiano per lo Studio dell' Endometriosi . Relationship between stage, site and morphological characteristics of pelvic endometriosis and pain.  Hum Reprod. 2001;  16 2668-2671
    CrossrefPubMedGoogle Scholar
  • 33 Harrison R F, Barry-Kinsella C. Efficacy of medroxyprogesterone treatment in infertile women with endometriosis: a prospective, randomized, placebo-controlled study.  Fertil Steril. 2000;  74 24-30
    CrossrefPubMedGoogle Scholar
  • 34 Heaps J M, Nieberg R K, Berek J S. Malignant neoplasms arising in endometriosis.  Obstet Gynecol. 1990;  75 1023-1028
    PubMedGoogle Scholar
  • 35 Hornstein M D, Yuzpe A A, Burry K A, Heinrichs L R, Buttram Jr V L, Orwoll E S. Prospective randomized double-blind trial of 3 versus 6 months of nafarelin therapy for endometriosis-associated pelvic pain.  Fertil Steril. 1995;  63 955-962
    CrossrefPubMedGoogle Scholar
  • 36 Howard F M. An evidence-based medicine approach to the treatment of endometriosis-associated chronic pelvic pain: placebo-controlled studies.  J Am Assoc Gynecol Laparosc. 2000;  7 477-488
    CrossrefPubMedGoogle Scholar
  • 37 Hucke J, Wallwiener D. Die laparoskopische suprazervikale Hysterektomie.  Frauenarzt. 2004;  45 681-682
    PubMedGoogle Scholar
  • 38 Hughes E, Fedorkow D, Collins J, Vandekerckhove P. Ovulation suppression for endometriosis. (Cochrane Review). In: The Cochrane Library, Issue 1. John Wiley & Sons Ltd., Chichester, UK 2005
    Google Scholar
  • 39 Isaacs Jr J D, Hines R S, Sopelak V M, Cowan B D. Clinical assisted reproduction: ovarian endometriomas do not adversely affect pregnancy success following treatment with in vitro fertilization.  J Assist Reprod Genet. 1997;  14 551-553
    PubMedGoogle Scholar
  • 40 Jacobson T Z, Barlow D H, Koninckx P R, Olive D, Farquhar C. Laparoscopic surgery for subfertility associated with endometriosis (Cochrane Review). In: The Cochrane Library, Issue 1. John Wiley & Sons Ltd., Chichester, UK 2005
    Google Scholar
  • 41 Jansen R P, Russel P. Nonpigmented endometriosis: clinical, laparoscopic, and pathological definition.  Am J Obstet Gynecol. 1986;  155 1154-1159
    CrossrefPubMedGoogle Scholar
  • 42 Jones K D, Sutton C J. Laparoscopic management of ovarian endometriomas: a critical review of current practice.  Curr Opin Obstet Gynecol. 2000;  12 309-315
    CrossrefPubMedGoogle Scholar
  • 43 Jones K D, Sutton C J. Recurrence of chocolate cysts after laparoscopic ablation.  J Am Assoc Gynecol Laparosc. 2002;  9 315-320
    CrossrefPubMedGoogle Scholar
  • 44 Kauppila A, Ronnberg L. Naproxen sodium in dysmenorrhea secondary to endometriosis.  Obstet Gynecol. 1985;  65 379-383
    PubMedGoogle Scholar
  • 45 Keckstein J, Ulrich U, Kandolf O, Wiesinger H, Wustlich M. Die laparoskopische Therapie der Darmendometriose und der Stellenwert der medikamentösen Therapie.  Zentralbl Gynäkol. 2003;  125 259-266
    Article in Thieme ConnectPubMedGoogle Scholar
  • 46 Keckstein J, Ulrich U, Possover M, Schweppe K W. ENZIAN-Klassifikation der tiefen infiltrierenden Endometriose.  Zentralbl Gynäkol. 2003;  125 304
    PubMedGoogle Scholar
  • 47 Keckstein J, Ulrich U. Endokrine und operative Therapie der Adenomyose.  Gynäkol Endokrinol. 2004;  2 11-18
