Advancing Urogynecological Knowledge Around the World
The Official Newsletter Volume 9, Issue 3, 2014
June 9-13, 2015 Nice Acropolis Convention Center
2014 AUGS/IUGA Scientific Meeting Summary........................................... 5 The Cochrane Incontinence Review Group Corner............................................. 16 Diary from Middle East.................... 18
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The IUGA Newsletter is published by the members of the Publications Committee Editor: Alex Digesu
Table of Contents Letter from the President...............................................................3
Associate Editors: Steven Swift Sohier Elneil
Letter from the Excecutive Director.............................................4
Managing Editor: Amy Cassini
2014 Award winners........................................................................13
Editorial Board: Ester Barter Bary Berghmans Heidi Brown Kimberly Ferrante Deborah Karp Annette Kuhn Aparecida Pacetta Lisa-Teresa Prodigalidad Paul Riss Ghazaleh Rostaminia Graphic Designer: Johanna Gomez The views and opinions expressed by the authors in this publication do not necessarily reflect those of IUGA, and/or its editors.
2014 AUGS/IUGA Scientific Meeting Summary.........................5-12
IUJ Corner........................................................................................13 An Introduction to the Israeli Society of Urogynecology and Pelvic Floor Medicine (IUPFM)......................................................14 Committee Corner - Public Relations Committee.....................15 Affiliate Societies Calendar...........................................................15 The Cochrane Incontinence Review Group Corner...................16 FIUGA Corner .................................................................................16 IUGA Photo Contest.......................................................................17 Diary from the Middle East............................................................18 2014 AUGS / IUGA Scientific Meeting Evaluation Results........18
A LETTER FROM THE PRESIDENT What is in the future for medical society Big Annual Meetings? “See you in Athens.” (said in Copenhagen, 2005) “See you in Taipei.” (said in Cancun, MX in 2007) “See you in Toronto.” (said in Como, Italy in 2009) It was almost a given expectation – that IUGA members would attend the Annual Meeting, wherever it was being held. Those were the days of Big Annual Meetings (BAMs). Now, attendance at Annual Meetings has plateaued, and in some cases declined. Are BAMs becoming extinct? This is a recognized concern across most medical societies. IUGA is not exempt. Since the BAM is still the main activity a Society organizes, and a source of significant income, it is not a situation Societies such as IUGA can ignore. Why? In most places around the world, doctors are working harder, being plagued by challenges in payments for services and medicolegal hurdles – and – not receiving offers for educational support from medical pharma and device companies. As large companies increasingly adhere to US-initiated guidelines for support of medical education, which prohibit support for expenses such as airfare, lodging and meeting registration, most doctors are faced with a decision whether to pay their own expenses to go to a BAM, or not attend. When the costs are calculated, the decision can be rather easy to make. In the US, academic institutions and many practices provide a budget for continuing education (CME), but
the budget is increasingly limited, and international meeting costs are frequently not covered. Attending a BAM is tough, even for American doctors. US-based companies may delegate educational support to their local distributors, which typically provide only partial support. BAMs are frequently selected based on attractiveness of the location – usually as a vacation or tourism site - and not based on more practical factors such as ease (and cost) of access, time of year, cost of lodging and other expenses. Look at recent sites where we have had our IUGA BAMs – these are recognized barriers to attendance. BAMs are very expensive to organize and host. The venue rental can reach over 150,000 EU, A-V costs over 100,000 EU, and rental of poster boards over 25,000 EU. Attendance must be high! As would be expected, our industry sponsors also prefer more accessible, less expensive venues. What can we do to adapt? We should not give up on BAMs. Even in this world of extensive virtual contacts, and maybe even because of these, it is still important to gather face-to-face to discuss new developments, generate research ideas and build the global connections that will advance our field of urogynecology. IUGA’s Board and office staff have been carefully evaluating how we can continue to have successful BAMs. It is clear that the selection process cannot continue to be a vacation popularity contest. The process must represent a well thought-through process to
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allow the largest possible number of IUGA members to attend the BAM. There a finite number of cities with easy, relatively inexpensive access from anywhere in the world, plenty of lodging of varying costs near the venue, and attractive for tourism. Europe and North America – that is where they are mostly located. These sites may not meet the needs of our members from other parts of the world. We have decided to propose a number of changes to the Annual Meeting selection process. •
We will institute a 3 year rotational cycle to include Europe/North America/Rest of the World. Proposals will be accepted based on the next in line geographically (joint meetings may pose an exception).
