Innovative Operationsverfahren bereichern das Portfolio in der operativen Uroynäkologie. Nicht zufriedenstellende Rezidivraten, vor allem in der Deszensuschirurgie, sind seit jeher Motivation, sich operativ weiterzuentwickeln. Die Robotik kann hier wertvolle Beiträge leisten, sowohl in der Inkontinenz- als auch in der Deszensustherapie neue Wege zu beschreiten. Hierbei spielen die Sakrokolpopexie, in Kombination mit oder ohne Hysterektomie, und die Kolposuspension eine große Rolle. Diese Operationen können als Multi- oder Single-Port-Eingriff durchgeführt werden. Auch die sakrale Neuromodulation hilft dabei, die Versorgung der Patientinnen nachhaltig zu verbessern und ist Teil einer sich fortwährend weiterentwickelnden Urogynäkologie.

Innovative surgical procedures are expanding the portfolio of operative urogynecology. Unsatisfactory recurrence rates-particularly in prolapse surgery-have long been a driving force behind continued surgical advancement. Robotic surgery can make valuable contributions in this context, opening new avenues in both incontinence treatment and prolapse therapy. Sacrocolpopexy, performed either in combination with or without hysterectomy, as well as colposuspension, play a major role in this field. These procedures can be carried out using either multiport or single-port approaches. In addition, sacral neuromodulation helps to sustainably improve patient care and represents an integral component of an ever-evolving field of urogynecology.

With increasing cancer survival rates, long-term sequelae of oncological therapies on the pelvic floor—including bladder, bowel, sexual dysfunction, and pelvic organ prolapse—have gained clinical relevance. The PANTHERA study evaluates the impact of systemic antineoplastic therapy on pelvic floor function (PFF) in women with breast and gynecological malignancies. This prospective observational study enrolled 201 patients with histologically confirmed breast or gynecological cancers undergoing systemic therapy. PFF was assessed using the validated German Pelvic Floor Questionnaire (GPFQ) before therapy initiation, at treatment completion, and during follow-up. The primary endpoint was the occurrence of a clinically relevant deterioration in overall PFF. Additional data on treatment type and risk factors were collected. Almost all patients (99

INTRODUCTION AND HYPOTHESIS:Female urinary incontinence affects over 60% of women globally. Despite its prevalence, social stigma limits public discussions. World Continence Week (WCW) June 17-23, 2024, aimed to increase awareness using coordinated social media campaigns. We aimed to evaluate the impact of official hashtags and campaigns during WCW on public engagement on Twitter/X. METHODS:We searched the posts containing official WCW hashtags (#CommitmentToCollaborationIncontinenceCare, #WCW2024, #ContinenceMatters, and #SupportIncontinence) and additional hashtags (#incontinence, #femaleincontinence, and #UrinaryIncontinence) collected from June 10 to June 30, 2024, covering WCW, using NodeXL Pro drawing upon social network analysis. User interactions, geographic distribution, hashtag usage, and key influencers were identified in our analysis. Our study drew upon the Clauset-Newman-Moore clustering and betweenness centrality algorithms. RESULTS:Our analysis included 20,000 posts and accumulated 861,591 interactions. The network included 317 users, with medical organizations, healthcare professionals, and patient groups dominating the conversation. Official WCW accounts had the highest influence, while active news outlets amplified reach. Shared URLs were from reputable medical institutions. The use of official hashtags showed widespread alignment on campaign themes. CONCLUSIONS:WCW 2024's social media strategy effectively raised incontinence awareness, highlighting the importance of coordinated digital campaigns for destigmatizing women's health issues.

Introduction and Hypothesis Pregnancy and delivery are known risk factors for the development of pelvic floor dysfunction (PFD). An electronic cross-sectional survey was distributed to physicians, midwives, and physiotherapists in Germany, assessing demographics, knowledge, and awareness of postpartum PFD risk/protective factors, and personal or spousal preferences for cesarean section (CS) as a preventive measure. Differences across professional groups were also analyzed. Methods An anonymous online survey was conducted via Qualtrics from January 25 to April 15, 2025. The German-language survey targeted healthcare professionals involved in obstetric or postpartum care. Data analysis was performed using SPSS version 28.0 for Mac OS X. Chi-square tests compared binary and categorical variables. P values of < 0.05 were considered statistically significant. Results After excluding 129 incomplete or non-consented responses, 228 questionnaires were analyzed. The majority of respondents demonstrated a high level of awareness and knowledge regarding the impact of pregnancy and childbirth on pelvic floor health. However, only 36.8% reported routinely providing postpartum counseling for PFD prevention. While 79.8% regularly asked about PFD symptoms postpartum, counseling rates remained low, consistent with earlier findings. Differences emerged between professional groups: physicians were more likely than midwives to view CS as protective against PFD (28.8% vs. 9.3%) and to consider CS for themselves or their partners (27.2% vs. 8.3%). These findings highlight the need to integrate structured PFD counseling protocols into routine antenatal and postnatal care.

