Funktionelle Aspekte der Beckenbodenchirurgie

Zusammenfassung

Beckenbodendysfunktionen sind häufig bei Frauen. Der menschliche Beckenboden ist eine komplexe anatomische Struktur und wird während des ­Lebens bei Frauen enorm beansprucht. Neuere ­Erkenntnisse in der funktionellen Anatomie des Beckenbodens haben zu einem viel besseren Verständnis geführt, was letzten Endes zu einer enormen Verbesserung in den therapeutischen Optionen geführt hat. Die Beckenbodenaktivität wird durch drei Hauptmuskelzugrichtungen reguliert, welche die Vagina zu jeder Zeit im kleinen Becken aufspannen und damit die Organe Harnblase und Enddarm unterstützen. Aus verschie­denen Gründen kann es zu einer Lockerheit der Vagina oder der unterstützenden Ligamente ­kommen, was diese funktionelle Anatomie signifikant verändert. Verschiedenste Symptome können dadurch entstehen, wie Harndrang- oder Belastungs­inkontinenz, Blasenentleerungsstörungen, Stuhlinkontinenz, Darmentleerungsstörungen oder fortgeleitete Beckenschmerzen. Eine erfolgreiche operative Beckenbodenrekonstruk­tion basiert heut­zutage auf dem Konzept, dass bei Vorhandensein von Beckenbodensymptomen, die Wiederherstellung der Anatomie zu einer Rekonstitution der Physiologie und damit Verbesserung oder Heilung der spezifischen Symptome der Patienten führt. Die operative exakte Rekonstruktion der Anatomie fokusiert sich deswegen fast ausschließlich auf die Wiederherstellung der lockeren Bandstrukturen im kleinen Becken. Eine genaue präoperative Identifikation der anato­mischen Defekte ist deswegen außerordentlich wichtig, um eine exakte anatomische Rekonstruktion im Hinblick auf die Muskelzugkräfte zu erreichen.

Abstract

Pelvic floor dysfunctions are frequently seen in females. The human pelvic floor is a complex structure and heavily stressed throughout female life. Recent findings in the functional anatomy of the pelvic floor have led to a much better understand­ing, on the basis of which enormous improvements in the therapeutic options have arisen. The pelvic floor activity is regulated by three main muscular forces that are responsible for vag­inal tension and suspension of the pelvic floor ­organs, bladder and rectum. For different reasons laxity in the vagina or its supporting ligaments as a result of altered connective tissue can distort this functional anatomy. A variety of symptoms can derive from these pelvic floor dysfunctions, such as urinary urge and stress incontinence, abnormal bladder emptying, faecal incontinence, obstructive bowel disease syndrome and pelvic pain. Pelvic floor reconstruction is nowadays driv­en by the concept that in the case of pelvic floor symptoms restoration of the anatomy will translate into restoration of the physiology and ultimately improve the patients’ symptoms. The exact surgical reconstruction of the anatomy is there­fore almost exclusively focused on the restoration of the lax pelvic floor ligaments. An exact identification of the anatomic lesions preopera­tively is eminently necessary, to allow for an exact anatomic reconstruction with respect to the muscular forces of the pelvic floor.

Schlüsselwörter

Beckenboden - funktionelle Anatomie - Harninkontinenz - Prolaps - chirurgische Rekonstruktion

Key words

pelvic floor - functional anatomy - urinary incontinence - prolapse - surgical reconstruction

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