    PubMedGoogle Scholar
  • 48 Kodama H, Fukuda J, Karube H, Matsui T, Shimizu Y, Tanaka T. Benefit of in vitro fertilization treatment for endometriosis-associated infertility.  Fertil Steril. 1996;  66 974-979
    PubMedGoogle Scholar
  • 49 Kupfer M, Schwimmer S, Lebonic J. Transvaginal sonographic appearance of endometrioma: Spectrum of findings.  J Ultrasound Med. 1992;  11 129-133
    PubMedGoogle Scholar
  • 50 Leyendecker G, Kunz G, Noe M, Herbertz M, Mall G. Endometriosis: a dysfunction and disease of the archimetra.  Hum Reprod Update. 1998;  4 752-762
    CrossrefPubMedGoogle Scholar
  • 51 Mastroianni Jr L. The fallopian tube and reproductive health.  J Pediatr Adolesc Gynecol. 1999;  12 121-126
    CrossrefPubMedGoogle Scholar
  • 52 Meyer R. Über den Stand der Frage der Adenomyositis, Adenomyome im Allgemeinen und insbesondere über Adenomyositis seroepithelialis und Adenomyometritis sarcomatosa.  Zentralbl Gynäkol. 1919;  36 745-750
    PubMedGoogle Scholar
  • 53 Mol B W, Bayram N, Lijmer J G, Wiegerinck M A, Bongers M Y, Bossuyt P M. The performance of CA-125 measurement in the detection of endometriosis: a meta-analysis.  Fertil Steril. 1998;  70 1101-1108
    CrossrefPubMedGoogle Scholar
  • 54 Moore J, Copley S, Morris J, Lindsell D, Golding S, Kennedy S. A systematic review of the accuracy of ultrasound in the diagnosis of endometriosis.  Ultrasound Obstet Gynecol. 2002;  20 630-634
    CrossrefPubMedGoogle Scholar
  • 55 Moore J, Kennedy S H, Prentice A. Modern combined oral contraceptives for pain associated with endometriosis (Cochrane Review). In: The Cochrane Library, Issue 3. John Wiley & Sons Ltd., Chichester, UK 2004
    Google Scholar
  • 56 Morita M, Asakawa Y, Nakakuma M, Kubo H. Laparoscopic excision of myometrial adenomyomas in patients with adenomyosis uteri and main symptoms of severe dysmenorrhea and hypermenorrhea.  J Am Assoc Gynecol Laparosc. 2004;  11 86-89
    CrossrefPubMedGoogle Scholar
  • 57 Muzii L, Marana R, Caruana P, Macuso S. The impact of preoperative gonadotropin-releasing hormone agonist treatment on laparoscopic excision of ovarian endometriotic cysts.  Fertil Steril. 1996;  65 1235-1237
    PubMedGoogle Scholar
  • 58 Neis K. Leitlinie zur laparoskopischen Operation von Ovarialtumoren.  http://www.dggg.de 2004
    Google Scholar
  • 59 Nisolle M, Casanas-Roux B S, Anaf V, Mine J-M, Donnez J. Morphometric study of the stromal vascularization in peritoneal endometriosis.  Fertil Steril. 1993;  59 681-684
    PubMedGoogle Scholar
  • 60 Olson J E, Cerhan J R, Janney C A, Anderson K E, Vachon C M, Sellers T A. Postmenopausal cancer risk after self-reported endometriosis diagnosis in the Iowa Women's Health Study.  Cancer. 2002;  94 1612-1618
    CrossrefPubMedGoogle Scholar
  • 61 Ozaki T, Takahashi K, Okada M. Live birth after conservative surgery for severe adenomyosis following magnetic resonance imaging and gonadotropin-releasing hormone agonist therapy.  Int J Fertil Womens Med. 1999;  44 260-264
    PubMedGoogle Scholar
  • 62 Pagidas K, Falcone T, Hemmings R, Miron P. Comparison of reoperation for moderate (stage III) and severe (stage IV) endometriosis-related infertility with in vitro fertilization-embryo transfer.  Fertil Steril. 1996;  65 791-795
