Fistulae Secondary to Vaginal Pessary Use for Pelvic Organ Prolapse: A Systematic Review.

Introduction And Hypothesis: Urogenital and rectovaginal fistulae are rare complications of pessary use for pelvic organ prolapse (POP). This systematic review investigates the prevalence of these complications in patients using pessary for POP, potential risk factors and approaches to their investigation and management.

Methods: All studies in English reporting urogenital or rectovaginal fistulae secondary to pessaries for POP were eligible for inclusion.

Can We Prevent Recurrent UTIs Without Antibiotics, in Both Those Who Do and Do Not Use Catheters? ICI-RS 2024.

Aims: Urinary tract infections are one of the most common reasons for antibiotic prescription. The widespread use of antibiotic treatments contributes to the global health problem of antimicrobial resistance development. To slow down the progression of antimicrobial resistance, it is essential that we explore nonantibiotic preventive treatments for this common condition.

Are We Able to Optimize Outcomes and Predict Complications in Pelvic Floor Surgery With a Better Understanding of Hormonal, Microbial and Other Factors? A Report From the ICI-RS 2024.

Introduction: Pelvic organ prolapse (POP) is a common condition, affecting women worldwide and is known to have a significant impact on Health Related Quality of Life (HRQoL). Although there are various treatment options available, including pelvic floor muscle training and support pessaries, many women opt for or require surgery, with a lifetime risk of needing surgery of 12%-19%. As with any operation, this does not come without its complications and the reoperation rate following POP surgery is up to 36%.

Patient Perception of Prolapse Condition Questionnaire: A Validated Patient-Reported Outcome Measure.

Introduction And Hypothesis: Identifying patient-reported outcome measures allows management of urogenital prolapse to be tailored to reflect symptom bother and expectations of treatment. We devised a new single-item questionnaire, the Patient Perception of Prolapse Condition (PPPC), based on the Patient Perception of Bladder Condition (PPBC). The aim was to evaluate the criterion validity, test/re-test reliability and responsiveness of the PPPC.

Should hormone replacement therapy (any route of administration) be considered in all postmenopausal women with lower urinary tract symptoms? Report from the ICI-RS 2023.

Aims: This International Consultation on Incontinence-Research Society report aims to summarize the evidence and uncertainties regarding the use of hormone replacement therapy by any route in the management of lower urinary tract symptoms (LUTS) including recurrent urinary tract infections (rUTI), with a review of special considerations for the elderly. Research question proposals to further this field have been highlighted.

Methods: An overview of the existing evidence, guidelines, and consensus regarding the use of topical or systemic estrogens in the management of LUTS.

Is the time right for a new initiative in mathematical modeling of the lower urinary tract? ICI-RS 2023.

Introduction: A session at the 2023 International Consultation on Incontinence - Research Society (ICI-RS) held in Bristol, UK, focused on the question: Is the time right for a new initiative in mathematical modeling of the lower urinary tract (LUT)? The LUT is a complex system, comprising various synergetic components (i.e., bladder, urethra, neural control), each with its own dynamic functioning and high interindividual variability.

A national survey of UK practice for day-case vaginal prolapse surgery: Unrealistic expectations?

Objective: The UK NHS Getting It Right First Time report (2021) recommended that a significant proportion of native tissue vaginal prolapse operations should be undertaken as day-case procedures (target: 80% anterior compartment, 70% posterior compartment, 60% combined anterior/posterior compartment). The evidence for perioperative care, options for anaesthesia and outcomes of day-case vaginal prolapse surgery is limited. This study aimed to establish current practice amongst UK gynaecologists and explore perceived barriers to implementing day-case surgery for pelvic organ prolapse.

What happens to female sexual function during pregnancy?

Introduction: Female sexual function remains an under-investigated and neglected topic in medical research. Studies have found a strong association between female sexual dysfunction (FSD) and decreased physical, emotional and overall life satisfaction [1]. Although FSD and the impact it has on quality of life is becoming increasingly recognised, the effect of pregnancy on FSD is relatively under-researched.

Do we have adequate data to construct a valid algorithm for management of synthetic midurethral sling complications? ICI-RS 2019.

Background: Synthetic midurethral sling (MUS) procedures, purported for the last two decades as the gold standard surgical treatment for stress urinary incontinence, have been in creasingly scrutinized in recent years with regard to the rate and severity of complications.

Methods: During the International Consultation on Incontinence Research Society meeting held in Bristol, UK, in 2019, a multidisciplinary panel held a think tank and discussed the contemporary evidence pertaining to the classification, investigation, and treatment of MUS complications.

Results: The current classification system of mesh-related complications was discussed, and shortcomings were identified.

Recommendations and future research initiative to optimize bladder management in pregnancy and childbirth International Consultation on Incontinence - Research society 2018.

With increasing birth rates globally, obstetric bladder care and long term pelvic floor dysfunction continues to be a issue. This paper aims to provide an overview of the concerns in the antenatal, intrapartum an post partum periods and presents recommendation for the research requirements necessary and education to challenge current practice.

Do we need better information to advise women with stress incontinence on their choice of surgery? Report from the ICI-RS 2018.

Aims: The regulatory warnings about the safety of the synthetic midurethral slings (MUS) had a significant effect on how patients and physicians approach surgical management of stress urinary incontinence (SUI). In this changing landscape, the purpose of this research Think Tank (TT) was to provide an update of the current knowledge about the safety and efficacy of SUI surgery, to review patient goals and expectations and to identify factors affecting the decision making for surgery.

