Karl-Werner Schweppe

• Universitätsmedizin Göttingen

Introduction After puberty, at least 10% of all women and girls suffer from endometriosis. Surgery is useful for both the diagnosis and therapy. To date, quality indicators for the surgical treatment of endometriosis are lacking. QS ENDO aims to record the quality of care provided in the DACH region and to introduce quality indicators for the diagn...

Introduction Endometriosis significantly reduces patientsʼ quality of life and is additionally a burden on healthcare and social security systems. There are currently no quality indicators for the treatment of endometriosis. The care of patients with endometriosis must be considered inadequate. QS ENDO aims to record the quality of care available i...

Objective: Two-dimensional (2D) transvaginal ultrasound (TVS) is an accessible and cost-effective diagnostic tool in the detection of adenomyosis. Different ultrasound features related to adenomyosis have been described, but the predictive value of each ultrasound sign and their combination requires further investigation. We analyzed the accuracy...

Training and education in diagnosis and therapy of endometriosis.

492 Fortbildung und Kongress í Aufgrund der Corona-Pandemie wird zunehmend die Befürchtung ge-äußert, dass die adäquate medizini-sche Versorgung eingeschränkt sein könnte. Die Stiftung Endometriose-Forschung (SEF) hat deshalb in Zu-sammenarbeit mit dem Deutschen IVF-Register die Situation von Frau-en mit Endometriose im Jahr 2020 untersucht, einem...

Aims The aim of this official guideline published and coordinated by the German Society of Gynaecology and Obstetrics (DGGG) in cooperation with the Austrian Society for Gynaecology and Obstetrics (OEGGG) and the Swiss Society for Gynaecology and Obstetrics (SGGG) was to provide consensus-based recommendations for the diagnosis and treatment of end...

Endometriosis is among the most frequent diseases of women during reproductive age. The disease itself but also its treatment significantly impairs quality of life. Top-level specialized centers have been established to ensure diagnosis and treatment. The certification process defined by Stiftung Endometriose-Forschung (SEF), European Endometriosis...

Advances in preoperative diagnostic as well as surgical techniques for the treatment of endometriosis, especially deep endometriosis call for a classification system that includes all aspects of the disease such as peritoneal, ovarian endometriosis and deep endometriosis and secondary adhesions. The widely accepted r‐ASRM classification has certain...

Endometriosis affects a significant number of young premenopausal women. Quite apart from the medical challenges, endometriosis is a relevant burden for healthcare and social security systems. Standardized quality indicators for the treatment of endometriosis have not previously been systematically verified. The three-stage study QS ENDO was initia...

Endometriosis represents nowadays a real burden for the patients as well as for the physicians, as it requires surgical and/or medical treatment, often long – termed and repeated. Moreover, the high costs necessary to diagnose and treat endometriosis represent a real economic burden, being comparable to other chronic diseases like diabetes or rheum...

Adenomyosis. Disease: Adenomyosis uteri (endometriosis genitalis interna) is defined by the presence of heterotopic glands of the zona basalis of the endometrium in the myometrium with a focal or homogeneous spread in the myometrium. In this proliferative, benign disease, as with endometriosis genitalis externa, presence of a local hyperestrogenism...

The implementation of a quality assurance program in endometriosis QS ENDO was initiated to evaluate the actual pattern of endometriosis care in German-speaking countries. After the first phase (QS ENDO Real) which will yield an overview of the current endometriosis care, phase II (QS ENDO Pilot) will be retrieving the actual care of the patients d...

Malignant degeneration of colon endometriosis is a very rare event. We report here on three cases. A 48-year-old woman with a 10-year history of endometriosis was treated for a rectal adenocarcinoma, a 61-year-old G1P1, who was operated at the age of 40 years for ovarian endometriosis and again at the age of 53 years for an endometriosis-associated...

