The committees in this chapter will focus on conservative management of Pelvic Organ Prolapse (POP). This will include topics on pessary management, physical therapy (PFMT, biofeedback), and weight loss/lifestyle modifications/mind body therapy (central desensitization).

The paper on Pelvic Floor Muscle Training (Physiotherapy, Biofeedback) has published in the IUJ online.  Click the chapter heading below to view the article.

Committees

1. Pessary Management
This committee will review the published literature regarding the use of pessaries for the treatment of pelvic organ prolapse (not stress urinary incontinence or other pelvic floor disorders). The review will encompass:

• patient populations to whom pessaries are offered
• benefits and complications / risks in the short and long-term
• data regarding pessary choices and factors guiding those choices
• maintenance patterns (self-maintenance and maintenance in concert with health professionals)
• skills and competencies for providers fitting and maintaining pessaries
• guidelines for pessary management from professional organization

Steering Committee Advisor
Heidi Brown (USA)
Committee Chair
Angela Rantell (UK)          
Committee Members
Zeelha Abdool (South Africa)
Morgan Fullerton (USA)
Abel Gedefaw (Ethiopia)
Kate Lough (UK)
Paweł Miotła (Poland)
Narmin Mukhtarova (USA)
Patricia Neumann (Australia)
Jordan Spencer (USA)

2. Pelvic Floor Muscle Training (Physiotherapy, Biofeedback)
This committee evaluated the mechanisms and evidence for pelvic floor muscle training in prevention and treatment of pelvic organ prolapse (POP) separated into anatomic (POP-Q stage) and symptomatic POP. Furthermore, the evidence for pelvic floor muscle training in conjunction with prolapse surgery was explored. Evidence from randomized controlled trials only was reviewed. The report details the pelvic floor muscle training protocols used and aims to make recommendations for effective pelvic floor muscle training in treatment of POP.

Steering Committee Advisor
Chantal Dumoulin (Canada)
Committee Chair
Kari Bo (Norway)
Committee Members
Cristine Homsi Jorge Ferreira (Brazil)
Jennifer Kruger (New Zealand)
Achla Batra (India)
Yi Ling Chan (UK)
Ingeborg Brækken (Norway)
Manisha Yadav (Nepal)
Sonia Angles (Spain)

3. Weight loss/lifestyle modifications/Mind body therapy (central desensitization)
This committee will explore the impact of lifestyle changes on the prevention and treatment of pelvic organ prolapse. This chapter will focus on 1) the impact of lifestyle factors on the mechanics associated with preventing and developing pelvic organ prolapse, 2) the effects of lifestyle modifications on symptom severity and objective physical exam finding, and 3) the data regarding postoperative duration and efficacy of lifestyle modifications/restrictions following prolapse surgery.  

Steering Committee Advisor
Sarah Collins (USA)
Committee Co- Chairs
Vivian Sung (USA)  
Peter Jeppson (USA)
Committee Members  
Lori Forner (Australia)
Jenny Thompson (USA)
Thomas Wheeler (USA)
Delena Caagbay (Australia)
Tyler Muffly (USA)
Isuzu Meyer (USA)
Sunil Balgobin (USA)

Timeline

The duration of the commitment is 3 years. The committees will be formed in August-September 2020 and will begin working together shortly thereafter.

Each committee will be invited to meet in person at the 2021 IUGA Annual Meeting in Singapore. A private meeting room will be provided for a half day (4 hours) to finalize the scope of the report. After scope of the report is finalized, each committee will present their ideas to the attendees of the IUGA Annual Meeting at a dedicated consultation session. Each committee will have 10 minutes to present their ideas followed by 5 minutes of questions and discussion with the audience.

After the consultation sessions at the IUGA Annual Meeting in 2021, the committee will have 12 months to finalize their recommendations and write the manuscript. This final work may be presented by the committee at the IUGA Annual Meeting in Austin, TX, USA in 2022. Immediately following the Annual Meeting, the final manuscript will be submitted to the IUJ in 2022 with the aim to be published in the beginning of 2023.

