[Analysis of subjective effect, acceptance and costs of conservative treatment of prolapse and incontinence in women].
A renaissance of conservative treatment for urinary incontinence and descensus is taking place presently in the German speaking area for pre-surgical improvement of tissue quality as well as for long-term-treatment replacing or postponing surgery. Modern pessaries (shape and material), a more intense and pathophysiological well-founded physiotherapy as well as the support of treatment by electrostimulation and its completion by adequate hormone substitution lead to a successful conservative treatment. "Gesundheitsstrukturreform" (reformatory measures of the German Public Health System), "Fallpauschalen" (flat-rate tariff of treatment by the case) and "Praxisbudgets" (budgets for out-clinic-treatment by the case, also a form of flat-rate tariff) lead to a restriction in prescribing necessary conservative treatment or preventive measures. Assigning the patient to surgical treatment is therefore in large parts favoured (treatment costs are then charged to clinic budgets). On the basis of the presented exemplary cost analysis completed by data on subjective effectiveness, acceptance and evaluation of efforts for patient and doctor we want to show that it is not either method that has to be considered in the treatment but both. Besides we have to treat the patient sequentially-conservative treatment in most cases first, especially in younger women. Conservative treatment thereby offers the possibility to delay or postpone surgery, a very meaningful option offered regarding the relatively poor results of surgery especially in cases of recurrent disease.
Fischer
A
A
Frauenklinik des St. Josefs-Hospitals, Wiesbaden.
Wolz
B
B
Hoffmann
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D004599:Electric Stimulation Therapy / Q000191:economics; D015914:Estrogen Replacement Therapy / Q000191:economics; D005260:Female; D005858:Germany; D006801:Humans; D008875:Middle Aged; D010570:Pessaries / Q000191:economics; D026741:Physical Therapy Modalities / Q000191:economics; D014549:Urinary Incontinence / Q000191:economics / Q000628:therapy*; D014596:Uterine Prolapse / Q000191:economics / Q000628:therapy*