Die Enzian – Klassifikation und ihre klinische Bedeutung

Der Medizinischen Fakultät

der Friedrich-Alexander-Universität

Erlangen-Nürnberg

zur

Erlangung des Doktorgrades Dr.med.

vorgelegt von

Dietmar Haas

Linz, Österreich

Als Dissertation genehmigt von der

Medizinischen Fakultät der Friedrich-Alexander-Universität

Erlangen-Nürnberg

Vorsitzender des Promotionsorgans: Prof. Dr. Dr. h.c. J. Schüttler

Gutachter: Prof. Dr. P. Oppelt

Gutachter: Prof. Dr. M.W. Beckmann

Tag der mündlichen Prüfung: 10. Dezember 2013

Inhaltsverzeichnis

1. Zusammenfassung Seite 1

2. Einleitung Seite 2

3. Veröffentlichung: „ACTA Obstetricia et Gynecologica Scandinavica“:

Enzian classification: does it correlate with clinical symptoms and the

rASRM score? Acta Obstet Gynecol Scand. 2013 May;92(5):562-6.

3.1.1. Abstract Seite 4

3.1.2. Introduction Seite 5

3.1.3. Material and methods Seite 6

3.1.4. Results Seite 7

3.1.5. Discussion Seite 11

3.1.6. Conclusion Seite 12

4. Literaturverzeichnis Seite 13

5. Abkürzungsverzeichnis Seite 14

6. Lebenslauf Seite 15

Zusammenfassung

Hintergrund und Ziele: Evaluierung von Korrelationen der Enzian –

Klassifikation mit dem rASRM – Score und klinischen Symptomen bei tief

infiltrierender Endometriose.

Methode: 194 Patientinnen wurden aufgrund von tief infiltrierender

Endometriose operiert. Nach histologischer Sicherung wurden diese nach

rASRM und Enzian klassifiziert. Klinische Symptome wurden präoperativ

erhoben. Es wurden Korrelationen zwischen der Enzian – Klassifikation und

sowohl dem rASRM – Score als auch den klinischen Symptomen berechnet.

Zur statistischen Berechnung wurden Spearman’s rank correlation,

Spearman's partial rank-order correlation, exact chi-square tests, Fisher’s

exact tests, point biserial correlation und generalized Cochran-Mantel-

Haenszel tests verwendet.

Ergebnisse: Es zeigt sich eine deutliche Korrelation zwischen den

Schweregraden des rASRM – Scores und der Enzian – Klassifikation

(p<0.001). Weiters korrelieren die rASRM Schweregrade und klinische

Symptome mit den Lokalisationen in der Enzian – Klassifikation im Sinne tief

infiltrierender Endometriose markant. Schmerz und Dysmenorrhoe korrelieren

stark (p=0,002; p<0,001) mit dem Schweregrad der Enzian – Klassifikation.

Schlussfolgerungen: Tief infiltrierende Endometriose kann anhand der

Enzian – Klassifikation ergänzend zum rASRM – Score gut dargestellt werden.

Anhand des morphologisch grenzüberschreitenden Charakters der Erkrankung

zwischen Enzian und rASRM gibt es auch eine deutliche Korrelation zwischen

den beiden Klassifikationen. Lokalisationen in der Enzian – Klassifikation

korrelieren zum Teil mit klinischen Symptomen und ihre Schweregrade

korrelieren substantiell mit Schmerz und Dysmenorrhoe. Aufgrund dieser

klinischen Ergebnisse und zur detailierteren Beschreibung der Endometriose

ist es empfehlenswert die Enzian – Klassifikation ergänzend zum rASRM –

Score zu verwenden.

Einleitung

Endometriose ist eine der häufigsten gutartigen Erkrankungen von Frauen im

gebärfähigen Alter. Man schätzt, dass 5-15% der Frauen im gebärfähigen Alter

davon betroffen sind. Um diese häufige Erkrankung international vergleichen

zu können und um sich über Therapie und Therapieerfolge austauschen zu

können, bedarf es einer gemeinsamen Sprache im Sinne einer Klassifikation.

Die Anforderungen an eine derartige Klassifikation stellen die morphologische

Beschreibung der Erkrankung und eine Simplizität in der Anwendung dar.

Zudem sollte sie empirisch und wissenschaftlich basieren und allgemeine

Anerkennung und Anwendung aufweisen.