Expectations

• The manuscripts will be developed using a collaborative process that requires regular communication email, periodic conference calls, and completion of assignments. Although many communications will be by email, Committee Chairs and Members are required to participate in teleconferences and in-person meetings.
• Committee Members will thoroughly research their topic or sub-topic, as specified by chair.
• Committee Members commit to produce and deliver all completed assignments and required information before the specified and agreed upon deadlines.
• Committee Chairs and Members will disclose all potential Conflicts of Interest. To see the IUGA Conflict of Interest policy, please click here.

• To see Committee Member Terms of Reference, please click here.

The committee, Committee Chair, and Committee Members are expected to meet all deadlines unless there are extenuating circumstances. In those cases, the Committee Chair is required to notify of their Steering Committee Member, Steering Committee Chairs and the IUGA Office before the missed deadline or as soon as is possible following the deadline. Any Committee Chair or Committee Member that does not meet these requirements, is unresponsive to more than 4 consecutive emails, or does not remain in regular contact with the Steering Committee and IUGA Office will be promptly replaced.

We are excited to begin the fourth chapter of the International Urogynecological Consultation (IUC). The committees in this chapter will focus on the surgical treatment of the patient with pelvic organ prolapse. This will include topics on: Definition of outcomes for POP surgery; Resolution of associated pelvic floor symptoms with surgical correction of POP (pain, GI, GU and sexual function); Management of complications of POP surgery (both mesh and native tissue repairs); Financial costs of POP surgery,  and New proposed treatments for POP (tissue engineering, stem cell, laser etc).  
IUC Chapter 4 consists of 5 subcommittees:

 Committees

1. Definition of Outcomes for POP Surgery (success, failure, improvement, complications, PRO, QOL, etc.)  
Download the publication of this chapter, published in the International Urogynecology Journal on October 11, 2023
Currently the definitions for outcomes of pelvic organ prolapse (POP) surgery are many and difficult to disentangle from one another. Successful outcome definitions range from purely anatomic endpoints to subjective patient reported outcomes to the need for subsequent treatment for complications to retreatment for recurrent POP. This makes it difficult to compare surgical procedures as there are no universally accepted outcome measure or measures to define surgical success, graded success, or failure. This chapter will look at the literature to determine which measure(s) of success of surgery to correct POP are relevant. It will take into consideration the definition of POP from chapter 1.1 of the International Urogynecology Consultation on the definition of POP. It will then review the literature and make recommendations for outcome measures to define surgical success or failure in the following areas: clinical practice, research protocols, and population based outcomes for surgical treatment of POP. 
Steering Committee Advisor
Rebecca Rogers (USA)   
Committee Chair
Fred Milani (The Netherlands)
Members
Matthew Barber (USA)
Philip Toozs-Hobson (UK)
Mokrane Medjtoh (Algeria)
Magdalena Emilia Grzybowska (Poland)
Joseph Kowalski (USA)
Wenche Klerkx (The Netherlands)

2. Resolution of Associated Pelvic Floor Symptoms with Surgical Correction of POP (pain, GI, GU and sexual function).  
There are many pelvic floor symptoms that accompany pelvic organ prolapse (POP). They range from urinary tract dysfunction to gastrointestinal tract dysfunction to sexual dysfunction to lower abdominal/pelvic pain. In Chatper 1.5, Relationship of Pelvic Organ Prolapse to Associated Pelvic Floor Dysfunction Symptoms: Lower Urinary Tract, Bowel, Sexual Dysfunction and Abdominopelvic Pain, only pelvic pain and obstructive voiding were significantly related to the presence of POP. Despite this, there is a large body of literature on the resolution of these other symptoms following the surgical repair of POP. This chapter will review the literature to determine how surgical correction of POP affects lower urinary tract dysfunction/function, gastrointestinal function/dysfunction, sexual function/dysfunction,and abdominopelvic pain. This will provide a summary of the literature to help clinicians properly counsel patients regarding anticipated outcomes of associated pelvic floor symptoms and will catalogue what is known and where the literature is lacking to help direct future research.
Steering Committee Advisor
Lynsey Hayward (New Zealand)
Committee Chair
Robert (Bob) Freeman (UK) 
Members
Monika Vij (UK)
Huub Van der Vaart (The Netherlands)
Anne Coolen (New Zealand)
Markus Huebner (Germany)
Monique Hiersoux Vaughan (USA)
Gabriel Ganyaglo (Ghana)
Jittima Manonai (Thailand)
Sivakumar Balakrishnan (Malaysia)
Roxana Geoffrion (Canada)