Die Endometriose ist eine chronisch rezidivierende und systemische Erkrankung. Deshalb schützen weder medikamentöse noch operative Therapien vor Rezidiven. Wiederholte, intermittierende oder auch langdauernde medikamentöse Behandlungen sind oft notwendig. In deren Rahmen kommt es nicht nur auf die Wirksamkeit der jeweiligen Substanz hinsichtlich de...

This guideline has been developed based on studied and clinical investigations. Therefore, it appears to be appropriate to use all the available evidence, which are very encouraging, in a summarized form to propose guidelines by a group of European experts in order to give the gynecologists, obstetricians and reproductive medicine specialists have...

Auf dem Boden einer Endometriose können maligne Tumoren entstehen; dabei fallen etwa 80 % auf Ovarialkarzinome und etwa 20 % auf extragonadale Manifestationen. Diese maligne Transformation kann jedes Gewebe betreffen, in dem auch Endometriose vorkommt. Eine direkte Kanzerisierung benigner Endometriose über Atypien erscheint möglich. Histologisch ha...

In this guideline, recommendations and standards for optimum diagnosis and treatment of endometriosis are presented. They are based on the analysis of the available scientific evidence as published in prospective randomized and retrospective studies as well as in systematic reviews. The guideline working group consisted of experts from Austria, Ger...

3.1 Definition and epidemiology Statements: Endometriosis – one of the most common gynecologic diseases – is defined as the occurence of endometrium-like cell formations outside the uterine cavity. The cardinal symptom is chronic pelvic pain. Infertility is common. There are about 20 000 hospital admissions per year for endometriosis in Germany...

The idea of quality improvement in the management of endometriosis has been brought to attention throughout Europe. This - first and foremost - includes the implementation of centers specialized in treating endometriosis. This leads to qualification of both physicians and other medical staff, enforcement of research efforts, and informing the patie...

In the last few years, considerable progress has been made understanding endometriosis and developing diagnostic procedures and therapeutic options. Sophisticated endoscopic instruments allow laparoscopic surgery even in progressed stages and deep infiltrating endometriosis of the bowel and bladder. The introduction of GnRH analogues with add-back...

Einleitung: Die Differenzialdiagnose der weiblichen Unterbauchbeschwerden ist schwierig und erfordert oft interdisziplinare chirurgische, gynakologische, urologische sowie gastroenterologische Abklarung. Bei jungen Frauen konnen Erkrankungen des inneren Genitale Appendizitissymptome verursachen, wobei neben Salpingitis auch an Endometriose zu denke...

Basic research has improved our knowledge concerning molecular biology and genetics in endometriosis and epidemiologic data have shown the relevance of this disease. Never the less the aetiology is still unknown and the therapeutic options are not causal. For exact diagnosis laparoscopy and biopsy are necessary and endoscopic surgery is therefore t...

During the last years understanding endometriosis and the diagnostic procedures and therapeutic options have improved considerably. Sophisticated endoscopic instruments allow laparoscopic surgery even in progressed stages and deep infiltrating endometriosis of the bowel and bladder. The introduction of GnRH-Analogues with add-back medication and th...

Oral progestins without an estrogen component have been described to be effective in the treatment of endometriosis. Several different substances have been tested, which are on the one hand derivatives of the natural progesterone or of the C-17-OH-progesteron, or on the other hand derivatives of C-19-nortestosteron. Their common characteristic is t...

Endometriosis is a frequent and clinically relevant disease. It affects the quality of life and reduces the ability of work. Patient complaints are uncharacteristic, differential diagnosis is difficult and the therapeutic options are symptomatic—this is true for surgical procedures and medication as well. Quality improvement in the management of en...

Oral progestins have been reported to be effective in the treatment of endometriosis. The mode of action is still a matter of debate, but it may involve modulation of mitotic activity, local growth factors and growth factor receptors, as well as other paracrine mechanisms and anti-inflammatory reactions. Other treatments such as danazol and GnRH-ag...