    PubMedGoogle Scholar
  • 63 Possover M, Diebolder H, Plaul K, Schneider A. Laparoscopically-assisted vaginal resection of rectovaginal endometriosis.  Obstet Gynecol. 2000;  96 304-307
    CrossrefPubMedGoogle Scholar
  • 64 Prentice A, Deary A J, Goldbeck W S, Farquhar C, Smith S K. Gonadotrophin-releasing hormone analogues for pain associated with endometriosis. In: The Cochrane Library, Issue 3. John Wiley & Sons Ltd., Chichester, UK 2004
    Google Scholar
  • 65 Pritts E A, Taylor R N. An evidence-based evaluation of endometriosis-associated infertility.  Endocrinol Metab Clin North Am. 2003;  32 653-667
    CrossrefPubMedGoogle Scholar
  • 66 Reinhold C, Tafazoli F, Mehio A, Wang L, Atri M, Siegelman E S, Rohoman L. Uterine adenomyosis: endovaginal US and MR features with histopathologic correlation.  Radiographics. 1999;  19 S 147-S 160
    PubMedGoogle Scholar
  • 67 Rickes D, Nickel I, Kropf S, Kleinstein J. Increased pregnancy rates after ultralong postoperative therapy with gonadotropin-releasing hormone analogs in patients with endometriosis.  Fertil Steril. 2002;  78 757-762
    CrossrefPubMedGoogle Scholar
  • 68 Saleh A, Tulandi T. Reoperation after laparoscopic treatment of endometriomas by excision and fenestration.  Fertil Steril. 1999;  72 322-324
    CrossrefPubMedGoogle Scholar
  • 69 Sampson J A. Peritoneal endometriosis due to menstrual dissemination of the endometrial tissue into the peritoneal cavity.  Am J Obstet Gynecol. 1927;  14 422
    CrossrefPubMedGoogle Scholar
  • 70 Sarmini R, Lefholz K, Froeschke H. A comparison of laparoscopic supracervical hysterectomy and total abdominal hysterectomy outcomes.  J Min Invas Gynecol. 2005;  12 121-124
    PubMedGoogle Scholar
  • 71 Sawada T, Satoshi O, Kawakami S. Laparoscopic surgery vs. laparotomy managament for infertile patients with ovarian endometriomas.  Gynaecol Endosc. 1999;  8 7-19
    PubMedGoogle Scholar
  • 72 Schweppe K-W. Endometriose - Eine Erkrankung ohne Lobby.  Zentralbl Gynäkol. 2003;  125 233
    Article in Thieme ConnectPubMedGoogle Scholar
  • 73 Schweppe K-W. Konsensus-Richtlinien vom 8. GnRH-Kongress Salzburg 2005. Behandlung der Endometriose mit GnRH-Analoga.  Gynecol Tribune. 2005;  6 3
    PubMedGoogle Scholar
  • 74 Schweppe K-W. Endometriose: Aktueller Stand von Diagnose und Therapie.  Frauenarzt. 2005;  46 373-381
    PubMedGoogle Scholar
  • 75 Shaw R W. An Atlas of Endometriosis. Parthenon Publishing Group, Carnforth-Pearl River 1993
    Google Scholar
  • 76 Sillem M, Teichmann A T. Patientinnenzentrierte Aspekte der Endometriose.  Gynäkologe. 2003;  36 41-52
    PubMedGoogle Scholar
  • 77 Surrey E S, Silverberg K M, Surrey M W, Schoolcraft W B. Effect of prolonged gonadotropin-releasing hormone agonist therapy on the outcome of in vitro fertilization-embryo transfer in patients with endometriosis.  Fertil Steril. 2002;  78 699-704
    CrossrefPubMedGoogle Scholar
  • 78 Swiersz L M. Role of endometriosis in cancer and tumor development.  Ann NY Acad Sci. 2002;  995 281-292
    PubMedGoogle Scholar
  • 79 Tinkanen H, Kujansuu E. In vitro fertilization in patients with ovarian endometriomas.  Acta Obstet Gynecol Scand. 2000;  79 119-122
