The Ulf Ulmsten Lecture presented at the opening ceremonies of the 30th Annual Congress of the International Urogynecologic Association—August 10, 2005, Copenhagen, Denmark

Abstract

Through my friendship with Gunnar Lose, I have learned the story of a Danish genius named Piet Hein, who died in 1996 at the age of 91. Piet was a mathematician, physicist, poet, author, and designer. When the Vietnam peace talks began in Paris, negotiators initially could not agree how to physically arrange themselves to maximize productivity and minimize conflict. Finally, they chose a table designed by Piet Hein, constructed in the shape of a super-ellipse, which had neither head nor tail. In this setting, everyone had a position of equality. Piet Hein (Fig. 1) also wrote a number of aphorisms or poems, called grooks, which he first published under a pseudonym in 1940 when the Nazis occupied Denmark. Years later, he published collections of his grooks, several of which I will use in this talk to emphasize important points. The organizing committee has given me the freedom to choose the subject of the talk: “Disorders of the pelvic floor— how did we get here and where should we go?” The objectives of this presentation will be to describe the current state of the art in disorders of the pelvic floor, compare our state of the art to sister specialties and draw appropriate conclusions, discuss a model that will encourage progress and ultimately improve how we care for our patients, and finally, leave you with some proposals regarding where our field may go from here. What is the state of the art currently in disorders of the pelvic floor? My bias, and the consensus among the members of our team in Texas, is that our discipline is primarily focused on clinical outcome research. We have placed minimal focus on understanding the pathophysiology, natural history, or epidemiology of pelvic floor dysfunction. Our modus operandi has been to introduce new diagnostic measurements, such as urethral closure pressure, Valsalva leak point pressure, pudendal nerve terminal motor latency, and pelvic organ prolapse quantification for the purpose of quantifying the patient’s physiologic and anatomic status. Once we make these measurements, attempts are made to apply them to decisions regarding therapeutic intervention. Lastly, another feature of our current status is that innovative physicians, in cooperation with industry, are developing new products and procedures at a considerable pace. Presume you are a patient who has a disorder of the pelvic floor. You see your physician who provides a diagnosis and offers treatment. The treatment has been, or is currently being, tested. In the case of a surgical Int Urogynecol J (2006) 17:430–435 DOI 10.1007/s00192-006-0142-6