Principles and Relevance of Sur- gery for Endometriosis. Usually endometrio- sis is diagnosed by invasive laparoscopy. It is reasonable to complete surgical removal of the disease and the adhesions during the same op- eration. Different types of endometriosis on the one hand (peritoneal disease, ovarian endome- trioma and deep infiltrating endometr...

Usually endometriosis is diagnosed by invasive laparoscopy. It is reasonable to complete surgical removal of the disease and the adhesions during the same operation. Different types of endometriosis on the one hand (peritoneal disease, ovarian endometrioma and deep infiltrating endometriosis) and different therapeutic goals on the other hand (pain...

Usually endometriosis is diagnosed by invasive laparoscopy. It is reasonable to complete surgical removal of the disease and the adhesions during the same operation. Different types of endometriosis on one hand (peritoneal disease, ovarian endometrioma and deep infiltrating endometriosis) and different therapeutic goals on the other hand (pain reli...

Besides the natural progestin, progesterone, there are different classes of progestins, such as retroprogesterone (i.e. dydrogesterone), progesterone derivatives (i.e. medrogestone) 17alpha-hydroxyprogesterone derivatives (i.e. chlormadinone acetate, cyproterone acetate, medroxyprogesterone acetate, megestrol acetate), 19-norprogesterone derivative...

The idea of quality improvement in the field of endometriosis has arrived in Europe. Different institutions and groups are working intensively towards the same goal using different and in some cases also identical approaches. The establishment of specialized endometriosis centres and the comprehensive qualification of physicians and medical staff a...

The diagnostic laparoscopy is the gold standard today to stage pelvic endometriosis and to prove it by biopsy and histology. Other diseases of the pelvic organs can be seen or excluded by differential diagnosis. Laparoscopic treatment of peritoneal implants is the treatment of choice, which is proven for pain and infertility with prospective random...

The introduction of the ENZIAN Score was indicated to classify especially the retroperitoneal endometriosis. Analog to oncological classifications four levels and three axis for localisation of the endometriosis were used. The ENZIAN Score was planned as a standalone extension of the well known rAFS Score (revised American Fertility and Sterility S...

Oral progestins, without an estrogen component, have been reported to be effective in the treatment of endometriosis, but not adenomyosis or myomas. The mode of action on the target tissue is still a matter of debate. Besides the importance of estrogens for the development and growth of endometriosis and myomas, progesterone seems to play an import...

Endometriose ist als Vorhandensein von endometrialem Gewebe (Drüsen und Stroma) außerhalb des Uteruskavums definiert.

The therapeutic management of endometriosis must focus the individual needs of the patient. Overtreatment - surgical or medical - has to be avoided, but relevant symptoms and pathological findings require sufficient strategies. First of all a complete diagnostic procedure is necessary, which includes laparoscopy, histological verification, judgemen...

We present our experience with diagnosing and treating 22 cases of urinary tract endometriosis in women of reproductive age. From January 2001 to January 2003, 22 women of reproductive age (mean age 34.8 years) were diagnosed suffering from endometriosis of the urinary tract. We used the Endoscopic Endometriosis Classification (EEC) for assessing t...

Zusammenfassung GnRH-Analoga sind gegenwärtig die effektivsten Medikamente zur Regression der Endometrioseherde und zur Reduktion der endometriosebedingten Beschwerden. Kombiniert mit einer niedrig dosierten so genannten Add-back-Medikation ist die Behandlung effektiv und nebenwirkungsarm. Die verschiedenen GnRH-Analoga, die in Deutschland auf dem...

The ENZIAN-Score is presented as a new instrument to classify the deep infiltrating endometriosis. Especially the retroperitoneal part of the severe endometriosis is focussed on. In analogy to an oncological staging four different stages are pronounced. The localisation and the expansion of the endometriosis nodule was indicated to different subgro...

Today GnRH-Analogues are the most effective substances for the regression of endometriosis and endometriosis related complaints. In combination with add-back medication the treatment is effective with only few tolerable side effects. The different types of GnRH-Analogues are equally effective, but depot preparation have the best compliance. The tai...