1979 wurde von der American Fertility Society (AFS) der AFS – Score (3)

vorgestellt, welcher sich nach Revision 1985 (rAFS – Score) als weltweit meist

angewandtes Klassifikationssystem etablierte. 1996 wurde dieser in den

rASRM – Score (American Society for Reproductive Medicine) umbenannt.

Der rASRM – Score stellt per se einen tatsächlichen Score dar. In ihm werden

Endometrioseläsionen am Peritoneum und an den Ovarien entsprechend ihrer

Größe mit Punkten bewertet. Analog werden Punkte für Adhäsionen an den

Ovarien und den Tuben vergeben. Weiterhin gibt es Punkte für eine partielle

oder komplette posterior cul-de-sac obliteration. Schließlich werden sämtliche

Punkte addiert und in vier Schweregrade eingeteilt (Grad I – IV).

Als Nachteil des ASRM – Scores erwies sich eine limitierte Reproduzierbarkeit

des Stagings bei Befall der Ovarien und des posterior cul-de-sac. Weiters

zeigte sich nur eine schwache Korrelation zwischen der Ausdehnung der

Endometriose und dem Schmerz und Sterilität. Ebenso wird der Befall von

retroperitonealen Strukturen im Sinne einer tief infiltrierenden Endometriose

nicht berücksichtigt.

Aufgrund der fehlenden Beschreibung retroperitonealer Strukturen im Sinne

einer tief infiltrierenden Endometriose wurde 2005 die Enzian – Klassifikation

entwickelt. Diese verstand sich nicht als Konkurrenz zum rASRM – Score,

sondern als Ergänzung zu diesem im Beschreiben tief infiltrierender

Endometriose.

Als Probleme der Enzian – Klassifikation zeigten sich eine schlechte

internationale Akzeptanz, Komplexizität in der Anwendung und teilweise nicht

gewünschte Überlappungen mit dem rASRM – Score. Aus diesen Gründen

wurde die Enzian – Klassifikation 2010 und 2011 revidiert um die

Klassifizierung zur vereinfachen und zu optimieren.

In den Ländern Deutschland, Österreich, Schweiz und Süd-Tirol (Italien) gibt

es derzeit 47 Endometriosekompetenzzentren der Stufe I, II und III. Die Stufen

I – III (höchste) richten sich nach den Kriterien der Stiftung Endometriose

Forschung (SEF), welche die Zertifizierungen auch durchführt. Im Rahmen

dieser Zertifizierungen und Rezertifizierungen werden alle Kompetenzzentren

der Stufe III (n=20) verpflichtet, sowohl nach rASRM als auch nach Enzian zu

klassifizieren.

Diese Arbeit untersucht folgende Punkte:

1. Korreliert die Höhe des rASRM - Schweregrades (rASRM - Stadium)

mit der Höhe des höchsten Enzian – Schweregrades in den

Kompartimenten A, B und C?

2. Korreliert die Höhe des rASRM - Schweregrades (rASRM - Stadium)

mit der Höhe des höchsten Enzian - Schweregrades, wenn bei

letzterem zusätzlich die Anzahl der Läsionen berücksichtigt wird?

3. Korreliert die Höhe des rASRM - Schweregrades (rASRM - Stadium)

mit den Lokalisationen in der Enzian – Klassifikation (befallene

Kompartimente)?

Bisher gibt es keine Untersuchungen, ob es Korrelationen zwischen der

Enzian – Klassifikation und klinischen Symptomen gibt.

4. Korrelieren klinische Endometriosesymptome mit den Lokalisationen in

der Enzian – Klassifikation (befallene Kompartimente)?

5. Korrelieren klinische Endometriosesymptome mit der Höhe des

höchsten Enzian – Schweregrades in den Kompartimenten A, B und

C?

6. Korrelieren klinische Endometriosesymptome mit der Höhe des

höchsten Enzian -Schweregrades, wenn bei diesem zusätzlich die

Anzahl der Läsionen berücksichtigt wird?

Abstract

Objective: To assess the extent to which the Enzian classification correlates

with the revised American Society for Reproductive Medicine (rASRM) score

and clinical symptoms in patients with deeply infiltrating endometriosis.

Design: Retrospective cohort study (Canadian Task Force classification II-2).

Setting: Endometriosis competence center specializing in minimally invasive

surgery.

Patients: Between January 1st, 2009 and December 31st, 2011, a total of 194

patients underwent surgery due to deeply infiltrating endometriosis. After

histological confirmation, they were classified using the rASRM and Enzian

systems. Clinical symptoms were recorded preoperatively.