Ki-67 is recommended by international/national guidelines for risk stratification in early breast cancer (EBC), particularly for defining “intermediate risk,” despite inter-laboratory/inter-observer variability and cutoff uncertainty. We investigated Ki-67 (> 10

Introduction: Stress urinary incontinence affects up to 50% of women at some point in their lives. Tension-free vaginal mid-urethral sling procedure should be offered as a primary surgical treatment option to women with stress urinary incontinence. Case Report: We report on the case of a 47-year-old patient presenting with heavy buttock and thigh pain, a severe walking disability necessitating the use of a walker after implantation of a retropubic sub-urethral sling (TVT-SERASIS) for the treatment of stress urinary incontinence in an external hospital. During the surgery in our hospital, it was revealed that the sling was placed incorrectly, charging the bladder wall as well as the left obturator nerve. We describe the diagnosis and operative management of this rare, but serious complication. Conclusion: Our case provides supporting evidence for the limited value of imaging tools and the need of a surgical exploration under certain circumstances. In addition, we emphasize that removal of a sub-urethral sling should be performed under laparoscopic visualization when serious adverse events occur. Sub-urethral sling placement should be executed by experienced, dedicated pelvic floor surgeons.

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 fur Gynakologie und Geburtshilfe, DGGG) and the Working Group for Urogynecology and Plastic Pelvic Floor Reconstruction (Arbeitsgemeinschaft fur Urogynakologie 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 surgical treatment of female patients with stress urinary incontinence and urge incontinence. Specific solutions for the diagnostic workup and treatment of uncomplicated and complicated urinary incontinence are discussed. The diagnostics and surgical treatment of iatrogenic urogenital fistula are presented.

Purpose This guideline provides recommendations for the diagnosis, treatment and follow-up care of 3rd and 4th degree perineal tears which occur during vaginal birth. The aim is to improve the management of 3rd and 4th degree perineal tears and reduce the immediate and long-term damage. The guideline is intended for midwives, obstetricians and physicians involved in caring for high-grade perineal tears. Methods A selective search of the literature was carried out. Consensus about the recommendations and statements was achieved as part of a structured process during a consensus conference with neutral moderation. Recommendations After every vaginal birth, a careful inspection and/or palpation by the obstetrician and/or the midwife must be carried out to exclude a 3rd or 4th degree perineal tear. Vaginal and anorectal palpation is essential to assess the extent of birth trauma. The surgical team must also include a specialist physician with the appropriate expertise (preferably an obstetrician or a gynecologist or a specialist for coloproctology) who must be on call. In exceptional cases, treatment may also be delayed for up to 12 hours postpartum to ensure that a specialist is available to treat the individual layers affected by trauma. As neither the end-to-end technique nor the overlapping technique have been found to offer better results for the management of tears of the external anal sphincter, the surgeon must use the method with which he/she is most familiar. Creation of a bowel stoma during primary management of a perineal tear is not indicated. Daily cleaning of the area under running water is recommended, particularly after bowel movements. Cleaning may be carried out either by rinsing or alternate cold and warm water douches. Therapy should also include the postoperative use of laxatives over a period of at least 2 weeks. The patient must be informed about the impact of the injury on subsequent births as well as the possibility of anal incontinence.

Fatigue is a very common side effect during intravenous chemotherapy. Unfortunately, only few effective therapeutic options are available, mostly based on daily activity. In our pilot trial we were able to demonstrate that intermittent fasting can reduce fatigue in healthy people, thus we aimed to assess the effects of the fasting dietary on quality of life during chemotherapy in patients with gynecological cancer, especially on the domain of fatigue. The IFAST trial is designed as a prospective, randomized-controlled, multi-center trial. Participation will be offered to women with gynecological cancers (breast cancer, ovarian cancer including peritoneal and fallopian tube cancers, endometrial cancer and cervical cancer) who are planned to receive intravenous chemotherapy for at least three months. Eligible patients will be randomized 1:1, stratified by tumor type and study center. Primary endpoint is the difference in mean change in fatigue, assessed with the Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT- FS©). Exploratory secondary endpoints will include general Quality of Life impairment, tolerance of chemotherapy, immunological changes, peripheral cell damage in blood cells, as well as tumor response to chemotherapy. There is new evidence that prolonged fasting periods of 46-96 hours during chemotherapy can positively influence the quality of life during chemotherapy. However, these fasting regiments are not feasible for many patients. Intermittent fasting could be a feasible (manageable) option for many patients to actively improve their quality of life and tolerance to chemotherapy and possibly even enhance the effectiveness of chemotherapy.Trial Registrationhttps://drks.de, identifier DRKS00031429.

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 fur Gynakologie und Geburtshilfe, DGGG) and the Working Group for Urogynecology and Plastic Pelvic Floor Reconstruction (Arbeitsgemeinschaft fur Urogynakologie 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.