Methods: This is a consensus report of the proceedings of TT3: "Do we need better information to advise women with stress incontinence on their choice of surgery?" from the annual International Consultation on Incontinence-Research Society (ICI-RS), June 2018.

Changing surgical trends for female stress urinary incontinence in England.

Introduction And Hypothesis: Stress urinary incontinence (SUI) surgery has significantly evolved with the introduction of synthetic midurethral slings (MUS). However, following reports from the US Food and Drug Administration and European Commission, the use of vaginal meshes in urogynaecology has been largely scrutinised. We analysed trends in female SUI surgery in England from 2000 to 2017.

Mode of delivery following an OASIS and caesarean section rates.

Objectives: While the rate of obstetric anal sphincter injury (OASIS) is increasing, there is a lack of evidence on how best to advise women on mode of delivery (MOD) afterwards. The objectives of this study were to assess the clinical value of bowel symptoms, endoanal ultrasound and anorectal manometry in the management of pregnancies after an OASIS and evaluate the performance of different algorithms.

Study Design: This was a retrospective analysis of prospectively collected data in a university hospital perineal clinic.

Does assessing urethral function allow the selection of the optimal therapy for recurrent SUI? Report from the ICI-RS 2017.

Aims: The management of recurrent stress urinary incontinence following failed previous continence surgery remains challenging. Whilst the role of urodynamic investigations has been questioned in the management of primary stress incontinence there is a widely held view that women with recurrent symptoms require further investigation although there is no agreement regarding which tests are required. We sought to understand what testing is recommended prior to managing this difficult cohort of patients.

Trends in prolapse surgery in England.

Introduction And Hypothesis: Women have a lifetime risk of undergoing pelvic organ prolapse (POP) surgery of 11-19%. Traditional native tissue repairs are associated with reoperation rates of approximately 11% after 20 years. Surgery with mesh augmentation was introduced to improve anatomic outcomes.

Is there an association between aspects of the metabolic syndrome and overactive bladder? A prospective cohort study in women with lower urinary tract symptoms.

Objective: The aim of our study was to determine whether there is a link between aspects of the metabolic syndrome (MetS) and overactive bladder (OAB) in women with lower urinary tract symptoms (LUTS).

Study Design: A single-centre prospective study. We evaluated a cohort of consecutive women with LUTS attending a tertiary referral urodynamic clinic from October 2012 to January 2015.

Can we predict detrusor overactivity in women with lower urinary tract symptoms? The King's Detrusor Overactivity Score (KiDOS).

Objective: Traditionally, urodynamic studies (UDS) have been used to assess lower urinary tract symptoms (LUTS), but their routine use is now discouraged. While urodynamic stress incontinence is strongly associated with the symptom of stress urinary incontinence (SUI) and a positive cough test, there is a weak relationship between symptoms of overactive bladder and detrusor overactivity (DO). The aim of our study was to develop a model to predict DO in women with LUTS.

Is there any association between urodynamic variables and severity of overactive bladder in women with idiopathic detrusor overactivity?

Aims: The lack of a validated detrusor overactivity (DO) severity tool limits the clinical value of urodynamics in the management of patients with overactive bladder syndrome (OAB). The aim of this study, was to identify urodynamic variables that correlate with validated OAB severity measures.

Methods: This was a cross-sectional study enrolling consecutive women with idiopathic DO.

Early postoperative voiding dysfunction after insertion of retropubic midurethral tape.

Introduction And Hypothesis: A significant proportion of patients develop voiding dysfunction after midurethral tape (MUT) insertion, which reduces patient satisfaction. The study's purpose was to identify predictive factors of voiding dysfunction after a retropubic MUT procedure.

Methods: This was a retrospective study of 100 patients who underwent only a retropubic MUT procedure between January 2010 and December 2011.

Therapies in early development for the treatment of urinary tract inflammation.

Introduction: Urinary tract inflammation is a very common clinical condition. It is caused by several pathogens and antibiotic treatment is the mainstay of therapy. Increasing antimicrobial resistance and high recurrence rates represent a challenge.

When should video be added to conventional urodynamics in adults and is it justified by the evidence? ICI-RS 2014.

Aims: To debate and evaluate the evidence base regarding the added value of video to urodynamics in adults and to define research questions.

Methods: In the ICI-RS Meeting 2014 a Think Tank analyzed the current guidelines recommending video urodynamics (VUD) and performed a literature search to determine the level of evidence for the additional value of the imaging with urodynamic assessment of both neurogenic and non-neurogenic lower urinary tract dysfunction.

Results: Current guidelines do not specify the added value of imaging to urodynamics.

Digital assessment and quantification of pelvic organ prolapse (DPOP-Q): a randomised cross-over diagnostic agreement trial.

Introduction: Pelvic Organ Prolapse Quantification (POP-Q) system, measured in centimetres using a ruler (e.g. POPstix®), is recommended to quantify prolapse severity.

Drug therapy for overactive bladder.

Overactive bladder is a syndrome with a significant worldwide prevalence and economic impact on health resources. With ageing populations, the health burden of this condition that is more common in older people, is likely to increase. Following conservative therapies, medical management of overactive bladder is the mainstay of treatment, usually with antimuscarinic therapy.