Hampel C
Fachklinik für Urologie am Marienhospital Erwitte, Betriebsstätte der Dreifaltigkeits-Hospital gGmbH, Akademisches Lehrkrankenhaus der Westfälischen Wilhelms-Universität Münster, Von-Droste-Str. 14, 59597, Erwitte, Deutschland.
Urologe A. 2019 Jun;58(6):627-633. doi: 10.1007/s00120-019-0943-0.
Proper indication, preoperative diagnostics and final choice of surgical technique in the operative management of female stress urinary incontinence are subject to somewhat irrational, trend-based changes. For various reasons (insufficient reimbursement, poor expertise, limited therapeutic spectrum) preoperative urodynamic tests are increasingly thought to be unnecessary and are progressively replaced by perineal ultrasound despite lack of evidence. Since the AWMF guidelines (AWMF: Association of the Scientific Medical Societies in Germany) for the diagnosis and treatment of stress urinary incontinence in women were published, individualized planning of therapy is "out". Unconditional guideline adherence in certified pelvic floor centers, which have become very popular in Germany, has furthermore restricted the spread of therapeutic options due to minimum procedure number requirements. With regard to suburethral tension-free alloplastic slings, the retropubic version, which was temporarily unfashionable, has been experiencing a renaissance at the cost of the transobturator alternative. Single-incision slings were developed for the outpatient US market and have never become established in Germany due to lack of proof of superiority. In the setting of a limited spectrum of surgical procedures, adjustable sling systems offer promising treatment options for risk groups with acceptance of higher infection and erosion rates, thus gaining popularity. Reliable and comprehensive preoperative patient information comprising the whole spectrum of therapeutic options with individual risks and opportunities is key to prevent the impending ban of alloplastic implants in female stress incontinence surgery.
在女性压力性尿失禁的手术治疗中，手术技术的正确适应证、术前诊断及最终选择在一定程度上受到非理性的、基于趋势的变化影响。由于各种原因（报销不足、专业知识欠缺、治疗范围有限），尽管缺乏证据，但术前尿动力学检查越来越被认为没有必要，逐渐被会阴超声所取代。自从德国科学医学协会联合会（AWMF）发布女性压力性尿失禁的诊断和治疗指南以来，个体化治疗方案规划已不再流行。在德国非常受欢迎的经认证的盆底中心，无条件遵循指南，此外，由于对最低手术例数的要求，限制了治疗选择的推广。关于尿道下无张力异体材料吊带，曾一度不流行的耻骨后式吊带正在复兴，而经闭孔式吊带则受到影响。单切口吊带是为美国门诊市场开发的，由于缺乏优越性证据，在德国从未得到广泛应用。在手术方法有限的情况下，可调节吊带系统为接受较高感染和侵蚀率风险的群体提供了有前景的治疗选择，因此越来越受欢迎。可靠且全面的术前患者信息，包括所有治疗选择及其个体风险和机会，是防止女性压力性尿失禁手术中异体材料植入物即将被禁止的关键。
