Surgery
Accupuncture
Intimate Aesthetic
Gynecology
Sub specialities of Gynecology
Birthcontrol
What is Birth Control Birth control is a complex issue that involves preventing unwanted pregnancy. There are numerous different methods available, each with varying levels of reliability and distinct advantages and disadvantages. These contraceptives work by regulating hormone levels in the body and preventing ovulation and the maturation of the egg. A commonly used method is hormonal contraceptives, which are taken in the form of pills, patches, or vaginal rings. However, it is important to note that this method is not 100% reliable, and there can still be cases of unintended pregnancies. Therefore, a detailed conversation with a doctor is essential to find the best birth control method for one's individual situation. Pearl Index: The Pearl Index is used to rate the effectiveness of a contraceptive method. It indicates how many out of 100 sexually active women become pregnant when using a particular method over one year. The Pearl Index is 85 without contraception. The smaller the Pearl Index number, the more effective the method. The Female Cycle In the first half of the cycle the period between the first day of bleeding and ovulation, several follicles mature in the ovary, one of which is released into the fallopian tube during ovulation. The ovary also produces estrogen, which causes the uterine lining to build up and makes the cervical mucus penetrable for sperm. In the second half of the cycle the period from ovulation to the beginning of bleeding, the released egg is taken up by the fallopian tube and transported to the uterus. The ovary now produces the corpus luteum hormone progesterone, the natural gestagen, which prepares the uterine lining for the possible implantation of a fertilized egg. Recommended contraception methods A. Hormonal Methods The Pill - Pearl Index from 0.05 to 0.9 Oral hormonal contraceptive with estrogens and gestagens The pill works by preventing the maturation of the follicle in the ovary and ovulation. It also changes the uterine lining and cervical mucus. The pill has many advantages, including high safety, positive additional effects, and easy use for young women. Possible side effects include breast tenderness, mood swings, headaches, and bleeding disorders. Since taking estrogen-containing pills can increase the risk of blood Vaginal Ring - Pearl Index: 0.65 Depot preparation with estrogen-gestagen combination The ring is inserted into the vagina for 21 days and continuously releases estrogen and gestagen. This, like the pill, inhibits ovulation and changes the cervical mucus and the growth of the uterine lining. The possible side effects are essentially the same as those of the pill. Hormonal Patch - Pearl Index: 0.88 Depot preparation with estrogen-gestagen combination The approximately 20 cm² patches are stuck on the buttocks, abdomen, the outside of the upper arms, or the upper body. After 3 weeks of use, a patch-free break of 7 days is taken, during which withdrawal bleeding occurs. The patches continuously release an estrogen and a gestagen, inhibiting ovulation and reducing the growth of the uterine lining, and thickening the cervical mucus, similar to the pill. Side effects can include breast tenderness, headaches, nausea, painful bleeding, and skin irritation at the application site. Mini Pill - Pearl Index: 0.5 -3 Oral hormonal contraceptive with gestagen The mini-pill contains low-dose gestagens without a break in intake. This leads to changes in the cervical mucus and uterine lining, preventing sperm from ascending or a fertilized egg from implanting. The mini-pill does not inhibit ovulation in all cases. Side effects can include menstrual disorders and skin changes. Depot Injection - Pearl Index: 0.4 Depot preparation with gestagen Every two to three months, a high-dose gestagen injection is administered, for example, into the upper arm muscle. This changes the uterine lining and cervical mucus and also prevents ovulation. Disadvantages include weight gain, acne, menstrual irregularities, or absence of menstruation, even some time after stopping the injections. Hormone-containing IUD - Pearl Index: 0.05 -0.2 Depot preparation with intrauterine gestagen The gestagen-containing IUD releases very low doses of the substance to the uterus over three or five years. This reduces the growth of the uterine lining. Additionally, a mucus plug forms in the cervix as a barrier to sperm and bacteria. Ovulation is not inhibited. Side effects can include menstrual disorders, headaches, skin changes, and breast tenderness. Hormone Implant - Pearl Index: 0 Depot preparation with gestagen A gestagen-containing plastic rod is implanted under the skin on the inside of the upper arm. It releases the active substance in low doses over three years. This prevents ovulation and changes the cervical mucus. Side effects can include headaches, weight gain, acne, breast tenderness, and menstrual disorders up to the absence of menstruation. B. Metal-containing Device Intrauterin IUD - Pearl Index: 0.5 – 3 Metal-containing IUD: Copper - Gold - Silver The metal-containing IUD works, among other things, by the damaging effect of the ions of gold, copper, and silver on sperm and by a foreign body reaction in the uterine cavity. Possible side effects include prolonged or more painful bleeding. Inflammation in the area of the fallopian tubes and ovaries can occur, leading to infertility. C. Natural Contraception Methods These require a regular cycle, discipline, and a willingness to invest time in getting to know one's body. On fertile days, an alternative method of contraception must be used, or sexual intercourse should be avoided. Temperature Method - Pearl Index: 1, for the extended form: 3 By measuring body temperature every morning, the fertile days are determined. The basis of this method is that after ovulation, the body temperature rises due to the production of gestagen. Sexual intercourse should be limited to the definitely infertile days after ovulation. Extended form: Sexual intercourse also occurs on the less reliably infertile days from the first day of the cycle up to six days before the earliest measured temperature rise. Billings Mucus Structure Method - Pearl Index: 2 – 15 Determines ovulation by assessing cervical mucus. Due to the rise in estrogen before ovulation, the mucus increases in quantity and becomes clearer and more "stretchable". Symptothermal Method by Roetzer - Pearl Index: 1 – 2 The temperature method and mucus structure method should always be used together. It is one of the safest ways to naturally prevent pregnancy Computer-Assisted Contraception - Pearl Index: 2 – 10 These methods are based on temperature values Pearl Index: 5 – 10, measurement of hormones in urine Pearl Index: 6, or a combination of both Pearl Index: 2 – 6. D. Chemical Methods Spermicides - Pearl Index: 3 – 25 Foam, tablets, suppositories, creams, gels, or sponges limit sperm mobility and kill them. E. Barrier Methods These methods use a mechanical barrier to prevent sperm from entering the uterus. Possible side effects include vaginal infections. The effectiveness can be increased with spermicides. Male Condom - Pearl Index: 2 -12 The condom provides the best protection against infectious diseases HIV, Hepatitis, and other sexually transmitted diseases. The effectiveness largely depends on correct usage. Female Condom - Pearl Index: 6 – 10 The latex-free condom is inserted into the vagina before sexual intercourse and secured with a ring at the entrance to the vagina. This allows the woman to protect herself from sexually transmitted diseases. Diaphragm - Pearl Index: 2 – 20 The diaphragm consists of a flexible metal ring covered with rubber and a membrane of thin, pliable rubber. A spermicide is applied to it and introduced into the vagina. Cervical Cap - Pearl Index: 6 A plastic cap is placed on the cervix. Spermicides should also be used. The cervical cap additionally provides some protection against ascending infections. F. Surgical Methods These should only be performed after family planning is complete, as later surgical restoration of fertility is often not possible. Female Sterilization - Pearl Index: 0.1 Through a laparoscopy minimally invasive keyhole surgery, the patency of the fallopian tubes is blocked. This prevents the transport of eggs while not affecting hormone production in the ovaries or sexual sensation. Male Sterilization - Pearl Index: 0.15 – 0.25 The patency of the vas deferens is blocked, preventing sperm transport. Hormone production in the testes, sexual sensation, and potency are not affected. G. Postcoital Contraception / Emergency Contraception "Morning-After Pill" - Pearl Index: 0.1-2.6 Hormonal implantation inhibition by gestagens After unprotected intercourse, a woman can take a hormone-containing pill within 3-7 days for postcoital birth control. However, this should always be an exceptional measure. Possible side effects can include menstrual disorders, breast tenderness, and nausea. Copper IUD - Pearl Index: <1 Up to 6 days after unprotected intercourse, a copper IUD can be placed, which prevents the implantation of the fertilized egg in the uterine lining. Not Recommended Contraception Methods The following methods provide less protection than the presented methods and are therefore not recommended. A. Extended Breastfeeding - Pearl Index: Unknown The absence of menstruation during breastfeeding does not provide reliable contraception, as it is unpredictable when the first ovulation will occur. B. Withdrawal - Pearl Index: 10-38 Coitus interruptus "Pulling out" Ejaculation occurs outside the vagina. However, small amounts of seminal fluid are often released before ejaculation, which can lead to conception. C. Douching - Pearl Index: 31 After intercourse, the vagina is rinsed. However, sperm may reach the uterus before douching.