Interventions: Operative laparoscopy to treat endometriosis.

Main outcome measures and results: A clear correlation was seen between

grades of severity in the rASRM score and the Enzian classification

(P < 0.001). In addition, the rASRM severity grade and clinical symptoms

correlated strikingly with the locations in the Enzian classification in relation to

deeply infiltrating endometriosis. Pain and dysmenorrhea correlated strongly

(P = 0.002, P < 0.001) with the severity grade in the Enzian classification.

Conclusions: Deeply infiltrating endometriosis is well characterized using the

Enzian classification as a supplement to the rASRM score. There is also a

clear correlation between the rASRM and Enzian classifications, due to the

way in which the disease crosses morphological boundaries. The locations in

the Enzian classification correlate partially with clinical symptoms, and the

classification’s severity grades correlate substantially with pain and

dysmenorrhea. In view of these clinical results, use of the Enzian classification

can be recommended as a supplement to the rASRM score for detailed

description of endometriosis.

Introduction

Endometriosis is one of the most frequent benign diseases in women of child-

bearing age. It is estimated that 5–15% of women of childbearing age are

affected by it (9). A common terminology in the form of a classification system

is needed in order to be able to compare this frequent disease internationally

and exchange information about treatment and therapeutic success. A

classification of this type needs to provide a morphological description of the

disease and must be easy to use. In addition, it should have an empirical and

scientific basis and should be generally recognized and widely used (1).

The American Fertility Society (AFS) published the AFS score in 1979 (10);

following revision in 1985 (becoming the rAFS score) (11), it became

established as the most widely used classification system throughout the

world. In 1996, it was renamed as the revised American Society for

Reproductive Medicine (rASRM) score (2). The advantages and disadvantages

of the rASRM score have been discussed in the literature (6).

Due to the lack of description of retroperitoneal structures in cases of deeply

infiltrating endometriosis, the Enzian classification was developed in 2005 (12).

This was not intended to compete with the rASRM score, but to supplement it

for the description of deeply infiltrating endometriosis. Problems that emerged

with the Enzian classification were its poor level of international acceptance,

complexity of use, and unintended partial overlapping with the rASRM score

(4). For these reasons, the Enzian classification was revised in 2010 and 2011

in order to simplify and optimize it (6). In a subsequent study, it was shown that

the revised Enzian classification had resolved this problem (5).

The rASRM score and the supplementary Enzian classification for describing

deeply infiltrating endometriosis thus reflect different manifestations of

endometriosis. The present study therefore investigated whether the level of

the rASRM severity grade (the rASRM stage) correlates with the level of the

highest Enzian severity grade in compartments A, B, and C and whether the

level of the rASRM severity grade (the rASRM stage) correlates with the level

of the highest Enzian severity grade, if the latter also takes the number of

lesions into account. It also investigated whether the level of the rASRM

severity grade (the rASRM stage) correlates with the locations in the Enzian

classification (the involved compartments).

To date, there have not been any studies investigating whether there is any

correlation between the Enzian classification and clinical symptoms. The study

therefore investigated whether the clinical symptoms of endometriosis

correlate with the locations in the Enzian classification (involved

compartments) and wether the clinical symptoms of endometriosis correlate

with the level of the Enzian severity grades.

Material and methods

Approval from the local institutional ethics committee was obtained on June

14th, 2012 (ref. no. K-20-12). Between January 1st, 2009 and December 31st,

2011, a total of 194 patients were treated for deeply infiltrating endometriosis

at the General Hospital in Linz, Austria. Endometriosis was confirmed

histologically after laparoscopic surgery. All of the operations were carried out

by the same team of five surgeons, in which each surgeon had previously

carried out at least 200 laparoscopies. In addition, the patients were classified

using the rASRM and Enzian systems. For each case, there were two

observers to assign the scores.

The following clinical symptoms were noted preoperatively as prospectively

observed clinical complaints: infertility, general abdominal pain, premenstrual

lower abdominal pain, chronic lower abdominal pain, dysmenorrhea,

dyspareunia, hypermenorrhea, menometrorrhagia, bowel symptoms, and

bladder symptoms. Seven of the 194 patients could only be classified using the

Enzian score, as they only had uterine adenomyosis, which is not taken into

account in the rASRM score. Deeply infiltrating involvement in compartments

A, B, or C was not found in 14 of the 194 patients. For statistical analysis, there

were therefore three cohorts with different numbers of patients in each (n =

180, n = 187, and n = 194).

