Spotlight on… urogynaecology

Abstract

It is now nearly 5 years since Mohamed Abdel-Fattah wrote the last Spotlight on… urogynaecology (TOG 2016;18:7), highlighting relevant articles throughout the lifetime of The Obstetrician & Gynaecologist (TOG). That Spotlight concentrated on the emergence of urogynaecolgy as a subspecialty, and I would like to use this update to discuss, in these post-COVID-19 times, the emergence of pelvic floor medicine as a wider concept, again highlighting the most topical articles published in TOG. For much of the last 20 years, we have witnessed the living proof of Scott’s Parabola (BMJ 2001;323:1477) in the development and decline of the use of mesh in vaginal surgery. The publication of the Cumberlege report has largely closed the debate, but it does leave the question posed by George White more than 100 years ago1 as to the correction of the white line. TOG has sought to address this with the articles by Khasriya et al. (TOG 2020;18:101–8) on laparoscopic urogynaecology and by Loganathan et al. (TOG 2019;17:21–6) on the issue of whether to combine continence and prolapse surgery. The challenges of managing such problems have seen the debate revisit both Manchester repair2 and colpocleisis (TOG 2020;22:233–6). In stress urinary incontinence, there has been a return to interest in bulking agents (TOG 2020;22:137–46) and the more controversial topic of the role of lasers in vaginal therapy (TOG 2019;21:233–6). As with any period of controversy, there has also been a re-evaluation of how we assess patients. Key articles in TOG have highlighted this change with a guide to urodynamics from Taithongchai et al. (TOG 2019;21:193–202) and Lyttle and Fowler’s excellent article on cystoscopy (TOG 2017;19:236–40), as well as those that have concentrated on the conservative aspects of care, including the use of vaginal estrogen (TOG 2019;21:37–42) and the management of recurrent urinary tract infections (TOG 2020;22:115–21). As we look forward, I am sure we will see more articles on emerging topics, like that by Jones et al. on sports gynaecology (TOG 2019;21:85–94). We will need to think differently and perhaps challenge more paradigms: as pelvic floor medicine matures, we see more urogynaecologists running services for women who have sustained obstetric trauma, and perhaps we will see the emerging need for skilled vaginal surgeons to be increasingly involved with complex cervical cerclage.