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Therapie der weiblichen Belastungsinkontinenz

Endoskopische extraperitoneale Implantation des artifiziellen Blasenhalssphinkters – erste Erfahrungen

Management of female stress urinary incontinence

Endoscopic extraperitoneal artificial urinary sphincter – early experience

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Zusammenfassung

Der artifizielle Sphinkter gilt als etablierte Behandlungsoption bei Harninkontinenz durch ausgeprägte Sphinkterinsuffizienz. Gewöhnlich erfolgt dieser Eingriff offen chirurgisch. Wir berichten über unsere ersten Erfahrungen mit der endoskopischen extraperitonealen Implantation.

Der Eingriff zur Implantation des artifiziellen Sphinkters (AMS 800®) wurde bei 2 Patientinnen (22 und 79 Jahre) durchgeführt. In beiden Fällen wurde die Belastungsinkontinenz mit intrinsischer Sphinkterinsuffizienz durch eine neurogene Störung verursacht.

Der endoskopische extraperitoneale Zugang gestattete eine gute Mobilisation des Blasenhalses und ermöglichte eine Platzierung des artifiziellen Sphinkters in Analogie zum offenen Vorgehen. Die Operationsdauer lag <120 min. Beide Patientinnen konnten bereits am Operationstag mobilisiert und kostaufgebaut werden. Die postoperative Verweildauer betrug maximal 6 Tage. Eine Aktivierung des Sphinkters wurde nach 6–9 Wochen vorgenommen. 6 Monate postoperativ waren beide Patientinnen kontinent.

Die endoskopische extraperitoneale Sphinkterimplantation bei der Frau erlaubt eine sichere Platzierung der Sphinkterkomponenten mit geringerer Gewebetraumatisierung. Serien mit größerer Anzahl von Patienten sind notwendig, um die Langzeiteffektivität der Methode beurteilen zu können.

Abstract

Implantation of an artificial urinary sphincter (AUS) is an established surgical option for treating female stress urinary incontinence due to internal sphincter deficiency (ISD). However, this operation is often performed as an open surgical procedure. Here, we introduce an endoscopic extraperitoneal approach for implanting an artificial urinary sphincter.

Two women (ages 22 and 79 years) underwent endoscopic extraperitoneal implantation of the AMS 800 artificial sphincter. In both cases, neurogenic bladder disease was the underlying cause of ISD.

The endoscopic extraperitoneal approach allowed excellent preparation and mobilisation of the bladder neck and implantation of the AUS. The overall operating time was <120 min. Both patients were mobilised on the same day and could be discharged from the hospital after 5-6 days. The AUS were activated after 6–9 weeks. However, after an average of 6 months, total continence was achieved in both patients.

Laparoscopic extraperitoneal implantation of AUS in women with moderate to severe stress urinary incontinence is safe and might be less traumatic to neighbouring organs than the open operation. However, more implantations are needed to evaluate the long-term feasibility of this method.

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Authors and Affiliations

  1. Urologische Klinik, Helios Klinikum Berlin-Buch, Hobrechtsfelder Chaussee 96, 13125, Berlin, Deutschland

    M.R. Hoda, C. Kümmel, T. Nitzke & G. Popken

  2. Fachbereich Urogynäkologie, Deutsches Beckenbodenzentrum Berlin, St. Hedwig-Krankenhaus, Berlin, Deutschland

    A. Gauruder-Burmester

Authors
  1. M.R. Hoda
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  2. A. Gauruder-Burmester
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  3. C. Kümmel
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  4. T. Nitzke
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  5. G. Popken
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Correspondence to M.R. Hoda.

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Hoda, M., Gauruder-Burmester, A., Kümmel, C. et al. Therapie der weiblichen Belastungsinkontinenz. Urologe 47, 1004–1008 (2008). https://doi.org/10.1007/s00120-008-1739-9

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  • DOI: https://doi.org/10.1007/s00120-008-1739-9

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