Menstrual Cycle Disorder
The Menstrual Cycle The menstrual cycle is defined as the period from the first day of menstruation to the day before the next period begins. It typically lasts about 28 days. Although individual variations may occur, the duration and intensity of bleeding, as well as the interval between two periods, should remain consistent. Irregular, Too Strong, Too Early, Too Late – Simple Diagnostics The regularity of menstrual bleeding can be disrupted by various factors, including hormonal imbalances, psychological stress, physical exertion, poor nutrition, dieting, as well as being underweight or overweight. Sometimes pathological causes such as fibroids, endometriosis, infections, or cysts are responsible. If menstruation ceases entirely, it may indicate pregnancy or disorders of the uterus or ovaries. In any case, irregular bleeding or spotting should be examined by a doctor. A gynecologist will conduct three diagnostic steps: 1. Check for anatomical abnormalities 2. Evaluate for hormonal imbalances 3. Assess for regulatory fluctuations In most cases, irregular bleeding results from hormonal irregularities since the buildup and breakdown of the uterine lining are controlled by three ovarian hormones. Diagnosing Irregular Bleeding Primarily Focuses on Two Questions: 1. How Can I Rule Out an Anatomical Disorder? This fundamental question is primarily addressed through hysteroscopy, a modern and increasingly established diagnostic method in which the uterus is examined using an optical rod inserted through the cervix into the uterine cavity. This examination can be performed on an outpatient basis, either under local anesthesia or light sedation. Hysteroscopy allows inspection of the uterine interior, identifying benign or malignant changes. In some cases, tissue samples may be required for histological examination. If no abnormalities are found in the uterus, anatomical causes for irregular bleeding can likely be ruled out. 2. Is the Cause of the Irregular Bleeding Hormonal? Hormonal causes are far more commonly responsible for irregular bleeding. Common situations include: - Premenstrual Bleeding: Bleeding before the scheduled period can indicate progesterone deficiency. Progesterone is a hormone dominant in the premenstrual phase, maintaining the uterine lining and offering protection against pregnancy. A deficiency can trigger early menstruation. This can be corrected by taking a progestogen to raise progesterone levels. - Postmenstrual Bleeding: Bleeding that continues after the regular menstrual period may be due to estrogen deficiency. Treatment involves balancing estrogen levels. - Random, Irregular Bleeding: Sometimes cycle disturbances occur irregularly, almost randomly. This may be due to an imbalance between estrogen and progesterone. Therapeutically, correcting this issue is more complex, often requiring the entire menstrual cycle to be artificially replicated and regulated. Surgical Treatment for Irregular Bleeding Surgical treatments for irregular bleeding include curettage, a procedure used for both diagnosis and therapy: Diagnostic and Therapeutic Curettage Known as a "scraping," this procedure is used for specific gynecological issues such as unclear or irregular bleeding, miscarriages, fibroids, or endometrial carcinomas. During diagnostic curettage, tissue is removed from the uterine cavity to diagnose or rule out certain conditions. The removed tissue is then histologically examined. Therapeutic curettage removes tissue from the uterine cavity that could affect health, such as fibroids or uterine lining remnants after a miscarriage. The procedure is typically performed on an outpatient basis, under local anesthesia or light sedation, and lasts about an hour. Post-procedure, mild pain, bleeding, and nausea for a few days are normal, but symptoms should subside quickly. It is essential to rest and follow the doctor's post-procedure care instructions for optimal healing. Diagnostic and Operative Hysteroscopy Hysteroscopy is a method for examining female reproductive organs. Using a hysteroscopic instrument, a thin rod inserted through the cervix into the uterine cavity, the inner surface of the uterus is inspected. During diagnostic hysteroscopy, the examination is used to detect potential changes or conditions such as fibroids, polyps, or adhesions. Tissue samples for histological analysis may be taken during the exam if necessary. Operative hysteroscopy also allows therapeutic measures, including the removal of polyps or fibroids and treatment for adhesions or anatomical anomalies. Both procedures can be performed under local anesthesia or light sedation, usually lasting about five to ten minutes. Endometrial Ablation Endometrial ablation is a surgical method used to treat irregular or excessive menstrual bleeding. During this procedure, the inner uterine lining the endometrium is removed or damaged to reduce or stop bleeding. Ablation can be performed using several techniques, including hysteroscopy, thermal coagulation, laser ablation, or hydrothermal coagulation. It is essential to note that endometrial ablation does not act as sterilization, so women who choose this procedure should use alternative contraceptive methods. Pathological structures can also be removed with the same device. Small scissors can be inserted into the uterus to remove polyps or small fibroids during the procedure. If no polyps or fibroids are present, the uterine lining can be cauterized to prevent heavy bleeding. This method has become an alternative to hysterectomy removal of the uterus, allowing women to stop excessive bleeding without the need for uterine removal.
