Chirurgische Therapie des urogenitalen Deszensus

Zusammenfassung

Urogenitale Prolapserkrankungen sind mit hoher Prävalenz und unterschiedlicher Morbidität belastet. Klinisch imponieren Senkungs- und Miktionsbeschwerden mit Obstruktion, Drangsymptomatik und Begleitharninkontinenz. Die Prävalenz einer Beckenbodeninsuffizienz wird auf etwa 30 – 50 % geschätzt. Aufgrund der steigenden Lebenserwartungen und den damit verbundenen erhöhten Aktivitäten der Frauen ist sogar mit einem weiteren Anstieg der Senkungsinzidenz zu rechnen. Eine nicht geringe Zahl stellen dabei Rezidive dar. Schon heute zählen Operationen zur Therapie des Deszensus zu den häufigsten durchgeführten Operationen der Gynäkologie. In den USA werden jährlich über 220.000 Senkungsoperationen durchgeführt. Das Ziel der operativen Therapie ist die Behebung der jeweiligen Beschwerdesymptomatik mit konsekutiver Verbesserung der Lebensqualität. Ziel der Arbeit ist, die operativen Ergebnisse und Techniken unterschiedlicher Deszensuserkrankungen zu evaluieren und deskriptiv zu erfassen.

Summary

Female pelvic organ prolapse is a widely prevalent condition and is associated with variable morbidity. It encompasses a number of clinical conditions, including subvesical obstruction, overactive bladder symptoms, sexual dysfunction and urinary und fecal incontinence. The prevalence of pelvic insufficiency is estimated to be between 30 and 50 %. As life expectancy is increasing and the elderly population is growing, there will be an increased incidence of the condition and growing demand for pelvic floor treatment in the future. The incidence of recurrent pelvic floor prolapse is also growing.

The goal of surgical management is the restoration of pelvic anatomy and bladder, vaginal and bowel function, resolution of patient symptoms and improvement in quality of life. The objective of this review is to present the main surgical procedures for different subtypes of genital prolapse and to evaluate their outcomes and complications. During the last ten years, technologies for the minimally invasive approach have advanced and robotic assisted sacrocolpopexy is now equivalent to classical vaginal and transabdominal procedures.

Schlüsselwörter

Deszensus genitalis - Prolaps - Sakrokolpopexie - Kolporrhaphia - vaginale Netzinterposition

Key words

Female descensus genitalis - vaginal prolapse - Sacrocolpopexy - colporrhaphy - transvaginal mesh

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