Rautenberg Oliver, Zivanovic Irena, Kociszewski Jacek, Kuszka Andrzej, Münst Julia, Eisele Lilly, Viereck Nicole, Walser Claudia, Gamper Marianne, Viereck Volker
1 Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, 8501 Frauenfeld, Switzerland.
2 Department of Gynecology and Obstetrics, Lutheran Hospital Hagen-Haspe, 58135 Hagen, Germany.
Praxis (Bern 1994). 2017 Nov 16;106(15):829e-836e. doi: 10.1024/1661-8157/a002843.
Initially, stress urinary incontinence should be treated by conservative measures, such as weight reduction, hormonal substitution, physiotherapy, pelvic floor exercise and/or the use of pessaries. Incontinence surgeries are only recommended in case of unsuccessful conservative therapy. Today, tension-free suburethral sling insertions represent the gold standard of incontinence surgery yielding very good outcomes (cure rates of 80–90 %). Pelvic-floor sonography provides important information on decision of surgical methods and the management of complications. Furthermore, intra- or paraurethral injection of bulking agents is a promising, minimally invasive surgical alternative. This article discusses treatment concepts, pre-, intra- and post-operative examinations, decision on surgical methods, operational details for surgical success, and the prevention and management of complications.
最初，压力性尿失禁应采用保守措施治疗，如减重、激素替代、物理治疗、盆底肌锻炼和/或使用子宫托。只有在保守治疗失败的情况下才建议进行失禁手术。如今，无张力尿道下吊带置入术是失禁手术的金标准，效果非常好（治愈率为80%-90%）。盆底超声可为手术方法的决策及并发症的处理提供重要信息。此外，尿道内或尿道旁注射填充剂是一种有前景的微创外科替代方法。本文讨论了治疗理念、术前、术中和术后检查、手术方法的决策、手术成功的操作细节以及并发症的预防和处理。
