Hampel C
Fachklinik für Urologie, Marienhospital Erwitte, Von-Droste-Str. 14, 59597, Erwitte, Deutschland.
Fachklinik für Urologie am Marienhospital Erwitte, Betriebsstätte der Dreifaltigkeits-Hospital gGmbH, Akademisches Lehrkrankenhaus der Westfälischen Wilhelms-Universität Münster, Münster, Deutschland.
Urologe A. 2017 Dec;56(12):1583-1590. doi: 10.1007/s00120-017-0525-y.
Alloplastic transvaginal meshes have become very popular in the surgery of pelvic organ prolapse (POP) as did alloplastic suburethral slings in female stress incontinence surgery, but without adequate supporting data. The simplicity of the mesh procedure facilitates its propagation with acceptance of higher revision and complication rates. Since attending physicians do more and more prolapse surgeries without practicing or teaching alternative techniques, expertise in these alternatives, which might be very useful in cases of recurrence, persistence or complications, is permanently lost. It is doubtful that proper and detailed information about alternatives, risks, and benefits of transvaginal alloplastic meshes is provided to every single prolapse patient according to the recommendations of the German POP guidelines, since the number of implanted meshes exceeds the number of properly indicated mesh candidates by far. Although there is no dissent internationally about the available mesh data, thousands of lawsuits in the USA, insolvency of companies due to claims for compensation and unambiguous warnings from foreign urological societies leave German urogynecologists still unimpressed. The existing literature in pelvic organ prolapse exclusively focusses on POP stage and improvement of that stage with surgical therapy. Instead, typical prolapse symptoms should trigger therapy and improvement of these symptoms should be the utmost treatment goal. It is strongly recommended for liability reasons to obtain specific written informed consent.
同种异体阴道网片在盆腔器官脱垂（POP）手术中已变得非常普遍，就如同同种异体尿道下吊带在女性压力性尿失禁手术中的情况一样，但却缺乏充分的支持数据。网片手术的简便性促使其得以推广，尽管人们接受了更高的翻修率和并发症发生率。由于主治医生进行越来越多的脱垂手术，却不练习或教授替代技术，那些在复发、持续存在或出现并发症的情况下可能非常有用的替代技术方面的专业知识就永远丧失了。根据德国盆腔器官脱垂指南的建议，向每一位脱垂患者提供关于阴道同种异体网片的替代方案、风险和益处的恰当而详细的信息，这一点令人怀疑，因为植入网片的数量远远超过了合理适应证的网片候选者数量。尽管国际上对现有的网片数据并无异议，但美国的数千起诉讼、因索赔导致公司破产以及国外泌尿外科学会明确的警告，仍未让德国妇科泌尿医生有所触动。现有的盆腔器官脱垂文献仅专注于盆腔器官脱垂的分期以及通过手术治疗改善该分期。相反，典型的脱垂症状应引发治疗，且改善这些症状应是首要的治疗目标。出于责任原因，强烈建议获得特定的书面知情同意。
