Stressharninkontinenz der Frau

Zusammenfassung

Die Integraltheorie nach Petros und Ulmsten hat unser Verständnis vom weiblichen Beckenboden wesentlich verändert. Lockerungen der Vaginalwand durch Beckenbodendefekte in unterschiedlichen Schadenszonen sind häufig verantwortlich nicht nur für das Auftreten einer Stressharninkontinenz, sondern auch für Pollakisurie/Urgency, Restharnprobleme und Beckenschmerzen. Es wurde eine Reihe von Methoden entwickelt, minimal-invasiv diese Defekte zu korrigieren. Zur Korrektur der vorderen Bänder hat sich die spannungsfreie Einlage eines Polypropylenbandes um die mittlere Harnröhre bereits durchgesetzt. Mittels infrakokzygealer Sakropexie kann eine dorsale Stabilisierung der Vaginalwand erzielt werden. Aktuell werden zunehmend Polypropylennetze zum Faszienersatz eingesetzt. Von den konservativen Methoden ist das Beckenbodenmuskeltraining eine häufig empfohlene Therapie. Duloxetin bewirkt eine Erhöhung der Rhabdosphinkterkontraktion während der Füllungsphase, nicht jedoch während der Miktion, ist daher ein viel versprechendes Medikament für den klinischen Einsatz.

Abstract

The integral theory of Petros and Ulmsten has profoundly changed our understanding of the female pelvic floor. Anatomic laxity of the vaginal wall caused by pelvic floor defects induced at different damage zones is frequently not only responsible for stress urinary incontinence but also for pollakisuria, urgency, post-void residual and pelvic pain. A number of minimally invasive techniques have been developed to correct these defects. Applying a tension-free polypropylene tape around the mid-urethra has become an established method to correct the anterior ligaments. The infra-coccygeal sacropexy can achieve dorsal stabilization of the vaginal wall. Currently, polypropylene meshes are increasingly used for repairing supporting pelvic fasciae. The most recommended conservative methods are exercises to strengthen the pelvic floor muscles. Duloxetine increases the rhabdosphincter contractility during the filling phases, but not during voiding, and therefore is a promising drug for clinical use.

Schlüsselwörter:

Stressharninkontinenz - Integraltheorie - Beckenbodendefekte

Key words:

Stress urinary incontinence - integral theory - pelvic floor defects

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