It should be noted that in the Enzian classification, a single lesion is

classified only once — i.e., it is assigned either to compartment A, B, or C.

When endometriosis is located on the margin between two intersecting

compartments, the lesion is assigned to the larger compartment affected by

endometriosis and not to both compartments. Multiple designations are only

made when several lesions are found in different locations — i.e., when

several compartments are affected. When several lesions are observed inside

a single compartment, only the larger lesion is taken into account for

classification purposes.

Statistical analysis

Spearman’s rank correlation coefficient (rs) was calculated for the rASRM and

Enzian severity grades. Spearman’s partial rank–order correlation coefficient

(rsp) was used for additional lesion adjustment. Correlations between affected

compartments and rASRM severity were calculated using exact chi-squared

tests; correlations between affected compartments and clinical endometriosis

symptoms were assessed using Fisher’s exact tests. Point biserial correlation

coefficients (rpb) were used to assess correlations between Enzian severity

grades and clinical endometriosis symptoms; generalized Cochran–Mantel–

Haenszel tests were used for additional lesion adjustment. All of the tests were

two-tailed, with a confidence level of 95% (P < 0.05). No adjustment for type I

error was made; the P values given are therefore only descriptive. The

statistics programs R and Bias version 10.0 were used for the calculations.

Results

The patients had a median rASRM stage of III (n = 187) and a median Enzian

severity grade in compartments A, B, and C of 1 (n = 180). On average, the

patients had 1.41 (SD ± 0.66) deeply infiltrating lesions (n = 194). The

distributions of the rASRM and Enzian severity grades are listed in Table 1.

Table 1. Revised American Society for Reproductive Medicine (rASRM)

Stages (n = 187) and Enzian Severity Grades in Compartments A, B, and C

(n = 180).

rASRM Stage n %

Enzian Grade

n %

I 22 11.8 I 94 52.2

II 41 21.9 II 51 28.3

III 36 19.3 III 35 19.4

IV 88 47.1

Total 187 100.0 Total 180 100.0

In the Enzian classification, deeply infiltrating lesions were noted in

compartment A (rectovaginal septum, vagina) in 57/194 patients (29.4%), in

compartment B (sacrouterine ligament to the pelvic wall) in 125/194 patients

(64.4%), and in compartment C (rectum, sigmoid colon) in 58/194 patients

(29.9%). Uterine adenomyosis (FA) was found in 18/194 patients (9.3%),

bladder involvement (FB) in 7/194 patients (3.6%), intestinal involvement (FI)

in 4/194 patients (2.1%), and intrinsic ureteral involvement (FU) in 5/194

patients (2.6%). Figure 1 shows the precise distribution pattern.

Figure 1. Distribution pattern of deeply infiltrating endometriosis in the

Enzian classification (n = patients).

The patients’ symptoms, in declining order of frequency, were: general

abdominal pain (67.5%), dysmenorrhea (47.4%), infertility (29.4%),

dyspareunia (29.4%), bowel symptoms (20.6%), chronic lower abdominal pain

(16.5%), premenstrual lower abdominal pain (9.8%), menometrorrhagia

(8.8%), bladder symptoms (8.2%), and hypermenorrhea (7.2%) (Fig. 2).

5

4

7

18

16

75

40

21

37

14

21

13

3

0 20 40 60 80 100 120 140

FU

FI

FB

FA

Compartment C

Compartment B

Compartment A

Grade 1 Grade 2 Grade 3

Figure 2. Symptoms (n = patients).

A striking correlation was seen between the level of the severity grades in

the rASRM score and the Enzian classification (rs = 0.555; P < 0.001). Even

when the number of lesions in the Enzian classification was taken into account,

there was a marked correlation between the severity grades in the two

systems (rsp = 0.484; P < 0.001).

Compartment A (rectovaginal septum, vagina) substantially correlated

(P = 0.002) with the rASRM score. In particular, there were strong correlations

with rASRM stage IV and in a negative direction with rASRM stage II. In

compartment B (sacrouterine ligament to the pelvic wall), there was also a

clear correlation with the rASRM score (P = 0.002). In detail, there were

correlations with rASRM stage II and in a negative direction with rASRM stage

III as well. Compartment C (rectum, sigmoid colon) correlated distinctly with

the rASRM sore (P < 0.001), with a very marked correlation with rASRM stage

IV. By contrast, the lower stages I and II showed negative correlations.

Uterine adenomyosis (FA, P = 0.313), bladder involvement (FB, P = 0.183),

intestinal involvement (FI, P = 0.696), and intrinsic ureteral involvement (FU,

P = 0.931) did not correlate significantly with the level of the rASRM score.