    CrossrefPubMedGoogle Scholar
  • 80 Tummon I S, Asher L J, Martin J S, Tulandi T. Randomized controlled trial of superovulation and insemination for infertility associated with minimal or mild endometriosis.  Fertil Steril. 1997;  68 8-12
    CrossrefPubMedGoogle Scholar
  • 81 Ulrich U, Possover M. Endometriose: Standards für problematische Krankheitsbilder.  Frauenarzt. 2003;  44 857-859
    PubMedGoogle Scholar
  • 82 Ulrich U, Richter O, Wardelmann E, Valter M, Schmutzler R, Sillem M, Possover M, Mallmann P. Endometriose und Malignom.  Zentralbl Gynäkol. 2003;  125 239-242
    Article in Thieme ConnectPubMedGoogle Scholar
  • 83 Ulrich U, Rhiem K, Kaminski M, Wardelmann E, Trog D, Valter M, Richter O. Parametrial and rectovaginal adenocarcinoma arising from endometriosis.  Int J Gynecol Cancer. 2005;  im Druck
    PubMedGoogle Scholar
  • 84 Vercellini P, Vendola N, Bocciolone L, Colombo A, Rognoni M T, Bolis G. Laparoscopic aspiration of ovarian endometriomas. Effect with postoperative gonadotropin releasing hormone agonist treatment.  J Reprod Med. 1992;  37 577-580
    PubMedGoogle Scholar
  • 85 Vercellini P, Frontino G, DeGiorgi O. Continuous use of an oral contraceptive for endometriosis-associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen.  Fertil Steril. 2003;  80 560-563
    CrossrefPubMedGoogle Scholar
  • 86 Vercellini P, Aimi G, Busacca M, Apolone G, Uglietti A, Crosignani P G. Laparoscopic uterosacral ligament resection for dysmenorrhea associated with endometriosis: results of a randomized, controlled trial.  Fertil Steril. 2003;  80 310-319
    CrossrefPubMedGoogle Scholar
  • 87 Vercellini P, Frontino G, De Giorgi O, Pietropaolo G, Pasin R, Crosignani P G. Endometriosis: preoperative and postoperative medical treatment.  Obstet Gynecol Clin North Am. 2003;  30 163-180
    CrossrefPubMedGoogle Scholar
  • 88 Walter A J, Hentz J G, Magtibay P M, Cornella J L, Magrina J F. Endometriosis: correlation between histologic and visual findings at laparoscopy.  Am J Obstet Gynecol. 2001;  184 1407-1411
    CrossrefPubMedGoogle Scholar
  • 89 Yamashita Y, Ueda M, Takehara M. Influence of severe endometriosis on gene expression of vascular endothelial growth factor and interleukin-6 in granulosa cells from patients undergoing controlled ovarian hyperstimulation for in vitro fertilization-embryo transfer.  Fertil Steril. 2002;  78 865-871
    CrossrefPubMedGoogle Scholar
  • 90 Zanetta G M, Webb M J, Li H, Keeney G L. Hyperestrogenism: a relevant risk factor for the development of cancer from endometriosis.  Gynecol Oncol. 2000;  79 18-22
    CrossrefPubMedGoogle Scholar
  • 91 Zupi E, Marconi D, Sbracia M, Zullo F, De Vivo B, Exacustos C, Sorrenti G. Add-back therapy in the treatment of endometriosis-associated pain.  Fertil Steril. 2004;  82 1303-1308
    CrossrefPubMedGoogle Scholar

1 für die Arbeitsgemeinschaft für Gynäkologische Endoskopie e. V. (AGE) der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe und die Stiftung Endometriose-Forschung

Prof. Dr. U. Ulrich

Klinik für Gynäkologie und Geburtshilfe · Kaiserswerther Diakonie · Florence-Nightingale-Krankenhaus

Kreuzbergstr. 79

40489 Düsseldorf

Email: ulrich@kaiserswerther-diakonie.de

      >