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A selection committee will review the appropriateness of the proposal, including costs and attractiveness to potential attendees (and industry sponsors).
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The membership will select the BAM site by voting among sites the committee deems acceptable.
What other options do we have? As with many other societies, reliance on the BAM as the main (or sole) source of education for the membership needs to be reduced. We have already initiated various processes with that purpose:
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Increased emphasis on the Regional Symposia – to facilitate regional access to state-of-the-art urogynecologic knowledge acquisition,
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Increased on-line e-learning programs, including webinars, and
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Increased expansion of activities in very specific areas within Urogynecology – via our very popular Special Interest Groups (SIGs) which include Laparoscopic Surgery, Neuro-Urology and neuromodulation, and Physiotherapy. As an example, the Laparoscopic SIG is preparing a series of standardized technical courses to expand education in laparoscopic sacrocolpopexy – which would allow a learner to receive didactic and hands-on training and proficiency development.
Education promotion in Urogynecology (which is at the heart of IUGA’s mission) is in a process of evolution. It will certainly be a trial-and-error process over the next few years, but our members should rest assured that IUGA will continue to provide vast opportunities to enhance knowledge and training. The determination of the “How” and “When” (and “Where”) is still TBD (to be determined). G. Willy Davila, MD President, IUGA
A LETTER FROM THE EXECUTIVE DIRECTOR By Charles A. Shields New Services for Members During the Joint Scientific Meeting with the American Urogynecologic Society there was considerable attention given to a number of new offerings for IUGA members that have been introduced over the past few months. These included: •
A library of surgical videos,
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The Mentorship Registry which connects experienced members with other members who are working to build their careers,
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The Find-A-Urogynecologist Tool, and,
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The archive of webinars.
The library of surgical videos (http://www.iuga.org/?page=video) includes the video that was judged the top video at each annual meeting since 2007. These are available for all viewers of the website. The twelve other videos that were included for presentation at this year’s annual meeting are also available, but only to IUGA members. A similar larger number of top videos from past years will gradually be added. In addition to helping to meet personal educational needs, these videos can serve as the core of stimulating educational programs in institutions or local gatherings by affiliate societies. There are also a number of interesting video interviews that were produced at the annual meeting in Washington and which can be seen on the IUGA Facebook page at: https://www.facebook.com/
iugaoffice. Included are conversations with Dr. John DeLancey, one of the main speakers; Dr. Halina Zyczynski, one of the meeting co-chairs; with Dr. Emanuel Trabuco, the winner of the best abstract award; and with Dr. Gabriel Y.K. Ganyaglo of Accra Ghana regarding the Fellows’ Cadaver Workshop. The Mentorship Registry is an initiative to help members connect with each other to help build the practice of urogynecology. The number of mentors will grow, but it already includes experienced members from 15 countries who are prepared to help other members. Those seeking a mentor could be young fellows just entering practice, or mid-career members who are interested in becoming more involved in a new area for them such as research, but hadn’t had the opportunity to be involved with up to that point in their working life. If you are seeking someone to provide you advice, or if you would like to offer to serve as a mentor, be sure to visit this section of the IUGA website: http://www.iuga. org/?page=mentorship The Find-A-Urogynecologist Tool already has hundreds of entries from experienced members in dozens of countries. It is accessible from the public section of the IUGA website – http://www. iuga.org/?page=findaurogynecologist – and is a valuable tool to help women find a professional near where they live. It also can be important for members to use when they need to refer a patient to another urogynecologist if their patient is moving. If you are not yet listed in the ‘Find-A-Urogynecologist’ database, please send an email to membership@iuga.org and IUGA staff will be
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pleased to help you become registered. For the past year IUGA has been offering webinars and now has an archive of sessions on mesh and OAB that only members can access – http://www.iuga.org/?page=webinar. As with the surgical videos, these recordings can be an excellent discussion stimulator for a small group educational session at a hospital or among members of an affiliate society. Webinars will continue to be produced on a regular schedule. The most recent of which was a special
webinar of highlights from the 2014 Joint Scientific Meeting chaired by Dr. Dudley Robinson, the Scientific Committee Chair, and featured Dr. John DeLancey, who gave the Raymond A. Lee Lecture. We on the IUGA staff hope that these new member services prove to be useful for all members. If you have suggestions about these or other services that would help you in your work and career, please contact me at: chuck@iuga.org.