Endometriosis
An Overview Endometriosis is a benign yet often painful condition where tissue similar to the lining inside the uterus, called the endometrium, starts to grow outside the uterus. This tissue can spread to various organs such as the ovaries, fallopian tubes, bladder, or intestines, causing cysts, scars, and inflammation. The precise causes of endometriosis are not fully understood, but it is thought that genetic factors, hormonal changes, and immune system issues may play a role. The condition affects 6-10% of women of reproductive age and can lead to infertility. Common among most forms of endometriosis is their occurrence coinciding with the menstrual cycle. Endometriosis can cause pain, especially during menstrual periods. But treatments can help you take charge of the condition and its complications. Localization: Endometriosis primarily settles on the peritoneum and the ovaries. The spread can vary from a few millimeters in diameter to the size of the palm when it extensively infiltrates the peritoneum. Endometriosis Affecting the Ovaries and Uterus: It also commonly nests in the bladder and intestines, where the associated symptomatology includes pain during urination, occasionally accompanied by blood discharge from the urethra. Endometriosis of the intestines can also signal dramatic symptoms: in addition to other complaints, severe diarrhea often occurs, which is typically mucus-laden and bloody. This disease can also be found in atypical locations – in the vagina, around the navel, and even in the heart or lungs. Etiology: Despite intensive research, the etiology and pathogenesis of endometriosis are only partially understood. Various concepts and theories on the origin of endometriosis exist, including: - The transplantation theory by J.A. Sampson from 1924, - The metaplasia theory by R. Meyer, - The "endometriotic disease theory" by P.H. Koninckx, - The archimetra concept by G. Leyendecker. Experts agree that no single theory can exhaustively explain the emergence of endometriosis in its various forms. It appears that the interplay of different factors such as genetic predisposition, endocrine, immunological, and mechanical/anatomical factors lead to metaplasia, implantation, and the formation of endometriosis implants. Description: Endometriosis can grow in nodular, vesicular, polypoid, plaque-like, cystic, or infiltrative forms, often presenting in combinations. Descriptions of endometriosis lesions can provide an indication of their biological activity, with red lesions considered active, blue-black lesions as less active, and white-scarred findings as inactive. Clinical Presentation: Classic leading symptoms of endometriosis include: - Cyclical or chronic pelvic pain, - Dysmenorrhea, - Dyspareunia, - Gastrointestinal symptoms, - Dysuria or painful periods: Pelvic pain and cramping may start before a menstrual period and last for days into it. You also may have lower back and stomach pain. - Sterility/infertility: For some people, endometriosis is first found during tests for infertility treatment. - Bleeding disorders, - A notable accumulation of 'nonspecific' symptoms like fatigue, diarrhea, constipation, bloating or nausea. These symptoms are more common before or during menstrual periods. Fertility Desires and Sterility: It is estimated that about 50% of infertile patients suffer from endometriosis. Advanced endometriosis, with corresponding changes to the internal genitalia, represents a factor in infertility. However, the mechanisms underlying the unfulfilled desire for children in cases of minimal or mild endometriosis are subtle and controversially discussed in the literature. Therapy: Current knowledge suggests that the origins of endometriosis are multifaceted, and the more medicine learns about this disease, the more differentiated its treatment becomes. The therapeutic concept for patients with endometriosis is always individualized. Treatment depends on the severity of the symptoms and the desire for children. Options include pain medication, hormonal therapy e.g., the pill, GnRH agonists, and surgical removal of endometriosis lesions. Although endometriosis can lead to infertility, there are treatment options to improve fertility, including surgical procedures or assisted reproductive technologies ART such as in-vitro fertilization IVF or intracytoplasmic sperm injection ICSI. When to See a Doctor? See a member of your health care team if you think you might have symptoms of endometriosis. Endometriosis can be a challenge to manage. You may be better able to take charge of the symptoms if: - Your care team finds the disease sooner rather than later. - You learn as much as you can about endometriosis. - You get treatment from a team of health care professionals from different medical fields, if needed. For further professional inquiries, we are always at your disposal and you can request an appointment. For more information on this topic, please visit the following links: - - -
Cancer Prevention or Screening
For many types of cancer, the chances of a cure are significantly higher if detected early. Therefore, it is important to take advantage of annual health check-ups for your own safety. Cervical Cancer A Pap test is an essential part of early cervical cancer detection and a simple, safe method for identifying changes in cervical tissue. Regular Pap tests can detect early signs of cell changes that may potentially develop into cancer. However, it's important to note that a Pap test is not a cancer screening tool but rather a test to monitor cell changes. In addition to the Pap test, other methods of early cervical cancer detection include colposcopy and ultrasound. A colposcope is a specialized microscope used to examine the cervix more closely. Ultrasound imaging can provide a picture of the cervical tissue to detect potential changes. It's crucial for women, especially those who are sexually active, to regularly screen for cervical health. Early detection of cervical cancer can lead to successful treatment and improved survival rates. Ovarian Cancer The most reliable method for early detection of ovarian cancer is an ultrasound examination. During cancer screenings, the ovaries are also examined to determine their size. However, detecting changes in the ovaries through a physical exam can be challenging because they are well-protected within the abdominal cavity. Therefore, this method can only diagnose advanced forms of ovarian cancer. If unclear symptoms like abdominal pain, pressure, or spotting occur, a gynecological examination is crucial. Modern high-frequency ultrasound devices can detect early stages of ovarian cancer, significantly improving the chances of a cure. If ovarian cancer is suspected, surgery is the only way to histologically examine the tumor. Colorectal Cancer As part of cancer prevention, a gynecologist will also perform an immunological stool test for occult blood. This test can detect sources of bleeding in the intestines, such as polyps or colorectal cancer, by reacting to human blood. If there is suspicion of an intestinal disease, further examinations by an internist or gastroenterologist will be ordered. Breast Cancer Important methods for early detection of breast cancer include self-examinations, clinical exams by a gynecologist, mammography, and ultrasound. Regular monthly self-examinations and yearly clinical exams by a gynecologist are especially important. The best time for a self-examination is shortly after the end of menstruation. If changes are noticed during the self-examination, it is important to see a doctor. Changes to watch out for include lumps, alterations in the shape, size, or mobility of the breasts, hard tissue changes, retracted nipples or skin, redness under the nipple, brown or bloody discharge, and enlarged lymph nodes around the breast or in the armpit. It's important to note that not every lump is malignant. Important Methods for Early Detection of Breast Cancer Mammography: Mammography is an essential component of cancer screening and helps detect breast cancer at an early stage before visible symptoms arise. It is crucial to have regular mammograms to reduce the risk of breast cancer and ensure early treatment. Ultrasound: Another tool for early detection of breast cancer is ultrasound. It uses sound waves to examine the breast and detect changes in the tissue. Ultrasound is particularly well-suited for evaluating palpable lumps and helps distinguish between benign and malignant changes. It can also be used to monitor changes in breast tissue detected during earlier examinations. Ultrasound can determine whether a lump is a fluid-filled cyst or a glandular tissue nodule. If a suspicious lump is found in the breast, a tissue sample must be taken through a core needle biopsy and examined microscopically.
