Zusammenfassung
Im Rahmen der Behandlung der Beckenbodeninsuffizienz findet die Sakralnervstimulation
(SNS) bei der Therapie der Stuhlinkontinenz, sowie der Auslassobstruktion und Slow-Transit-Obstipation
Anwendung. Die SNS zielt auf die Mobilisierung funktioneller Reserven durch Stimulation
der peripheren Innervation des Kontinenzorgans. Seit der Erstanwendung 1994 zur Behandlung
bestimmter Formen der Stuhlinkontinenz hat sich der Patientenselektionsprozess etabliert,
das Indikationsspektrum erweitert und die Technik verbessert. Die Patientenselektion
für die Implantation eines permanenten Stimulationssystems basiert auf dem Ergebnis
eines zweistufigen diagnostischen, temporären Stimulationsverfahrens: derart konnte
bislang Patienten mit Stuhlinkontinenz unterscheidlichster Ätiologien erfolgreich
behandelt werden. Der positiv prädiktive Wert der diagnostischen Stimulation liegt
bei 90 %. Chronische SNS verbessert oder stellt nicht nur Kontinenz wieder her, sondern
führt auch zu einer signifikanten Steigerung der Lebensqualität der Betroffenen. Die
klinischen Wirkung der SNS konnte in mehreren Einzelzenterstudien und Multizenteruntersuchungen
nachgewiesen werden. Die physiologische Wirkungsweise der SNS ist bis dato nicht schlüssig
erklärbar. Während die SNS in der Behandlung der Inkontinenz etabliert ist, steht
ihr Einsatz bei anderen Formen der Beckenbodeninsuffizienz im kolorektalen Fachbereich
am Anfang. Erste Anwendungen bei Auslassobstruktion und Slow-transit-Obstipation sind
vielversprechend.
Abstract
In the treatment of pelvic floor dysfunctions sacral nerve stimulation (SNS) is used
for faecal incontinence, for outlet obstruction and for slow transit constipation.
SNS aims to recruit residual function of the anorectal continence organ by stimulation
of its peripheral nerve supply. Since the first application of SNS for specific forms
of faecal incontinence in 1994 patient selection has been modified, the spectrum of
indication has been enlarged and the technique has been improved. Patient selection
for implantation of a permanent neurostimulation system is based on a two step diagnostic,
temporary stimulation: thus patients suffering from incontinence due to widely varying
etiologies are treated successfully. The positive predictive value of the diagnostic
test stimulation is around 90 %. Chronic SNS not only improves or re-establishes incontinence,
but also has a significant impact on quality of life. The clinical efficacy of SNS
has been proven in multiple single centre and multicentre studies. Its mechanism of
action is not yet clearly defined. Whereas SNS can be considered to be an established
treatment option for faecal incontinence, its application is other forms of pelvic
floor dysfunction is in its beginnings. Preliminary results of the use of SNS in outlet
obstruction and slow transit constipation are encouraging.
Schlüsselwörter
Inkontinenz - Sakralnervenstimulation - Analsphinkter - Beckenbodenschwäche
Key words
Fecal incontinence - sacral nerve stimulation - anal sphincter - pelvic floor dysfunction
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Prof. Dr. K. E. Matzel
Chirurgische Klinik mit Poliklinik der Universität Erlangen
Krankenhausstr. 12
91054 Erlangen
Germany
Phone: +49/91 31/8 53 32 96
Email: Klaus.Matzel@chir.imed.uni-erlangen.de