3. Management of Complications of POP Surgery (both mesh and native tissue repairs)
The complications that can arise from surgery to correct pelvic organ prolapse (POP) are manifold and often only briefly described with case series. However, there are no large reviews to discuss the myriad of recommendations on how to best manage these and provide some comparative information for clinicians or researchers. This chapter will review the incidence of complication from various POP surgical procedures and describe the various recommendations for management, and when possible provide recommendations based on comparative research. Techniques to avoid certain complications will also be reviewed and presented.
Steering Committee Advisor
Sarah Collins (USA)
Committee Chair
Peter Rosenblatt (USA)
Members
Melinda Abernethy (USA)
Eduardo Bataller (Spain)
Alka Bhide (UK)
Patrick Culligan (USA)
Elise De (USA)
Ana Belén Muñoz Menéndez (Spain)
Tsung Mou (USA)
Rahel Nardos (USA)
Eleonora Russo (Italy)
Charles Rardin  (USA)
Danielle Carr (USA)

4. Financial Costs of POP Surgery 
Surgery to correct pelvic organ prolapse (POP) can range in complexity from simple transvaginal procedures to robotic-assisted endoscopic procedures. The costs to both patients and society are often not well described but should be part of any discussion on the risk/benefits analysis of a given procedure and how it compares to other procedures recommended for treating similar conditions.

Steering Committee Advisor
TS Lo (Taiwan)
Committee Chair
Dudley Robinson (United Kingdom)
Members
Bahiyah Abdullah (Maylasia)
Sandy Pei-Ying Wu (Taiwan)
Amy Liao Askew (UK)
Mittal Patel (UK)
Lisa Prodigalidad (Philipinnes)
Luiz Brito (Brazil)
Javier Pizarro-Berdichevsky (Brazil)
Anna Karoline Lopes Rocha (Chili)
Carlos Delroy (Brazil)

5. New Proposed Treatments for POP (tissue engineering, stem cell, laser etc)
The removal of low weight transvaginal polypropylene mesh kits from many marketplaces has left a void in how to surgically manage some patients. There are newer hybrid grafts and other technology that will fill this void in the surgical management of POP. This section will review the current literature on new technologies to bring the membership up to date on what is being investigated and identify any new areas of technology that show promise.

Steering Committee Advisor
Maria Bortolini (Brazil)
Committee Chair
Marianna Alperin (USA)
Members
Caroline Gargett (Australia)
Julie Suyama (USA)
Carolyn Swenson (USA)
Cassandra Kisby  (USA)
Cheryl Iglesia (USA)
Valentin Manriquez (Chili)
Srikala Prasad (India)
Svjetlana Lozo (USA)

Timeline

The duration of the commitment is 3 years.  Each committee will have a regular (monthly) meetings to secure the progress of each Committee Chapter.  Each committee will be invited to meet in person and to present their proposed scope at the IUGA/AUGS Annual Meeting in Austin, TX, USA in June 2022. After the scope of the report is finalized, the committee will have 12 months to finalize their recommendations and write the manuscript. This final work may be presented by the committee at the IUGA Annual Meeting in The Hague, The Netherlands 2023. Immediately following the Annual Meeting, the final manuscript will be submitted to the IUJ in 2023 with the aim to be published in the beginning of 2024.

Expectations

• The manuscripts will be developed using a collaborative process that requires regular communication via email, periodic conference calls, and completion of assignments. Although many communications will be by email, Committee Chairs and Members are required to participate in teleconferences and in-person meetings.
• Committee Members will thoroughly research their topic or sub-topic, as specified by chair.
• Committee Members commit to produce and deliver all completed assignments and required information before the specified and agreed upon deadlines.
• Committee Chairs and Members must disclose all potential Conflicts of Interest. To see the IUGA Conflict of Interest policy, please click here.
• To see the Committee Member Terms of Reference, please click here.