Endometrial Cancer
Etiology Endometrial cancer is one of the most common cancers in women. In the Western world, it ranks as the fourth most common cancer among women and the most prevalent cancer of the female genital tract. In Switzerland, about 1,000 women are diagnosed annually, primarily postmenopausal, with the average age of onset at 63 years. Globally, it stands as the sixth most common cancer in women, with approximately 320,000 new cases and about 76,000 deaths each year. Mortality rates vary with the disease stage, with early detection offering a favorable prognosis and a global five-year survival rate of about 80%. Disease Forms There are two types of endometrial carcinomas: - Estrogen-dependent carcinoma Type I - Estrogen-independent carcinoma Type II Risk Factors Confirmed risk factors for the carcinogenesis of Type I endometrial carcinoma include: - Long-term intake of estrogens without progestogen protection - Hormone therapy with less than 12 days per month of progestogen administration - Metabolic syndrome with obesity BMI 25 kg/m^2 - Diabetes mellitus - Polycystic ovary syndrome PCOS - Prolonged menstrual life - Nulliparity - Personal history of breast cancer - Elevated serum estradiol concentrations - Tamoxifen therapy Reducing the risk of developing endometrial carcinoma: - Multiparity - Smoking - Physical exertion - Contraceptive use - Lifelong soy-rich diet Diagnosis and Therapy Diagnostics For the clarification of any postmenopausal bleeding and abnormal bleeding in premenopausal patients with any of the risk factors mentioned: • Gynecological examination to determine if the bleeding originates from the uterus and to assess if the cancer has extended beyond the uterus. Transvaginal sonography is used to evaluate the endometrium and rule out other pathological processes in the pelvic area. • In postmenopausal patients with uterine bleeding, an endometrial thickness 5 mm is considered suspicious. • For postmenopausal patients on hormone therapy including SERM therapy and premenopausal patients, measuring endometrial thickness alone is not diagnostically conclusive. • Hysteroscopy and fractional curettage scraping are generally required. Therapy The treatment of endometrial carcinoma depends on factors such as the stage of the disease, tumor size and grade, as well as the patient's age and general condition. For most women with endometrial carcinoma, the primary treatment is the removal of the uterus and ovaries. In early stages Stages I and II, surgery alone may suffice, while in advanced stages Stages III and IV, additional radiotherapy and/or chemotherapy may be required. Hormone therapy with progestin preparations can be beneficial in some cases. It is used in patients with advanced or metastatic endometrial carcinoma who are not candidates for surgery or radiation therapy. Survival rates for endometrial carcinoma depend heavily on the stage at diagnosis. For patients in early stages I and II, the five-year survival rate is around 90%, significantly lower in advanced stages III and IV. Close follow-up and regular check-ups are crucial for early detection and treatment of any recurrence.
Cervical Carcinoma
Cervical carcinoma Early Detection and Prevention Cervical cancer is particularly suitable for early detection tests. Effective early detection requires regular participation in the cancer screening program, especially for women with a history of risk. Patient Information – Early Detection/Prevention Effective early detection of cervical cancer and its precursors requires regular participation in the cancer screening program. This should include a colposcopic assessment of the cervix and a targeted cytological smear from the cervical surface and the cervical canal. If abnormal findings are found, a colposcopically targeted biopsy should be taken. Diagnosis Diagnosis in Asymptomatic Patients A mirror adjustment and a targeted cytological smear sampling, if possible under colposcopic control from the portio surface and the cervical canal, are required. In recent years, the diagnosis of HPV infection using PCR or hybrid capture II assay HC II assay has made it possible to detect patients with persistent HPV infections. HPV detection enables identification of patients at risk for developing high-grade dysplasia. HPV detection currently has no significance in screening for precancerous lesions of cervical cancer. Necessary Examinations: - Inspection of the vagina and portio uteri by mirror adjustment during gynecological examination - Bimanual vaginal and rectovaginal examination - Colposcopy of the vagina and portio uteri - Endocervical curettage of the cervix - Confirmation of the suspected diagnosis by colposcopically targeted tissue sampling in the case of conspicuous findings or macroscopically visible tumor Preoperative Examination Procedures - Diagnosis of tumor spread preferably by magnetic resonance imaging MRI - Chest X-ray - Transvaginal sonography, sonography of the kidneys and liver - Cystoscopy and rectoscopy to exclude tumor invasion into the bladder or rectum - Endocervical curettage of the uterus, possibly with hysteroscopy Patient Information – Diagnostic Measures The diagnosis and staging of cervical cancer is primarily made through a gynecological examination. An MRI or CT scan is not always necessary, but may be useful for advanced tumors. The diagnosis is confirmed by histological examination of a sample from the tumor. Tumor markers are of little importance, but if elevated at the time of primary diagnosis, they can be useful in follow-up care. Patient Information – Tissue Examination When treating precancerous lesions of cervical cancer, it is important that the affected lesion is removed in healthy tissue. Clear written information should be available about the size, extent of the lesion, the resection margins, and any invasive lesions present. Therapy The decision on the appropriate treatment modality is made in an interdisciplinary manner, involving gynecological oncology, radiotherapy, anesthesiology, and pathology. This includes a discussion of the short- and long-term consequences of various treatment options. The treatment decision must be made individually and together with the patient, considering the patient's general condition, life situation, disease stage, and risk factors. Surgical Therapy - Conization: Can be performed as a knife conization, with an electric loop, or as a laser conization. The conization should remove premalignant or microinvasive changes with tumor-free margins. In 2-3% of cases, post-conization bleeding occurs. If conization is performed during pregnancy, the risk of post-conization bleeding is significantly increased and premature births are more likely. - Operational Staging: Staging laparoscopy laparoscopy/laparotomy open surgery and intraoperative findings are essential for treatment planning and assessment of the disease extent. - Radical Abdominal Surgery: Performed depending on the stage in accordance with the recommendations of Wertheim, Meigs, Latzko, Okabayashi various techniques. - Lymphadenectomy Lymph Node Removal: Systematic pelvic lymphadenectomy involves the removal of all lymph nodes and fatty tissue in the area of the pelvic vessels. Patient Information – Therapy In the early stages of cervical cancer, surgery, radiotherapy, or chemoradiotherapy, alone or in combination, are possible treatment options, depending on the tumor stage and risk factors. The therapy should be adapted to the patient's life situation and general condition. In the case of clinically borderline surgical findings, a surgical assessment of the tumor stage ideally through minimally invasive measures should support the choice of therapy. Radiotherapy and Radiochemotherapy - Primary Radio- or Radiochemotherapy: Typically consists of a combination of intracavitary contact and percutaneous high-voltage irradiation. Combining radiotherapy with simultaneous chemotherapy significantly improves healing results compared to radiotherapy alone. Chemotherapy Chemotherapy is effective in treating cancer of the cervix uteri. Stage-Dependent Therapy Classification of Precancerous Lesions The definition of dysplasia syn. cervical intraepithelial neoplasia - CIN includes cellular atypia of the squamous epithelium with disruption of the tissue structure, referred to as precancerous lesions. Depending on the severity of the cellular atypia and the extent of the change, three grades are distinguished: - CIN I: Low-grade dysplasia - CIN II: Moderate-grade dysplasia - CIN III: High-grade dysplasia and carcinoma in situ CIS Therapy of Histologically Confirmed Cervical Intraepithelial Neoplasia CIN - CIN I: If the finding is limited to the ectocervix confirmed by colposcopy, check every 3 months. In case of persistence and ectocervical location, biopsy or CO2 laser vaporization is possible. In the case of endocervical location, generous indication for conization. - CIN II: Colposcopic and cytological examination every three months. If persisting for more than one year, treatment as CIN III. - CIN III: Treatment by loop excision or conization. Invasive carcinomas are treated surgically according to the FIGO stage. Rehabilitation Rehabilitation in the somatic and psychosocial areas results from the determination of disorders resulting from the disease and treatment, in accordance with the classification principles of the ICF classification of the WHO 2001. Rehabilitation can be started in a suitable clinic within two weeks of the end of primary therapy or regular treatment can be applied for and approved within two years of primary therapy. Aftercare Follow-up care focuses on individual orientation with an informative conversation, a detailed, structured medical history, and a clinical, symptom-oriented examination. One possible scheme provides for follow-up examinations quarterly during the first three years, half-yearly in the fourth and fifth years, and annually thereafter. Diagnosis Without Suspicion of Recurrence The gynecological mirror and palpation examination vaginal/rectal is the most important form of searching for a recurrence. Early detection of urinary retention can be achieved through sonography of the urinary tract. Determination of tumor markers is part of the follow-up. Diagnostics With Suspected Recurrence If loco-regional recurrence is suspected, histological confirmation and assessment of previous therapies and removability must be examined. Extensive diagnostics are required, including local findings through gynecological examination, vaginal sonography, MRI of the pelvis, cystoscopy, and rectoscopy. Exclusion of distant metastases through whole-body computed tomography and histological confirmation of metastases or supraclavicular lymph node metastases. Patient Information – Aftercare/Rehabilitation/Psychosocial Care Aftercare serves to identify problems caused by the illness and therapy. The main goals of aftercare are psychological stabilization, reintegration into working life, and restoring the best possible quality of life. Palliative treatment decisions are individual, depending largely on the patient’s personal life plans and should be made together with her. In addition to sufficient symptom control pain, nausea, constipation, ileus, etc., medical care also includes psychosocial and religious-ethical support for the patient and her relatives.
