Chapter 3 - Conservative Treatment of the Patient with Pelvic Organ Prolapse

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.

Chapter 4 - Surgical Treatment of the Patient with Pelvic Organ Prolapse

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.

Urodynamics Terminology Paper

Urodynamics (UDS) is the current gold standard set of investigations to explain pathology in lower urinary tract dysfunction. The role of UDS is to answer a Urodynamic question based on reproducing the patient’s symptoms. Despite the introduction of several standardization documents on terminology and methodology for performing UDS and the standard of equipment required there remains no standardization on how to report and therefore how to interpret UDS findings. The lack of guidance in this specific area may undermine the value of this extremely important tool in the patient evaluation. The aim of this document is to propose a standardized proforma and checklist for the reporting of Urodynamic studies, the main text discusses the rationale for the proforma.

 

You can find the patient evaluation tool available in Spanish and French by clicking below.

PATIENT EVALUATION TOOL (SPANISH)

PATIENT EVALUATION TOOL (FRENCH)