The committee, Committee Chair, and Committee Members are expected to meet all deadlines unless there are extenuating circumstances. In those cases, the Committee Chair is required to notify their Steering Committee Member, Steering Committee Chairs and the IUGA Office before the missed deadline or as soon as possible following the deadline. Any Committee Chair or Committee Member who does not meet these requirements, is unresponsive to more than 4 consecutive emails, or does not remain in regular contact with the Steering Committee and IUGA Office, will be promptly replaced.

The committees will focus on clinical evaluation. It will include using and developing disease specific quality of life measures, radiologic evaluation of POP and identifying co-disease such as urinary incontinence, fecal incontinence, sexual dysfunction and pelvic pain.

The paper on Quality of life questionnaires has published in the IUJ online.  Click the chapter heading below to view the article.

Committees

1. Quality of life questionnaires
   Download the publication of this chapter, published in the International Urogynecology Journal on August 18, 2022

   This committee evaluated those health related quality of life (HRQoL) questionnaires that have been developed specifically for patients with pelvic organ prolapse. This includes evaluating the validity and reliability of this family of HRQoL questionnaires with an aim toward recommending which tools have clinical versus research value and the strength behind these recommendations. This committee also evaluated which HRQol questionnaires have been translated into other languages and the rigor of this translation process to make recommendations on which tools can be reliably used in which languages.  Final recommendations on how to use these tools in; 1). clinical practice to aid clinicians with identify those patients with clinically significant pelvic organ prolapse and 2). research applications for both epidemiology studies and therapeutic trials.

   Steering Committee Advisor
   Maria Bortolini (Brazil)
   
   Committee Chair
   Rebecca Rogers (USA)             
   
   Committee Members
   Mageed Abdelrahman (United Kingdom)
   Ahmed Al-Badr (Saudi Arabia)
   Sara Cichowski (USA)
   Montserrat Espuña (Spain)
   Magdalena Grzybowska (Poland)
   Gabriela Halder (USA)
   Sierra Jansen (USA)
   Swati Jha (United Kingdom)
   Daniela Ulrich (Austria)
   
   

2. Radiologic evaluation
   

   This committee will evaluate the literature on the use of radiologic investigation into the clinical investigation of pelvic organ prolapse. This will include evaluating how radiographic studies can aid in the diagnostic evaluation of pelvic organ prolapse and in understanding mechanisms of disease and prognosis. The committee with confine search and recommendations to the body of literature evaluating pelvic organ prolapse and will not evaluate those radiographic studies evaluating co-morbid conditions (ie urinary retention and hydronephrosis, evacuation disorders, or fecal or urinary incontinence). The overall aim of this committee will be to make recommendations as to which radiographic studies can aid the clinician in the clinical evaluation of the patient with pelvic organ prolapse and which radiographic investigations remain in the realm of research related activities. 

   Steering Committee Advisor
   Lynsey Hayward (New Zealand)
   
   Committee Chair
   Lieschen Quiroz (USA)   
   
   Committee Members
   Megan Bradley (USA)
   Rachel Cheung (Hong Kong)
   Ankita Sundeep Gupta (USA)
   Sharif Ismail (United Kingdom)
   Roopali Karmarkar (United Kingdom)
   Vikram (Vik) Khullar (United Kingdom)
   Lioudmila Lipetskaia (USA)
   Ghazaleh Rostaminia (USA)

3. Clinical evaluation to include investigations into associated Morbidity/Pelvic floor dysfunction (Potential incontinence, urinary retention/voiding dysfunction, sexual dysfunction, pelvic pain and GI abnormalities)
   Download the publication of this chapter, published in the International Urogynecology Journal on September 22, 2023
   This committee will evaluate the literature on the clinical evaluation of the patients with pelvic organ prolapse. This will include how to use the physical exam to describe pelvic organ support or prolapse, associated testing to evaluate for comorbid conditions. Evaluation of the methods currently available to assess for comorbid urinary tract and gastrointestinal tract dysfunction will be covered by this committee. The aim of this committee will be to establish the physical exam components and associated testing which make up the basic evaluation of the patient with isolated complaints of pelvic organ prolapse. This committee with not cover the primary evaluation of associated complaints, such as urinary incontinence or fecal incontinence, in subjects with pelvic organ prolapse unless these evaluations are different and unique in subjects with co-existing pelvic organ prolapse.
   Steering Committee Advisor
   Bob Freeman (United Kingdom)
   Committee Chair
   Anna Rosamilia (Australia)   
   