Breast Cancer
A. Introduction According to the Swiss Cancer League, breast cancer is the most common type of cancer among women in Switzerland. In 2020, approximately 6,100 new cases of breast cancer were diagnosed, accounting for about 30% of all cancer diagnoses in women. About one in eight women in Switzerland will be diagnosed with breast cancer during their lifetime. The average age at diagnosis of breast cancer in Switzerland is 62 years. Breast cancer also affects men, but very rarely. In Switzerland, about one in 100,000 men is diagnosed with breast cancer. B. Early Detection, Screening Breast cancer screening is recommended in Switzerland for women between the ages of 50 and 69. Women in this age group receive an invitation for a mammography examination every two years. A quality-assured, interdisciplinary breast cancer early detection/screening program can significantly reduce breast cancer mortality. If risk factors are present, an individual early detection strategy must be discussed and recommended. Breast self-examination should be learned early and performed by the patient, as it can promote motivation and awareness for preventive measures. C. Risk Factors for the Development of Breast Cancer - Normal Weight: Obesity - Increase in new cases by 150% - No Relatives of the 1st Degree Affected: Family history mother diagnosed before the age of 60 - Increase in new cases by 100% - Age at First Birth 20 Years: Age at First Birth 30 Years and Childlessness - Increase in new cases by 90% - Non-Smoker: Smoking 20 cigarettes/day - Increase in new cases by 83% - Last Menstrual Period at 45 – 54 Years: Last Menstrual Period at 55 Years - Increase in new cases by 50% - First Menstrual Period at 14 Years: First Menstrual Period at 11 Years - Increase in new cases by 30% - No Alcohol: Alcohol Consumption 20 g/day ~ 0.25 l wine - Increase in new cases by 30% - Total Duration of Breastfeeding 5 Years: No Breastfeeding - Increase in new cases by 20% - Physical Activity: Physical Inactivity - Increase in new cases by 20% - Never Hormone Therapy: - Hormone Therapy 1-4 Years - Increase in new cases by 8% - Hormone Therapy 5-9 Years - Increase in new cases by 31% - Hormone Therapy 10-14 Years - Increase in new cases by 24% - Hormone Therapy 15 Years - Increase in new cases by 56% D. Diagnostics in Symptomatic Patients Basic Diagnostics The basic diagnostics of any suspicious breast change consist of: - Palpation of the breast and lymphatic drainage areas - Mammography - Ultrasound diagnostics with high-frequency probes 7.5-13 - Histological clarification-Diagnosis assurance - MRI supplementary to local staging Imaging Diagnostic Procedures Every patient should receive a mammography in 2 planes. The mammosonography with high-frequency probes can provide informative value and should therefore be performed additionally. Mammosonography has its place particularly in women under 35 years with connective tissue-rich breasts. Ultrasound offers better disease detection in younger patients compared to mammography. Histology Breast lesion Every suspicious mammal lesion should be clarified through tissue examination regarding its dignity. The fine tissue examinations for clarification are carried out as follows: - X-ray guided vacuum biopsies-Stereotaxy mammographic changes - Ultrasound-guided vacuum biopsies sonographic changes - Ultrasound-guided needle core biopsies sonographic changes The diagnostic measures using imaging procedures mammographies and breast ultrasound with subsequent necessary histological clarification of the breast change through STEREOTAXY or VACUUM BIOPSIES is a focus of treatment at GYNAEKOLOGIE ZÜRICHSEE. E. General Therapeutic Strategy E.1. Surgical Therapy of Breast Carcinoma Clinical studies have shown that considering certain clinical and histological parameters, breast-conserving therapy achieves identical survival rates as mastectomy. Patients for whom breast-conserving therapy is an option must be informed about this possibility. Breast-Conserving Therapy Breast-conserving therapy BCT with subsequent radiation treatment is at least equivalent in terms of survival to a modified radical mastectomy MRM. Therefore, all patients should be informed about the possibility of breast-conserving therapy BCT and modified radical mastectomy MRM with and without immediate reconstruction. The patient's wish must be respected. Mastectomy Modified radical mastectomy breast removal is always performed when breast-conserving treatment is not possible according to the criteria mentioned above. The entire breast tissue, skin, and nipple-areola complex, as well as the pectoral fascia, are removed. The pectoral muscle is preserved. Plastic Reconstructive Surgery The reconstruction of the amputated female breast can only be offered to a patient after comprehensive information about all existing possibilities. The indication for breast reconstruction is made by the patient after individual consultation with her advising and treating doctors. Plastic reconstructive surgeries can be performed as part of the primary procedure or at an interval. They serve to cover defects and replace volume, as well as fulfill the patient's desire to restore her physical integrity. Surgical Therapy of the Axilla The sentinel lymph node finding is a procedure for examining the sentinel lymph node in breast cancer. This procedure examines the sentinel lymph node, which is the first lymph node to which lymph fluid flows from the breast. If this lymph node is free of cancer cells, it can be assumed that the other lymph nodes and the entire lymphatic system are also not affected. This helps doctors decide whether the removal of further lymph nodes is necessary. The method can reduce the need for axillary lymph node dissection and thus reduce the side effects associated with this procedure. E.2. Adjuvant Radiotherapy of Breast Carcinoma Radiotherapy after surgical tumor removal may be necessary because systemic therapy alone does not have sufficient influence on local or locoregional tumor control. Preventing isolated local or locoregional recurrence has a positive impact on survival rates and quality of life for patients. In invasive breast cancer, post-operative irradiation of the remaining breast is indicated as it can improve local control. E.3. Systemic Adjuvant Therapy Hormone and Chemotherapy After the surgical removal of a breast carcinoma, chemotherapy may be recommended as adjuvant therapy in addition to surgery depending on tumor characteristics and stage. The goal is to kill any potentially remaining cancer cells in the body and reduce the risk of recurrence or metastasis. The decision for chemotherapy depends on various factors such as tumor size, lymph node involvement, hormone receptor status, and HER2 status. Chemotherapy