Pelvic floor sonography is currently the gold standard in gynecology for the morphological diagnosis of incontinence and of functional disorders of the pelvic floor. X-ray examinations and MRI of the pelvic floor are much less common nowadays, and these examinations are usually only done to investigate more complex issues which cannot be adequately evaluated with ultrasonography. Diagnostic ultrasonography should be done both perioperatively and after surgery for urinary incontinence or prolapse to evaluate complications. Sonography also provides useful biofeedback and can be used to assess the patientʼs progress after conservative treatment. A review of recent international literature shows that, in the majority of studies, morphological diagnoses are obtained with sonography. A number of different methods are used for investigation and evaluation, which can make it difficult to compare the findings of different studies. While in previous years introital sonography and perineal ultrasound were the preferred 2D imaging methods used for diagnosis, more recent studies have focused on the use of 3D imaging methods. The basic principle, which applies to both approaches, is that metric assessments are secondary to descriptive evaluations as an important constituent of urogynecological diagnostics. Both methods are useful, particularly to assess complications after surgery for urinary incontinence and prolapse procedures, and both procedures have an important role to play in understanding and managing complications.
Investigation TechniquesStandard diagnostics should include 2D imaging. The choice of where to insert the probe and whether to use 2D or 3D imaging depends on the availability of ultrasound units and probes. In principle, three different methods can be used for ultrasound investigation: 1. endosonographic applications: vaginal ultrasound, endo-anal sonography, 2. external applications: perineal/introital/abdominal ultrasound, 3. a combination of the two methods, as described by J. Kociszewski (Hagen) who refers to this approach as "pelvic floor sonography".Interdisciplinary S2k Guideline: Sonography in Urogynecology Short Version -AWMF Registry Number: 015/055Interdisziplinäre S2k-Leitlinie: Sonografie im Rahmen der urogynäkologischen DiagnostikKurzfassung -AWMF-Register-Nummer: 015/055
Aim This completely revised interdisciplinary S2k-guideline on the diagnosis, therapy, and follow-up care of female patients with urinary incontinence (AWMF registry number: 015-091)
was published in December 2021. This guideline combines and summarizes earlier guidelines such as “Female stress urinary incontinence,” “Female urge incontinence” and “Use of Ultrasonography
in Urogynecological Diagnostics” for the first time. The guideline was coordinated by the German Society for Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und
Geburtshilfe, DGGG) and the Working Group for Urogynecology and Plastic Pelvic Floor Reconstruction (Arbeitsgemeinschaft für Urogynäkologie und plastische Beckenbodenrekonstruktion e. V.,
AGUB).
Methods This S2k-guideline was developed using a structured consensus process involving representative members from different medical specialties and was commissioned by the
Guidelines Commission of the DGGG, OEGGG and SGGG. The guideline is based on the current version of the guideline “Urinary Incontinence in Adults” published by the European Association of
Urology (EAU). Country-specific items associated with the respective healthcare systems in Germany, Austria and Switzerland were also incorporated.
Recommendations The short version of this guideline consists of recommendations and statements on the epidemiology, etiology, classification, symptoms, diagnostics, and treatment of
female patients with urinary incontinence. Specific solutions for the diagnostic workup and appropriate conservative and medical therapies for uncomplicated and complication urinary
incontinence are discussed.
The editorially complete, long version of these guidelines as well as a summary of the conflicts of interest of all the authors can be found on the homepage of AWMF: http://www.awmf.org/leitlinien/detail/II/015-079.html.
l " urinary incontinence l " retropubic sling l " transobturator sling l " postoperative pain l " pelvic floor function Schlüsselwörter l " Harninkontinenz l " retropubisches Band l " transobturatorisches Band l " postoperative Schmerzen l " Beckenbodenfunktion
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