As colorectal surgeons, we are regularly concerned with pathomorphological disorders of the female pelvic organs, the pelvic floor and its sphincter systems; therefore, we consider it important to highlight aspects of the topic which were only mentioned in passing in the article, if at all. Unfortunately, the article’s title is somewhat misleading (1). We have the impression that the article only deals with the investigation and treatment of urinary incontinence and pelvic organ prolapse. However, many patients experience not only urinary incontinence but a combination of urinary and fecal incontinence, with some suffering only from fecal incontinence. Many epidemiological studies are available on this topic, but these are not mentioned in the article.
With regard to the evaluation of pelvic floor dysfunction (Box 2), the basic evaluation is carried out by a “general practitioner, gynecologist, or urologist”, according to the article. For the extended basic evaluation, it suffices if it is carried out by a “gynecologist or urologist (with the aid of a psychiatrist and/ or specialist in psychosomatic medicine, if indicated)”. Only at the level of special tests, the article requires a “specialist (perhaps at a specialized continence and pelvic floor center”. At the end of the list, we find “endoanal intrasonography, if indicated, and dynamic magnetic resonance defecography, if indicated“.
A more differentiated approach to pelvic and pelvic floor dysfunctions has long been followed in many offices and hospitals (gynecology, urology and proctology) all over Germany—not only in specialized continence and pelvic floor centers. Interdisciplinary collaboration between the specialties, including colorectal surgery, is the only way to ensure that all aspects of the investigation and treatment of female pelvic floor dysfunction are covered in a way that fulfils today’s quality requirements.
Dr. med. Johannes Jongen
Prof. Dr. med. Volker Kahlke
Proktologische Praxis, Kiel, Abteilung Proktologische Chirurgie, Park-Klinik, Kiel, Germany
Prof. Dr. med. Hendrik Schimmelpenning
Klinik für Chirurgie, Fachzentrum Viszeralchirurgie, Koloproktologie, Gefäß- und Unfallchirurgie, Schön Klinik Neustadt, Germany
Conflict of interest statement
The authors declare that no conflict of interest exists.
|1.||Jundt K, Peschers U, Kentenich H: The investigation and treatment of female pelvic floor dysfunction. Dtsch Arztebl Int 2015; 112: 564–74 VOLLTEXT|