is often conducted in multiple cycles, either before or after radiation therapy. Depending on the type of chemotherapy, side effects may include hair loss, nausea, vomiting, fatigue, risk of infection, and pain. There are also neoadjuvant chemotherapies performed before surgery to shrink or stabilize the tumor, potentially allowing for breast-conserving surgery that might not otherwise be possible. F. Aftercare Aftercare for Breast Carcinoma Aftercare not only serves to monitor the course of the disease but also aims to promote the physical and psychological health of affected women and support their psychosocial rehabilitation. It should be tailored to the individual needs of women and aimed at alleviating post-operative and post-therapeutic symptoms. Further goals of aftercare include: - Early detection of local or intramammary recurrences - Timely diagnosis and treatment of consequences and side effects of previous breast cancer treatment - Targeted search for distant metastases in case of complaints or justified suspicion - Diagnosis of treatment-associated changes/diseases Follow-up and Early Detection Examinations Years after primary therapy: - 1, 2, 3 Years: - Anamnesis, physical examination, information/education: Quarterly - Laboratory examinations, imaging procedures excluding mammography only if clinically suspected recurrence and/or metastases - 4, 5 Years: - Anamnesis, physical examination, information/education: Semi-annually - 6 and further Years: - Anamnesis, physical examination, information/education: Annually Follow-up Examinations for Breast Carcinoma – Mammography - 1 – 3 Years: Breast-conserving operation: - Affected breast: Every 6 months - Contralateral breast: Annually - From the 4th Year: - Breast-conserving operation: - Affected breast: Annually - Contralateral breast: Annually - Mastectomy – contralateral breast: Annually Related Links: - - - - - - - - - - - - -
Benign Breast Diseases
The female breast tissue is prone to benign proliferations, which present diagnostic and therapeutic challenges. Clinical symptoms are diverse and can include changes in breast tissue in the form of diffuse or localized lumps, skin inflammation, nipple or gland tissue inflammation, breast pain, or nipple discharge. Common Benign Tumors 1. Fibroadenoma - Description: Fibroadenomas are the most common solid, benign tumors found in the breasts of premenopausal women. They are usually round, firm, and movable, and can vary in size. These tumors are typically painless and are often discovered during routine physical exams or mammograms. - Treatment: Treatment is not always necessary unless the fibroadenoma grows rapidly or causes discomfort. 2. Juvenile Fibroadenoma - Description: Juvenile fibroadenomas are a subtype of fibroadenomas that occur in adolescent girls and young women. They tend to grow quickly but are usually benign and non-cancerous. These tumors are similar in characteristics to standard fibroadenomas but occur at a younger age. - Treatment: Monitoring if asymptomatic; surgical removal may be considered due to rapid growth or discomfort. 3. Giant Fibroadenoma - Description: Giant fibroadenomas are large benign breast tumors that can grow to more than 5 centimeters in size. Despite their size, they are typically non-cancerous. - Treatment: Surgical removal may be considered if the size of the tumor causes discomfort or affects the shape of the breast. 4. Adenoma - Description: Adenomas are benign tumors that originate from the glandular tissue of the breast. They are less common than fibroadenomas and can sometimes be mistaken for other types of breast lumps. - Treatment: Generally non-cancerous and may not require treatment unless they grow or cause symptoms. 5. Lipoma - Description: Lipomas are benign tumors made up of fatty tissue. They are soft, movable, and usually painless. Lipomas are typically small and do not require treatment unless they increase in size or cause discomfort. 6. Cystosarcoma Phylloides Phyllodes Tumor - Description: Phyllodes tumors are rare breast tumors that can be benign, borderline, or malignant. They tend to grow quickly and can become quite large. - Treatment: Surgical removal is often recommended due to the potential for rapid growth and recurrence. 7. Hamartoma - Description: Hamartomas are benign, non-cancerous growths composed of an abnormal mixture of normal tissues and cells. In the breast, hamartomas are often described as “breast within a breast” due to their well-defined borders and varied tissue composition. - Treatment: They are typically painless and are often found incidentally during imaging studies. Surgical removal may be performed if they cause discomfort or diagnostic uncertainty. General Approach to Benign Breast Tumors - Diagnosis: Accurate diagnosis through physical exams, imaging mammography, ultrasound, MRI, and sometimes biopsy is essential to determine the nature of the tumor. - Monitoring: Regular follow-ups and imaging may be recommended for benign tumors to monitor any changes in size or characteristics. - Minimally Invasive Procedures: In some cases, minimally invasive procedures such as cryoablation freezing the tumor may be considered. - Patient Education: Educating patients about the benign nature of their condition and providing reassurance is important. Discussing potential symptoms to watch for and when to seek further medical advice is also crucial. Understanding these common benign breast tumors is crucial for proper diagnosis and management. While they are generally not life-threatening, monitoring and sometimes treating them can help alleviate symptoms and prevent complications. Other Breast Conditions - Cysts: Larger cysts are punctured under ultrasound guidance, and the fluid is examined cytologically. - Fibroadenomas: Common in premenopausal women. Removal is recommended for rapid growth or symptoms; otherwise, watchful waiting is advised. - Mastopathy: Occurs in 30-50% of women, typically between ages 35 and 40. Symptoms include breast swelling, lump formation, and mastodynia breast pain. - Breast Development Disorders: Includes atypical breast shapes or significant size differences. Surgical procedures are available for treatment. - Breast Infections: Common during postpartum, treated with antibiotics, and sometimes require surgical drainage if abscesses form. - Galactorrhea: Nipple discharge, which can be unilateral or bilateral, varying in color. Bloody discharge often indicates papillomas in the milk duct and requires further examination. Conclusion By understanding these benign breast diseases and conditions, patients and healthcare providers can work together to ensure accurate diagnosis, effective treatment, and comprehensive management, ultimately improving patient comfort and quality of life.
