Surgery For Urinary Incontinence In Women Research Articles

It was a long journey for most of the international delegateswho came to Brisbane, Australia for the 37th InternationalUrogynecological Association (IUGA) annual scientificmeeting this year. Despite the distance, there was not suffi-cient time to digest all the abstracts in-flight. Indeed, 17nations were represented, with 1,400 delegates attending the2012 IUGA. There were 21 workshops in the first 2 days, 7state-of-the-art roundtable addresses and debates, 96podium/video presentations, and 228 poster presentations.The meeting began with interactive workshops which wereall popular, especially Abdul Sultan’s anal sphincter repair,the 3 ultrasound workshops, the anatomy cadaver workshopwith John DeLancey, and the Urogynaecological Society ofAustralasia (UGSA) live surgery demonstration chaired byMickey Karram and Malcolm Fraser.The extensive scientific program, which also included theEuropean Urogynecological Association (EUGA) surgicalcourse and Ibero-American urogynecology session, cateredto a variety of experience and educational needs. The com-plementary nature and high caliber of the scientific programwas evident. Basic science communications gave an over-view of current research interests including one describingthe effects of cyclic mechanical loading on fibroblasts fromwomen with different Pelvic Organ Prolapse Quantification(POP-Q) stage [1]. High-quality studies followed with tworandomized controlled trials on the most controversial topicof the day: the mesh repair [2, 3] and a Cochrane review [4]which was awarded best abstract. Further surgical studiesincluded one where the classical Richter suspension (vagi-nal sacrospinous fixation) at hysterectomy had a higherfailure rate in patients with levator injury and was signifi-cantly inferior to the mesh procedure [5] and another wherebetter anatomical and functional success rates were reportedwith mesh compared with traditional anterior colporrhaphy[2]. Surgical procedures were assessed on quality of life [6]and symptoms [7] with greater emphasis on these thananatomical results, highlighting the importanceof subjectiveoutcomes. Nonrandomized controlled studies included, forexample, in the surgical complication category, the impor-tance of diagnosis of intraoperative visceral injury to thebladder with the methylene blue test and digital rectal examin vaginal surgery [8, 9]. An elegant demonstration of ab-dominal prolapse repair with robotic assistance was shownin the video category [10]. The category of urinary dysfunc-tion included topics such as “Does surgery for urinaryincontinence in women affect their use of symptom-relieving medications?” [11], musculoskeletal pain evalua-tion of patients with interstitial cystitis [12], and a system-atic review of bulking agents for urinary incontinence [13].A wide range of conservative therapies were evaluated,includingthe safe andeffective use of pessary over amedianduration of 35 months [14], a prospective multicenter studyof solifenacin for overactive bladder [15], and the role ofpercutaneous stimulation with sensory response as a predic-tor of success [16]. Bladder reeducation and physiotherapywere reemphasized with regard to their role in the manage-ment of urinary incontinence [17]. Obstetric and perinealcare was highlighted in two studies on anal sphincter inju-ries [18] and episiotomy evaluation [19]. There was a fas-cinating presentation on the utility of an open configurationdynamic magnetic resonance imaging (MRI) proctogram[20], showing that erect sitting and supine MRI proctogramsare similar in assessing functional and anatomical disordersof the anorectum.