Infertility, dysmenorrhea, dyspareunia, menometrorrhagia, and

hypermenorrhea correlated clearly (P = 0.026, P = 0.027, P = 0.026,

131

92

57 57 40 32

19 17 16 14 0

20

40

60

80

100

120

140

P = 0.002, and P = 0.005, respectively) with uterine adenomyosis (FA).

General abdominal pain correlated distinctly with lesions in compartment A

(rectovaginal septum, vagina; P = 0.012) and with uterine adenomyosis (FA;

P = 0.002). Bowel symptoms correlated distinctly with compartment C (rectum,

sigmoid colon; P = 0.011). Premenstrual lower abdominal pain, chronic lower

abdominal pain, and bladder symptoms did not show a clear correlation with

any locations in the Enzian classification.

The maximum severity grade in compartments A, B, and C in the Enzian

classification correlated clearly with the symptoms of general abdominal pain,

dysmenorrhea, and bowel symptoms (Table 2). There was a distinct

correlation here between the level of the highest Enzian severity grade and the

symptoms of general abdominal pain (P = 0.012), dysmenorrhea (P < 0.001),

and bowel symptoms (P = 0.021).

Table 2. Correlation of the highest Enzian severity grade with clinical

symptoms.

Maximum Enzian severity grade

Premenstrual lower abdominal pain rPb –0.014

P 0.853

Infertility rPb 0.101

P 0.177

General abdominal pain rPb 0.233

P 0.002

Dysmenorrhea rPb 0.297

P <0.001

Hypermenorrhea rPb –0.090

P 0.231

Dyspareunia rPb 0.053

P 0.478

Menometrorrhagia rPb –0.018

P 0.811

Bowel symptoms rPb 0.231

P 0.002

Chronic lower abdominal pain rPb –0.112

P 0.135

Bladder symptoms rPb 0.021

P 0.781

Discussion

The results show a distinct correlation between the rASRM score and the

Enzian classification. The rASRM score and the Enzian classification describe

different manifestations of endometriosis, with the Enzian system providing a

supplementary classification of deeply infiltrating lesions. It is important that a

single lesion should not be duplicated in the two systems (4). Clearly, the ideal

was to determine the depth of infiltration by histological examination and

should at least reach 5 milimeters (7). Despite this, the results show that

endometriosis is not limited by the morphologically established boundaries in

the two classification systems. Instead, it appears generally as either high-

grade or low-grade, irrespective of such boundaries.

A clear correlation was observed between the rASRM severity grade and the

location of the lesion in the Enzian classification. The marked correlation

between compartment A (rectovaginal septum, vagina) and rASRM grade IV is

easily understandable clinically. Partial or total obliteration of the cul-de-sac is

often observed in this type of involvement, which is given a very high grade in

the rASRM system. The correlation between compartment B (sacrouterine

ligament to the pelvic wall) and rASRM score II and in a negative direction with

rASRM score III is also interesting. This type of involvement often reflects

solitary low-grade peritoneal lesions that nevertheless infiltrate deeply into the

sacrouterine ligament and cause the typical rectovaginally palpable nodes

there. The correlation between compartment C (rectum, sigmoid colon) and

rASRM grade IV is also frequently observed intraoperatively. When there is

bowel involvement, adhesions, peritoneal lesions, and partial or total

obliteration of the cul-de-sac are often found. Consistently with such findings,

bowel endometriosis is rarely seen with low rASRM stages.

In addition to the strong correlation between uterine adenomyosis and

various symptoms, there was also a clear correlation between pain and

involvement of compartment A (rectovaginal septum, vagina). Many of the

symptoms reported in uterine adenomyosis are already familiar from the

literature (3, 8). It is surprising, however, that compartment A only correlates

with pain, but not in any notable way with dyspareunia. In addition to uterine

adenomyosis, endometriotic involvement of the rectovaginal septum, vagina

(compartment A), and involvement of the sacrouterine ligament (compartment

B) are often found clinically as a reason for dyspareunia. However, this is not

reflected in the results. The correlation between bowel symptoms and bowel

involvement (compartment C) is hardly surprising, but no such correlation is

seen between bladder symptoms and involvement of the bladder (FB).