A comparison of the surgical and medical approach to endometriosis in Europe and the United States reveals similar management strategies for the disease. Although scientific data indicate that laparoscopy alone is not a reliable method of diagnosis, this technique continues to be used in 54% and 66% of cases in Europe and the United States, respect...

A comparison of the surgical and medical approach to endometriosis in Europe and the United States reveals similar management strategies for the disease. Although scientific data indicate that laparoscopy alone is not a reliable method of diagnosis, this technique continues to be used in 54% and 66% of cases in Europe and the United States, respect...

Die Endometriose wird invasiv durch Laparoskopie und bioptische Sicherung diagnostiziert, sodass es nahe liegt, dass sich die chirurgische Therapie in gleicher Narkose anschliet. Unterschiedliche Wachstumsformen der Endometriose einerseits und unterschiedliche mikroskopische und biochemische Charakteristika andererseits erfordern einen individuelle...

The medical treatment of endometriosis needs to be optimized. Therapeutic management strategies of endometriosis-associated pain or recurrent disease is primarily aimed at downregulating the ovarian function or at antagonizing the effect of estrogen in ectopic endometrial implants. In this context, basic research is delivering powerful tools for th...

Progestins are used for the treatment of endometriosis and endometriosis related complains in low dosages since more than four decades. Progestins induce incomplete regression of endometriotic implants only, they have a high recurrence rate, and they cause side effects--depending of the type of progestin and doses used--therefore GnRH-Agonist induc...

Endometriosis has a wide range of symptoms and no pathognomonic signs. Therefore differential diagnosis is difficult and delay of the correct diagnosis is common. In addition, there is no correlation between severity of symptoms and stage of the disease. In clinical routine, improvement can be achieved only, when endometriosis is considered as diff...

In vitro studies demonstrated that implantation on membranes (peritoneum, amniotic membranes) can take place if there are defects on the surface of the membranes. If these mechanisms play a role for the development of endometriosis in vivo, then patients with surgical treatment of peritoneal endometriosis in the luteal phase must have a high recurr...

Active proliferating implants in endometriosis cause pain by inducing biochemical and mechanical mechanisms. Medical and/or surgical treatment is indicated. Regressive and inactive foci induce no mechanisms which cause pain, therefore therapy is not necessary. In contrast, even in inactive endometriosis surgery can be beneficial when fibrosis and s...

Oral progestins have been used for the treatment of endometriosis and endometriosis-associated complaints for more than 40 years. The mechanism of action on the menstrual cycle is well understood; however, the mechanism of action on endometriosis is still a matter of debate. The different progestins are able to stop proliferation in endometriotic i...

Oral progestins have been used for the treatment of endometriosis and endometriosis-associated complaints for more than 40 years. The mechanism of action on the menstrual cycle is well understood; however, the mechanism of action on endometriosis is still a matter of debate. The different progestins are able to stop proliferation in endometriotic i...

Telepathology (TP) as a service in pathology at a distance is now widely used. It is integrated in the daily workflow of numerous pathologists. Meanwhile, in Germany 15 departments of pathology are using the telepathology technique for frozen section service; however, a common recognised quality standard in diagnostic accuracy is still missing. In...

The diversity of function that sex steroids have proven to have in the female body, gives them a position of central importance in gynaecology. Scientific research demonstrates not only the well known genital functions of sexual steroids, furthermore, various extragenital organs are influenced and modulated by ovarian hormones. Therefore, the gener...

Das natürliche Progesteron und seine Metaboliten haben neben den Östrogenen eine wesentliche Bedeutung für die physiologische Entwicklung und Funktion des Körpers sowie der Psyche der Frau. Ein Mangel an Progesteron führt zu einer Störung des Gleichgewichtes an den östrogenstimulierten Geweben, was letztendlich bis zur Karzinomentwicklung führen ka...