Osteoporosis
Understanding Osteoporosis Osteoporosis is a systemic skeletal disease characterized by low bone mass and the deterioration of bone tissue microarchitecture. This leads to increased bone fragility and susceptibility to fractures. Clinically, osteoporosis is diagnosed based on low bone density measurements, though microarchitectural deficiencies and external factors also contribute to bone fragility. Approximately 7.8 million individuals over 50 are affected, with 80% being women. Postmenopausal women particularly face a one in three chance of experiencing an osteoporosis-related fracture, with the incidence of vertebral and hip fractures increasing exponentially with age. Symptoms There typically are no symptoms in the early stages of bone loss. But once your bones have been weakened by osteoporosis, you might have signs and symptoms that include: - Back pain, caused by a broken or collapsed bone in the spine. - Loss of height over time. - A stooped posture. - A bone that breaks much more easily than expected. When to see a doctor You might want to talk to your health care provider about osteoporosis if you went through early menopause or took corticosteroids for several months at a time, or if either of your parents had hip fractures. The WHO's 1994 definition of osteoporosis is based on a bone mineral content that is more than 2.5 standard deviations below the mean for a 20-29-year-old woman and can also be applied to men over 50. Causes Your bones are in a constant state of renewal — new bone is made and old bone is broken down. When you're young, your body makes new bone faster than it breaks down old bone and your bone mass increases. After the early 20s this process slows, and most people reach their peak bone mass by age 30. As people age, bone mass is lost faster than it's created. How likely you are to develop osteoporosis depends partly on how much bone mass you attained in your youth. Peak bone mass is partly inherited and varies also by ethnic group. The higher your peak bone mass, the more bone you have "in the bank" and the less likely you are to develop osteoporosis as you age. WHO Classification The WHO classification is based on the observation that fracture risk increases continuously with decreasing bone density and exponentially at very low values. WHO criteria should therefore be viewed as guidelines that contribute to the confirmation of an "osteoporosis" diagnosis and therapeutic decisions. Ultimately, a combination of history, physical examination, and diagnostic tools is decisive. Prevention and Treatment - Normal: T-Score up to -1 SD up to 10% loss of bone density - Osteopenia: T-Score between -1 and -2.5 SD 10-25% loss of bone density - Osteoporosis: T-Score < -2.5 SD more than 25% loss of bone density - Manifest Osteoporosis: Osteoporosis with fracture - Diagnosing Osteoporosis: Diagnosis is established through a combination of patient history, clinical findings, basic laboratory tests, and diagnostic imaging. Recommended Basic Diagnostic Approach: For Who: - Women aged 50-60 and men 60-70 with certain risk factors or findings. - Women aged 60-70 and men 70-80 with additional risk factors. - Women over 70 and men over 80, if therapeutic consequences are to be drawn. Physical Examination Particularly in patients with manifest osteoporosis and related fractures, such as vertebral fractures, physical examination may reveal acute and chronic pain, as well as specific findings like contusions or scars from falls, and a reduced rib-to-pelvis distance. Osteological Laboratory Screening It’s advised to take fasting morning samples for a comprehensive panel including BSR/CRP, differential blood count, calcium, phosphate, protein electrophoresis, alkaline phosphatase, creatinine, TSH basal, gamma-GT, 25-OH-D, intact PTH in hypo- or hypercalcemia, and bone turnover markers like β-CrossLaps CTx and Procollagen Type 1 N Propeptide P1NP. Instrumental Diagnostics - Osteodensitometry: The reduction in bone density is a strong, independent risk factor for osteoporosis-related fractures. Bone density measurements, particularly dual-energy x-ray absorptiometry DXA, provide critical risk assessment information. - Quantitative Ultrasound QUS: This radiation-free method measures ultrasound transmission velocities and/or broadband ultrasound attenuation at the heel or phalanges. Absolute Fracture Risk and Therapy Threshold The goal of osteoporosis diagnostics is to provide a precise individual risk assessment for osteoporosis-related fractures. The WHO defined osteoporosis in 1994 solely based on bone density, thus focusing on a single risk factor. Clinical Risk Factors Factors associated with a significantly increased fracture risk depending on age and gender include underweight BMI < 20, immobility, smoking, multiple falls, malabsorption, primary hyperparathyroidism, early menopause, Cushing's syndrome, rheumatoid arthritis, ankylosing spondylitis, type I diabetes below 70 years, type II diabetes, inflammatory bowel disease, and basal TSH < 0.3mU/I²⁾, among others. Therapy: General Osteoporosis and Fracture Prevention - Nutrition and lifestyle recommendations include no smoking, limited alcohol consumption, daily outdoor time, adequate calcium and vitamin D3 intake, and regular physical activities to improve muscle strength and coordination. - Measures for fall prevention and medication review, considering the individual benefits and risks of medications that may contribute to falls or osteoporosis. Therapy Concepts Implementation of baseline measures. - For fractures: Pain therapy, functional improvement, possible vertebroplasty or kyphoplasty if resistant to pain therapy for more than 3 months. - Further investigation and treatment of secondary causes if clinical and/or laboratory evidence suggests a high fracture risk. - Potential medication
Young girls support
Supporting Young Girls Through Puberty Young girls seek reliable information to help them understand and navigate the internal and external changes that occur during the turbulent phase of puberty. Positive Integration of Female Identity Gynecologists can assist young girls in positively integrating the connections between their menstrual cycles, fertility, and overall female identity. Comprehensive Resource for Teenage Issues Our gynecological practice aims to be a comprehensive resource for teenage issues, offering guidance and support to young people. Creating a Welcoming Environment By creating a welcoming environment that signals a willingness to listen and engage, and by clarifying that a gynecological examination is not mandatory during the first visit, we can help alleviate initial fears. Responsible Use of Contraception To ensure responsible use of the pill and to promote adherence, we thoroughly discuss the effectiveness of various contraceptive methods. Tailored Consultations Consultations with adolescent patients are tailored to address their specific symptoms, which may include: - Menstrual disorders - Vaginal infections - Period pain dysmenorrhea - Breast development issues - Hormonal imbalances such as acne or increased hair growth hirsutism
Sterility
Causes of Infertility An unfulfilled desire to have children can have many causes. The cause is not always pathological and can be found in either the woman or the man. Therefore, it is necessary for both partners to participate in the diagnosis and treatment. Female Causes: - Hormonal disturbance of egg maturation - Absence of ovulation - Partial or no patency of the fallopian tubes - Endometriosis growth of uterine lining outside the uterus - Malformations of the ovaries, fallopian tubes, or uterus - Antibodies against one’s own eggs or sperm Male Causes: - Insufficient production of motile sperm - Blockage of the vas deferens Psychological Causes: In some cases, the causes of involuntary childlessness can be found in both partners. If no organic causes for infertility are found, stress may be the main cause. This stress can also be the reason for involuntary childlessness. The longer it takes to conceive a child and the more the couple wants it, the more often this stress is the reason why fertilization does not occur despite all efforts. Stress can affect hormones, preventing ovulation in women and inhibiting sperm production in men. Diagnosis Anamnesis In all medical questions, including the assessment of childless couples, discussing and evaluating possible factors associated with childlessness is of utmost importance. This creates a basis of trust, which is crucial considering the psychosomatic dimension of sterility. Age is a significant factor when advising whether a woman's desire to have children can still be fulfilled, as conception rates drop sharply after the age of 30. Many women start planning a family after 30 due to career and educational commitments, which reduces the probability of conception. Diseases and operations can provide clues to the causes of sterility. Inflammations and surgical interventions in the pelvic area suggest tubal factors and require a closer examination of the fallopian tubes. Diseases of hormone-producing organs like the thyroid, pituitary gland, and adrenal glands are often associated with sterility and must be evaluated before treatment. Hormone Diagnostics Endocrine examination of the infertile woman is necessary if cycle irregularities or anovulation detected by basal temperature measurement indicate a hormonal cause. Ovulation Diagnostics The easiest way to evaluate ovulation is by measuring basal body temperature. Progesterone-induced changes in body temperature can indicate ovulation. Vaginosonographic folliculometry and the evaluation of luteinizing hormone and estradiol can also provide information about ovulation. Eustachian Tube Diagnostics With the increase in sexually transmitted diseases, tubal factors are becoming more important for female sterility. Sonographic tube imaging and laparoscopy with chromoperturbation are methods used to evaluate tubal patency and the presence of endometriosis. Treatment Once the causes have been identified, treatment can begin. There are various ways to remedy infertility. Hormonal Stimulation Hormonal treatment involves injecting fertility hormones, starting on the third day of the cycle. Egg maturation is monitored with ultrasound and blood tests, and ovulation is triggered with another dose of hormones. Insemination Insemination is used when sperm count or mobility is reduced. Sperm are introduced directly into the uterus via a catheter at the time of ovulation. In Vitro Fertilization IVF IVF is considered if other methods are unsuccessful. Eggs are fertilized outside the womb and then inserted into the uterus via a catheter. Intratubal Gamete Transfer GIFT In this method, eggs and sperm are placed in the fallopian tubes via a catheter, allowing natural fertilization. Micro-Injection This method is an advancement of IVF. A single sperm is injected directly into an egg cell using a thin pipette.