   Committee Members   
   Heather Barbier (USA)
   Cassandra Carberry (USA)
   Paivi Karjalainen (Finland)
   Charlotte Mahoney (United Kingdom)
   Valentín Manríquez Galán (Chile)
   Esther Ruess (South Africa)
   David Shaker (Australia)
   Karishma Thariani (India)

Timeline

The duration of the commitment is 3 years. The committees are have begun working together.  Each committee presented their ideas to the attendees of the IUGA Virtual 45th Annual Meeting during the dedicated consultation session.

The committees have 12 months to finalize their recommendations and write the manuscript. This final work may be presented by the committee at the IUGA Annual Meeting in Singapore in 2021. Immediately following the Annual Meeting, the final manuscript will be submitted to the IUJ in 2021 with the aim to be published in the beginning of 2022.

Expectations

• The manuscripts will be developed using a collaborative process that requires regular communication email, periodic conference calls, and completion of assignments. Although many communications will be by email, Committee Chairs and Members are required to participate in teleconferences and in-person meetings.
• Committee Members will thoroughly research their topic or sub-topic, as specified by chair.
• Committee Members commit to produce and deliver all completed assignments and required information before the specified and agreed upon deadlines.
• Committee Chairs and Members will disclose all potential Conflicts of Interest. To see the IUGA Conflict of Interest policy, please click here.

The committee, Committee Chair, and Committee Members are expected to meet all deadlines unless there are extenuating circumstances. In those cases, the Committee Chair is required to notify of their Steering Committee Member, Steering Committee Chairs and the IUGA Office before the missed deadline or as soon as is possible following the deadline. Any Committee Chair or Committee Member that does not meet these requirements, is unresponsive to more than 4 consecutive emails, or does not remain in regular contact with the Steering Committee and IUGA Office will be promptly replaced.

Experience

• Committee Members must have completed training at the Masters, MD, and/or or PhD level
• Committee Members must be an expert in the topic of their respective committee.

Chapter 1 has been completed and published in the IUJ with articles that include the Clinical Definition of POP; the Epidemiology (Incidence/Prevalence and Natural History); the Pathophysiology including Risk Factors, Family History, Genetic Mutations; the Patients' Perception of Disease Burden of POP and the Relationship to Associated Morbidity/Pelvic Floor Dysfunction (Urinary Incontinence/Voiding Dysfunction, Fecal Incontinence, Sexual Dysfunction and Pelvic Pain).

• Are you an IUGA Member? Click below on each Chapter heading to view the articles.
• Are you not an IUGA Member? Please submit your name and email address to us and you will receive a personal email to view the publications.

Introduction to the International Urogynecological Consultation: the new IUGA educational project

Committees

1. Clinical Definition of POP
This will be the first report for this section and will set the tone for this entire report. Defining the disease and how symptoms and physical exam findings play a role in an accurate definition of the disease state of pelvic organ prolapse. This committee should seek to develop a clinically useful definition of this disease based on what is known about normal support vs abnormal support and how the interaction of physical exam findings relates to pelvic organ prolapse specific symptoms.

Steering Committee Advisor : TS Lo (Taiwan)
Committee Chair: Kimberly Kenton (USA)
Committee Members: Tiffany Chih (USA) / Sarah Collins (USA) / Kim van Delft (The Netherlands) / Nicola Dykes (New Zealand) / Autumn Edenfield (USA) / Michele O'Shea (USA) / Olga Ramm (USA) / Clara Shek (Australia)

2. Epidemiology of Pelvic Organ Prolapse: Incidence/Prevalence, Natural History
This report will discuss how the mechanisms of vaginal birth and age predispose women to develop pelvic organ prolapse. The impact of pregnancy, the mechanics of the delivery process and enzymatic and protein alterations or deficiencies will be reviewed and their contribution to the process of developing pelvic organ prolapse will be discussed. What is known about how genetics and family history contribute to these processes will be discussed looking for potential risk factors for developing pelvic organ prolapse.