Abstract 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 surgical treatment of female patients with stress urinary incontinence and urge incontinence. Specific solutions for the diagnostic workup and treatment of uncomplicated and complicated urinary incontinence are discussed. The diagnostics and surgical treatment of iatrogenic urogenital fistula are presented. Zusammenfassung Ziel Im Dezember 2021 erschien die völlig überarbeitete interdisziplinäre S2k-Leitlinie für die Diagnostik, Therapie und Nachsorge der Patientinnen mit einer Harninkontinenz (AWMF-Registernummer: 015-091) und fasst erstmals die früheren Leitlinien „Belastungsinkontinenz der Frau“, „Dranginkontinenz der Frau“ und die Leitlinie „Sonographie im Rahmen der urogynäkologischen Diagnostik“ zusammen. Die Koordination erfolgte durch die Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) und der Arbeitsgemeinschaft für Urogynäkologie und plastische Beckenbodenrekonstruktion e. V. (AGUB). Methoden Diese S2k-Leitlinie wurde durch einen strukturierten Konsens von repräsentativen Mitgliedern verschiedener Professionen im Auftrag der Leitlinienkommission der DGGG, OEGGG und SGGG entwickelt. Grundlage der vorliegenden Leitlinie ist die aktuelle Leitlinienversion „Urinary Incontinence in Adults“ der European Association of Urologie (EAU), zusätzlich wurden landesspezifische Punkte für das deutsche bzw. das österreichische und das Gesundheitswesen der Schweiz berücksichtigt. Empfehlungen Die Kurzversion dieser Leitlinie beinhaltet Empfehlungen und Statements zur operativen Therapie von Patientinnen mit einer Belastungsharninkontinenz und Dranginkontinenz. Spezifische Lösungsansätze für Diagnostik und Therapie werden für die unkomplizierte und komplizierte Harninkontinenz diskutiert. Ebenso werden Diagnostik und operative Therapie der iatrogen bedingten urogenitalen Fisteln ausgewiesen.

Die 59-jährige Patientin wurde uns aufgrund von rezidivierenden linksseitigen Unterbauchschmerzen seit etwa 3 Wochen,aktuellmitSchmerzexazerbation, zugewiesen. Zuvor war bei Verdacht auf eine Divertikulitis eine antibiotische Therapie durch den Hausarzt erfolgt, die jedoch nicht zu einer Beschwerdebesserung geführt hatte. Übelkeit, Erbrechen und Defäkationsprobleme bestanden nicht, ebenso wenig wie eine B-Symptomatik. GIII/PII, regelmäßige gynäkologische Vorsorge, bis auf eine arterielle Hypertonie und einen bekannten Uterus myomatosus keine Vorerkrankungen, keine Voroperationen. In der Familienanamnese fand sich ein Zervixkarzinom der Mutter.

FOG-DAGG-Online findet am 23. und 24. September dieses Jahres statt. Im Mittelpunkt des Kongresses stehen editierte und kommentierte Operationsvideos als exzellente Alternative zur Live Surgery. Das Forum operative Gynakologie besteht seit 20 Jahren, der Kongress findet zum 10. Mal statt. Vor dem Jubilaumskongress wenden sich die Veranstalter an die Teilnehmer.

Background The impact of comprehensive pelvic and para-aortic lymphadenectomy on survival in patients with stage I or II endometrial cancer with a high risk of recurrence is not reliably documented. The side effects of this procedure, including lymphedema and lymph cysts, are evident. Primary Objective Evaluation of the effect of comprehensive pelvic and para-aortic lymphadenectomy in the absence of bulky nodes on 5 year overall survival of patients with endometrial cancer (International Federation of Gynecology and Obstetrics (FIGO) stages I and II) and a high risk of recurrence. Study Hypothesis Comprehensive pelvic and paraaortic lymphadenectomy will increase 5 year overall survival from 75% (no lymphadenectomy) to 83%, corresponding to a hazard ratio of 0.65. Trial Design Open label, randomized, controlled trial. In arm A, a total hysterectomy plus bilateral salpingooophorectomy is performed. In arm B, in addition, a systematic pelvic and para-aortic lymphadenectomy up to the level of the left renal vein is performed. For all patients, vaginal brachytherapy and adjuvant chemotherapy (carboplatin/paclitaxel) are recommended. Major Inclusion Criteria Patients with histologically confirmed endometrial cancer stages pT1b-pT2, all histological subtypes, and pT1a endometrioid G3, serous, clear cell, or carcinosarcomas can be included when bulky nodes are absent. When hysterectomy has already been performed (eg, for presumed low risk endometrial cancer), study participation is also possible. Exclusion Criteria Patients with pT1a, G1 or 2 of type 1 histology or uterine sarcomas (except for carcinosarcomas), endometrial cancers of FIGO stage Ill or IV (except for microscopic lymph node metastases) or visual extrauterine disease. Primary Endpoint Overall survival calculated from the date of randomization until death. Sample Size 640 patients will be enrolled in the study. Estimated Dates for Completing Accrual and Presenting Results At present, 252 patients have been recruited. Based on this, accrual should be completed in 2025. Results should be presented in 2031.