Incontinence
Understanding Urinary Incontinence Not always a matter of age Definition Involuntary urine loss through the urethra due to stress with stable detrusor due to inadequate closure function. Synonyms: Stress incontinence, sphincter incompetence Urinary incontinence is a functional disorder characterized by the involuntary loss of urine that exceeds the normal extent and control of bladder emptying. This condition can have various causes, including anatomical, neurological, hormonal, or age-related changes in the body. Typical symptoms of urinary incontinence include involuntary loss of urine during physical activity, coughing or sneezing, frequent urination or nocturnal urination, and a general feeling of bladder weakness. According to the Swiss Society for Urology, about 400,000 people in Switzerland are affected by incontinence, with women being about twice as likely to be affected as men. It is estimated that incontinence causes healthcare costs amounting to several hundred million Swiss francs annually. Risk Factors The frequency of urinary incontinence increases with age. Bladder infections are also a common cause of urinary incontinence. During pregnancy, about 30 to 60% of pregnant women suffer from urinary incontinence. Normally, this is temporary incontinence that does not occur after birth. However, urinary incontinence can also be caused by childbirth. Due to the high strain and stretching of the pelvic floor muscles, dysfunction of the sphincters can occur. Menopause leads to an increased likelihood of bladder infection, as it causes thinning and drying of the genital tissue genital atrophy. Overweight can also promote urinary incontinence. The additional weight can strain the pelvic tissue to the point of stretching and weakening the pelvic floor muscles. Diagnostic Classification - Stress Incontinence – uncontrolled urine loss due to increased abdominal pressure, such as heavy lifting, coughing, sneezing, or laughing. - Causes can include weakening of the bladder sphincter, pelvic floor muscle weakness due to childbirth or surgery, and lack of female sex hormones during menopause. - Urge Incontinence – characterized by a very strong urge to urinate with involuntary urine loss. - Causes include overactivity or sensitivity of the bladder. Other possible causes are urinary tract infection, bladder mucosal polyps, or bladder tumors. - Mixed Incontinence – a combination of both components is possible. Medical History The temporal and activity-related assignment of incontinence episodes allows for an initial suspected diagnosis regarding the type of incontinence. Standardized incontinence assessment forms facilitate and complete the history taking. These questionnaires also record urination frequency, nocturia, and daily pad usage – information that is usually provided in a very general manner. Urine Analysis Inflammations of the lower urinary tract can mimic the clinical symptoms of an overactive bladder or urge incontinence. Asymptomatic bacteriuria often occurs. Therefore, a urine analysis using test strips should be performed during each initial consultation, and a bacteriological examination should be requested if pathological findings are present. Genital and Pelvic Floor Status The genital status serves to exclude a urogenital prolapse vaginal/uterine prolapse and provides information about the local hormone status. With a full bladder, the stress test objectifying involuntary urine loss when coughing can be performed. If it is negative despite the history indicating stress incontinence, a pad test should be conducted after completing all examinations. Urogenital Ultrasonography In addition to assessing the responsiveness of the pelvic floor, an ultrasound examination of the urethra funneling when pressing is a typical finding in stress incontinence. Urodynamics Before any stress incontinence surgery, an overactive bladder should be excluded. Additionally, the stress incontinence is confirmed by using a resting and stress pressure profile of the urethra. Urethrocystoscopy In cases of therapy-resistant urge symptoms, hematuria blood in the urine, or postoperative dysuria painful urination, urethrocystoscopy should be generously indicated to exclude possible tumors and chronic inflammatory changes in the bladder wall. ## Treatment of Urinary Incontinence Stress, urge, and mixed urinary incontinence are chronic conditions and require permanent therapy following a step-by-step concept. Treatment of Urge Incontinence Urge incontinence is treated with medication that relaxes the bladder and facilitates emptying. Organic causes, as described above, must be excluded or treated beforehand. - Anticholinergics: Anticholinergics should be checked for possible contraindications e.g., narrow-angle glaucoma, arrhythmias, cerebral sclerosis and indicated accordingly. During therapy, emerging side effects e.g., constipation, residual urine formation must be recognized in time. - Electrostimulation: This is performed transvaginally with 20 Hz daily for three months initially. Then a decision is made regarding the continuation of therapy. Treatment of Stress Incontinence - Pessary Therapy: Pessary therapy for stress incontinence convinces with immediate therapeutic success. - Pelvic Floor Awareness Training: Pelvic floor training for stress incontinence is individually tailored and oriented to the pelvic floor status. If there is no responsiveness when asked to contract, electrostimulation should be started. Once responsiveness is achieved, various forms of biofeedback training can be recommended. - Surgical Therapy: The principles of surgical therapy for stress incontinence have not changed despite innovative surgical techniques. General Therapy - Fluid and Toilet Training, Nutritional Counseling: By creating a voiding diary, “bad” drinking and voiding patterns can be corrected. Examples include pollakiuria to avoid stress incontinence episodes, which can lead to reduced bladder capacity. In urge incontinence, many patients try to reach the toilet immediately upon feeling the imperative urge to urinate; hasty movements or slow undressing due to musculoskeletal limitations then support involuntary urine leakage. - Antibiotics: If urinary tract infections are identified as the cause of urge incontinence, they are treated according to the antibiogram. - Hormones: Local estrogenization estriol preparations has infection-preventive as well as urge and stress incontinence episode-reducing properties and should be generously applied postmenopausally. - BOTOX Applications Related Links: - Links - - - - - -