Steering Committee Advisor : Lynsey Hayward (New Zealand)
Committee Chair: Heidi Brown (USA)         
Committee Members: Aparna Hegde (India) / Markus Huebner (Switzerland) / Ervin Kocjancic (USA)/ Gisele Vissoci Marquini (Brazil)/  Bernard Mbwele (Tanzania)/ 
Hedwig Neels (Belgium) / Visha Tailor (United Kingdom) / Elisa Trowbridge (USA)

3. Pathophysiology of Pelvic Organ Prolapse: Risk Factors, Family History, Genetic Mutations
This report will focus on the how many women are affected with pelvic organ prolapse, the lifetime risk of developing pelvic organ prolapse and how untreated pelvic organ prolapse progresses or regresses. This will set the tone going forward by giving the overall impact of pelvic organ prolapse as a disease in women. There should be discussion of the future need for services, particularly surgical care of prolapse as the population ages. This report can touch on definitions  (symptomatic definitions vs physical exam definitions) and how this relates to the various reports on incidence, prevalence and natural history, but should not express opinions on which definition is most appropriate (that will precede this report in the chapter on the definition). The committee chairs will coordinate their writing so that terminology in this report is consistent with the report on the Definition of Pelvic Organ Prolapse.

Steering Committee Advisor: Maria Bortolini (Brazil)
Committee Chair: Jan Deprest (Belgium)
Committee Members: Kristina Allen-Brady (USA) / Vivian Aguilar (USA) / Luiz Gustavo Oliveira Brito (Brazil)/ Rufus Cartwright (United Kingdom)/ Hans Peter Dietz (Australia)/ Marianne Koch (Austria) / Jittima Manonai (Thailand)/ Adi Weintraub (Israel)

4. Patients' Perception of Disease Burden of POP
This report will focus on how women perceive pelvic organ prolapse and its relationship to body image and poor health.  How the vaginal bulge affects women’s sense of health and wellbeing and how women perceive benefit from treatment will be reviewed. This report will attempt to best define what aspects of pelvic organ prolapse have the greatest impact on women’s sense of wellbeing so that appropriate treatment goals can be established. The cost to society of treating pelvic organ prolapse will be covered in this chapter. The chair of this report will coordinate with the chair of the report on Relationship to Associated Morbidity/Pelvic Floor Dysfunction Prolapse to assure consistency as there will be some overlap of these reports.

Steering Committee Advisor: Chantal Dumoulin (Canada)
Committee Chair: Dudley Robinson (United Kingdom)
Committee Members: Symphorosa Chan (Hong Kong) / Chiara Ghetti (USA) / Suzanne Hagen (United Kingdom) /  Jerry Lowder (USA)/ Svjetlana Lozo (USA)
Kathie Hullfish USA/ Lisa Prodigalidad (Philippines)/ Maurizio Serati (Italy)

5. Relationship to Associated Morbidity/Pelvic Floor Dysfunction (Urinary Incontinence/Voiding Dysfunction, Fecal Incontinence, Sexual Dysfunction and Pelvic Pain)
This report will focus on comorbid conditions that commonly impact women with pelvic organ prolapse. Vaginal/lower abdominal/back pain, sexual dysfunction, lower and upper urinary tract disease and gastrointestinal dysfunction will be discussed and their prevalence in women with pelvic organ prolapse defined. How these comorbid conditions affect health and treatment planning will be briefly reviewed. Treatment of these co-morbid conditions will follow in subsequent reports dedicated to treatment and will not be discussed in depth in this report. The chair of this report will coordinate with the chair of the report on Patients Perception of Disease, Quality of Life and Disease Burden to assure consistency as there will be some overlap of these reports.

Steering Committee Advisor: Bob Freeman (United Kingdom)
Committee Chair: Marie-Andree Harvey (Canada)
Committee Members: Alexandriah Alas (USA) / Baharak Amir (Canada)/ Alka Bhide (United Kingdom)/ Roxana Geoffrion (Canada)/ Pawel Miotla (Poland)/ Ifeoma Offiah (United Kingdom)/ Manidip Pal (India)/ Peter Rosier (The Netherlands)