Die Endometriose gehört zu den häufigsten gynäkologischen gutartigen Erkrankungen. Sie wird ursächlich in Zusammenhang gebracht mit unklaren pelvinen Schmerzen und mit der Sterilität. Die heutige Stadieneinteilung der Endometriose erlaubt nicht die genaue Beurteilung der Aktivität dieser Erkrankung.

The diversity of function that sex steroids have proven to have in the female body, gives them a position of central importance in gynaecology. Scientific research demonstrates not only the well known genital functions of sexual steroids, furthermore, various extragenital organs are influenced and modulated by ovarian hormones. Therefore, the gener...

Myomas are the most frequent benign gynecological tumors and are responsible for several symptoms and complaints. Their etiology is unknown and their pathology and proliferation is poorly understood. Besides the importance of estrogens for development and growth of the myoma, progesterone seems to play an important role in the modulation of mitotic...

Endometriosis and infertility are frequently associated. There is controversy in the literature about the causal correlation. There is no doubt, that progressed disease causes infertility by mechanical disturbances of the reproductive organs. Mild and moderate endometriosis however is discussed to cause functional infertility by changes of the peri...

In the case of infertility the macroscopically and/or histologically confirmed diagnosis of endometriosis alone is not an indication for surgical or medical treatment of endometriosis. Treatment is necessary only when additional clinical symptoms of pain caused by the disease, active proliferative implants, severe mechanical disturbances of Fallopi...

Endometriosis and infertility are frequently associated. There is controversy in the literature about the causal correlation. There is no doubt, that progressed disease causes infertility by mechanical disturbances of the reproductive organs. Mild and moderate endometriosis however is discussed to cause functional infertility by changes of the peri...

With sensor-based demand-controlled ventilation (SBDCV), the rate of ventilation is modulated over time based on the signals from indoor air pollutant or occupancy sensors. SBDCV offers two potential advantages: better control of indoor pollutant concentrations, and lower energy use and peak energy demand. Based on theoretical considerations and on...

The association patterns between maternal anthropometric characteristics (stature, prepregnancy weight, prepregnancy body mass index, pregnancy weight gain) and newborn size (birth weight, length, head circumference) were tested with 10,240 single births taking place between 1985 and 1995 in Vienna, Austria, and 3,452 single births taking place bet...

On 9-11 May 1997, the second Meeting of the European Progestin Club was held in Turin, Italy. Aspects of progestin use on the breast were discussed, based on the currently available scientific data. The paper covers topics addressed at the meeting and summarizes the recommendations which could be agreed on by the participants.

The term "mastopathy" has yet to receive a common accepted definition. 70% of all mastopathies do not demonstrate, morphologically speaking, a proliferation, where as less than 10% show an atypical proliferation that suggests an increased risk for cancer development. The indication for the treatment of a mastopathy without proliferative processes i...

Endometriosis is a chronic benign proliferative disease with high risk of recurrences, despite of medical and/or surgical treatment. The variation and severity of symptoms reduce the quality of life, the ability of working and the sexual behaviour. Medical cure of symptoms is a central concept in the therapeutic strategy. Low dose progestins have s...

Funktionsstörungen der Harnblase sind dadurch gekennzeichnet, daß sich die Harnblase entweder unkontrolliert entleert oder ein unzeitiger, teilweise schmerzhafter Harndrang auftritt. Nur durch den Einsatz der Willkürkontrolle wird die Kontinenz aufrechterhalten (Schwenzer 1992). Klinisch wird zwischen Drangsymptomatik und Dranginkontinenz unterschi...

Add-back hormone replacement therapy has been shown to alleviate some of the hypo-oestrogenic side effects associated with gonadotrophin-releasing hormone agonists, including demineralisation of bone. Studies on patients with uterine fibroids have shown that concomitant add-back therapy reduced the efficacy of these agents, but that deferred admini...

Patients with endometriosis significantly develop autoantibodies directed against endometrial proteins, which may be involved in the aetiology of this gynaecological disease. Based on standard Western blot analysis, a 48 kDa protein was localized in the soluble protein extract of endometrial adenocarcinoma cells using sera from patients with clinic...