A clinically interesting and important finding is the substantial correlation that

appeared between the Enzian severity grade and symptoms of general pain,

dysmenorrhea, and bowel symptoms. These correlations with clinical

symptoms represent a major advantage of the Enzian classification.

Conclusions

Endometriosis becomes manifest with various types of involvement. Deeply

infiltrating endometriosis can be well described using the Enzian classification

as a supplement to the rASRM score. As it is in the nature of the disease to

cross morphological boundaries, there is also a clear correlation between the

two classifications. A major advantage of the Enzian classification lies in its

clinical value. The locations used in the Enzian classification correlate partly

with clinical symptoms, and its severity grades correlate substantially with pain.

In view of these results and the detailed description of endometriosis the

classification provides, use of the Enzian classification as a supplement to the

rASRM score can be recommended.

Literaturverzeichnis

1. Adamson GD. Endometriosis classification: an update. Curr Opin

Obstet Gynecol. 2011;23:213–20.1. Schweppe KW. [Endometriosis —

a disease that has no lobby]. Zentralbl Gynakol. 2003;125:233.

German.

2. American Society for Reproductive Medicine. Revised American

Society for Reproductive Medicine classification of endometriosis:

1996. Fertil Steril. 1997;67:817–21.

3. Garcia L, Isaacson K. Adenomyosis: review of the literature. J Minim

Invasive Gynecol. 2011;18:428–37.

4. Haas D, Chvatal R, Habelsberger A, Wurm P, Schimetta W, Oppelt P.

Comparison of revised American Fertility Society and ENZIAN staging:

a critical evaluation of classifications of endometriosis on the basis of

our patient population. Fertil Steril. 2011;95:1574–8.

5. Haas D, Wurm P, Shamiyeh A, Shebl O, Chvatal R, Oppelt P. Efficacy

of the revised Enzian classification: a retrospective analysis. Does the

revised Enzian classification solve the problem of duplicate

classification in rASRM and Enzian? Arch Gynecol Obstet. 2012; DOI:

10.1007/s00404-012-2647-1

6. Haas D, Shebl O, Shamiyeh A, Oppelt P. The rASRM score and the

Enzian classification for endometriosis: their strengths and

weaknesses. Acta Obstet Gynecol Scand. 2012;91:

DOI:10.1111/aogs.12026.

7. Koninckx PR, Martin DC. Deep endometriosis: a consequence of

infiltration or retraction or possibly adenomyosis externa? Fertil Steril.

1992 Nov;58(5):924-8.

8. Matalliotakis IM, Katsikis IK, Panidis DK. Adenomyosis: what is the

impact on fertility? Curr Opin Obstet Gynecol. 2005;17:261–4.

9. Schweppe KW. [Endometriosis — a disease that has no lobby].

Zentralbl Gynakol. 2003;125:233. German.

10. The American Fertility Society . Classification of endometriosis. Fertil

Steril. 1979;32:633–634

11. The American Fertility Society . Revised American Fertility Society

classification of endometriosis: 1985. Fertil Steril. 1985;43:351–352

12. Tuttlies F, Keckstein J, Ulrich U, Possover M, Schweppe KW, Wustlich

M, Buchweitz O, Greb R, Kandolf O, Mangold R, Masetti W, Neis K,

Rauter G, Reeka N, Richter O, Schindler AE, Sillem M, Terruhn V,

Tinneberg HR. [ENZIAN-score, a classification of deep infiltrating

endometriosis]. Zentralbl Gynakol. 2005;127:275–81. German.

Abkürzungsverzeichnis

AFS American Fertility Society

rAFS revised American Fertility Society

rASRM revised American Society for Reproductive Medicine

LEBENSLAUF

Name Dr. med. univ. Dietmar Haas

Anschrift Schubertstraße 40

A – 4020 Linz

Mobil: +43/650-5107473

E-mail dietmar.haas@gespag.at

Geburtsdatum 27. November 1973, Steyr

Familienstand verheiratet, zwei Kinder

Staatsbürgerschaft Österreich

Schulausbildung

1980 – 1984 Volksschule Mauthausen

1984 – 1992 Bischöfliches Gymnasium am Kollegium Petrinum in

Linz/Urfahr

Juni 1992 Matura

Studium

1992 – 1994 Studium WiTech (Wirtschaftsingenieurwesen Technische

Chemie) an der Johannes Kepler Universität Linz

1995 – 2005 Medizinstudium an der Karl Franzens Universität Graz

und Promotion

Famulatur

September 2003 Famulatur an der Inneren und Onkologischen Abteilung

der medizinischen Universitätsklinik Graz; Graz,

Österreich

März 2005 Famulatur an der Chirurgischen Abteilung des

Krankenhauses der Barmherzigen Brüder Graz; Graz,

Österreich

Juni 2005 Famulatur an der Internen Abteilung des Krankenhauses

der Barmherzigen Brüder Graz; Graz, Österreich

Juli 2005 Famulatur an der Allgemeinen Inneren und

Gastroenterologischen Abteilung der medizinischen

Universitätsklinik Graz; Österreich

August 2005 Famulatur an der Intensivstation (CCU) der

medizinischen Universitätsklinik Graz; Graz, Österreich

Berufspraxis

1999 – 2003 Selbständige Tätigkeit als Handelswarenpräsentator für

Medizinprodukte. Leitung von Mitarbeitern für Beratung

und Verkauf von Medizinprodukten.

September 2005 Ärztliche Tätigkeit und Weiterbildung in der

Tauchmedizin im Medical Center Kuramathi, Malediven

Leitung: Abteilung für Anästhesie der Universitätsklinik

Halle, Deutschland.

Jänner – März Turnusarzt im Krankenhause der Kreuzschwestern

2006 Sierning; Sierning, Östereich.

April 2006 - Turnusarzt im Allgemeinen Krankenhaus der Stadt Linz,

Jänner 2009 Linz, Österreich.

Seit Oktober 2008 Ausbildung zum Facharzt für Gynäkologie und

Geburtshilfe,

Abteilung für Gynäkologie und Geburtshilfe,

Allgemeines Krankenhaus der Stadt Linz, Österreich

Vorstand: Prim. Priv.-Doz. Dr. med. Peter Oppelt, MBA

Zusatzqualifikationen

Mai 2000 Teilnahme am 2 tägigen Management-Skills Seminar mit

Andreas Ackermann; Wien, Österreich.

2001 Pragmatische Diagnostik, Motivation und Therapie bei

Suchtkranken an der Psychiatrischen Abteilung der

medizinischen Universitätsklinik Graz; Graz, Österreich.

2004 – 2005 Vertiefte Ausbildung in der Notfallmedizin an der

medizinischen Universitätsklinik Graz, Graz, Österreich.

September 2005 Spezialausbildung für Tauchmedizin im Medical Center

Kuramathi, Malediven,

Leitung: Abteilung für Anästhesie der Universitätsklinik

Halle, Deutschland.

November 2006 Zertifikat Abdomen Sonographie Grundkurs

entsprechend der ÖGUM, LKH Hohenems; Hohenems,

Österreich.

Oktober 2007 bis Ärztekammer für Oberösterreich

Juni 2008 PSY 1 Diplom der ÖÄK: Psychosoziale Medizin

September 2008 Notarztdiplom der ÖÄK und ERC-ALS-Provider Diplom

2008 Absolvierung des Train the Trainer-Seminar zur

Schulung von Diabetes-Patienten, Ärztekammer für

Oberösterreich, Linz, Österreich.

November 2008 Bestandene Prüfung zum Arzt für Allgemeinmedizin und

Approbation für Allgemeinmedizin, Linz, Österreich

Dezember 2010 Ausbildung zum Qualitätsbeauftragten für

Gesundheitswesen

Allgemeines Krankenhaus der Stadt Linz, Österreich.

Dezember 2011 Zertifikat Grund-, Aufbau- und Abschlusskurs

Ultraschalldiagnostik nach den Richtlinien der KBV und

DEGUM, Charite Berlin, Berlin, Deutschland.

März 2012 Zertifikat Grundkurs Gynäkologische Endoskopie MIC I;

Allgemeines Krankenhaus der Stadt Linz, Österreich

Juli 2012 Zertifikat GCP – Kurs; Allgemeines Krankenhaus der

Stadt Linz, Österreich

Mitgliedschaften

OEGGG – Österreichische Gesellschaft für Gynäkologie und Geburtshilfe

DGGG - Deutsche Gesellschaft für Gynäkologie und Geburtshilfe

SEF – Stiftung Endometrioseforschung

EEL – Europäische Endometrioseliga