2014 AUGS/IUGA Scientific Meeting Summary By IUGA Publications Committee Members
In July, over 2,100 people from 61 countries gathered in Washington, D.C. (USA) for the AUGS/IUGA Scientific Meeting. This year’s annual meeting featured many exciting components, including lively debates and lectures, exciting social events and last, but not least an exceptional scientific program. Congratulations to the AUGS and IUGA Program Committee, Board and staff members for planning a meeting that perfectly combined the cultures of the two organizations. It was certainly a meeting that will not be forgotten!
Best Abstract Award Winner, Emanuel C. Trabuco
Awards The quality of science presented at this year’s annual meeting was outstanding! The Axel Ingelman-Sunberg Best Abstract Award went to E.C. Trabuco et al. at the Mayo Clinic and the University of Missouri, USA for “A randomized comparison of incontinence procedures performed concomitantly with abdominal sacral colpopexy: The Burch versus mid-urethral sling trial” (Oral Paper 1). These authors
randomized 113 women to Burch or midurethral sling at the time of sacral colpopexy and concluded that mid-urethral sling resulted in greater patient satisfaction and higher urinary continence rates compared to Burch retropubic urethropexy. The Best Video Award was bestowed on S.M. Lenherr et al. at the University of Michigan, USA, for “Incidental Findings on Cystoscopy: A Video Tutorial” (Video 1). These urologists sought to create “a visual library of benign, malignant and foreign body pathologies incidentally encountered on cystoscopy” to help gynecologists performing cystoscopy to identify abnormalities they may encounter and to encourage early urology consultation when appropriate. The Best Epidemiology/QoL Paper went to S. Zebede et al. at Mount Sinai Hospital, University of Toronto, Canada for “Prevalence of obstructive sleep apnea detected by the Berlin Questionnaire in patients with nocturia attending a urogynecology unit” (Oral Paper 13). In this case-control study of 160 patients, 62% of patients with nocturia versus 24% of control patients had obstructive sleep apnea, and the authors thus concluded that all patients with nocturia should be screened for obstructive sleep apnea. The Best Basic Science Paper went to H.E. Richter and N. Whitehead at the University of Alabama at Birmingham and RTI International in the USA for “Urgency urinary incontinence genome wide association study” (Oral Paper 45). This study, conducted by the NICHD Pelvic Floor Disorders Network using data from the Women’s Health Initiative GARNET sub-study, identified multiple, significant hits within a single intron of ZFP521, a gene associated with stem cells, suggesting that this gene may be involved in the development of urge urinary incontinence. It should be noted that Cartwright et al. also presented findings from another genome-wide association study in a
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late-breaking abstract in POD 8-OAB. This study, authored by teams in the United Kingdom, Hong Kong, and Australia, identified novel genetic variants at five genomic loci associated with stress and urge urinary incontinence. Abigail Ford was awarded Best Presentation by a Physician-in-Training for her paper "2014 Cochrane Review: Minimally Invasive Synthetic Suburethral Sling Operations For Stress Urinary Incontinence In Women". Finally, the Best Non-Surgical Paper was awarded to G. Hilde et al. of the Norwegian School of Sport Science in Oslo, Norway, for “Does pelvic floor muscle training enhance pelvic floor muscle recovery? An assessor blinded randomized controlled trial” (Oral Paper 15). J. Marion Sims Lecture: Dr. Linda Brubaker Uncommon Dedication Linda Brubaker gave a wonderful, meaningful and entertaining talk. The lecture focused on the routine clinical practice of a urogynaecology physician and on the role of dedication and passion needed in the care of women with pelvic floor dysfunction. She valued Charlie Nager’s dedication to urogynaecology and highly appreciated his work and personality. Linda referred to the four core needs of human beings: physical, emotional, mental and spiritual. She also stressed the importance of finding our own definition of happiness and - probably most important – to balance the “yes” and “no’s” in our life. Music clips that had been inserted into the talk supported Linda Brubaker’s words nicely. The mixture of facts, music and particularly her personal input made this talk fascinating. Abdul Sultan, who was sitting next to me, summarized these 30 minutes brilliantly:
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“This was not a talk – it was right from her heart!” This was the reason why this talk went directly to the hearts of the audience. Ulf Ulmsten 10th Memorial Lecture: Prof. Peter Petros and Dr. Carl Gustaf Nilsson
follow up visits reassured the efficacy of training. Dr. Nilsson concluded his speech as: “A theory without proof is fantasy, a theory translated into successful clinical practice is reality “.
Creating a Gold Standard Surgical Device: The Development of TVT Professor Petros was the first speaker for the Ulf Ulmsten 10th Memorial Lecture. He reviewed the history of animal experiments and histological studies that led to a product known as TVT which became ready to test in human. Integral theory by Professor Petros was first published in 1990 that explained existing phenomena in terms of anatomic defects in the vagina and its supporting ligaments. Based on this theory, a new classification of female urinary incontinence and several new minimally invasive surgical procedures were introduced. After referring to the causes of many operative methods to cure female urinary incontinence failing the technique of an intravaginal slingplasty was described. To obtain long-term success, Dr. Ulmsten and Dr. Petros decided to use permanent slings. Various types of grafts with many erosion complications had been tested and polypropylene mesh resolved the erosion problem in 1996. Dr. Nilsson as second speaker reviewed the history of human trials for TVT while it passed initial experiments. He addressed three areas: target population for TVT, safety and efficacy of method, and training. TVT was first performed in Nordic countries and Europe at the end of 1997 and a year later in the US. The protocol for pre and post procedure evaluation as well as criteria for cure and improvement, as described by Dr. Ulmsten, had been the reference for studies. TVT showed excellent cure rate for different target populations including primary non-complicated SUI, complicated recurrent SUI and even intrinsic sphincter deficient cases. Concerns regarding TVT’s safety and efficacy were addressed in a study on 1455 patients published in 2001 that showed very low rate of complications with TVT procedure. How was required training decided upon? Training was consisted of theoretical training, surgical training, and follow-up program. Surgical training included attending 2-8 TVT procedures, assisting 2-4, and performing 2-3 TVT procedures. Regular
Dr. Carl Gustaf Nilsson delivers the Ulf Ulmsten Lecture
Dr. Ulmsten turned the theory to a reality that is now on its way to becoming gold standard surgery for stress urinary incontinence. Raymond A. Lee Lecture: Dr. John DeLancey - Imagine Limitations in visualising pelvic floor dysfunction are compounded by a limited anatomical view of underlying ligaments, muscles and anatomy. Leaving us ‘imagining’ the structure and function of the pelvic organs rather than objectively and accurately define them. The dynamics of the overall structure of the pelvic floor is key to understanding its overall functional relationships. Contemporary investigatory modalities include 3D MRI, 3D stress MRI and finite element biomechanical models to look at the locations of structures at maximal Valsalva, as well as simulate specific changes to ligament and muscles dynamics, greatly enhances our understanding of pelvic floor prolapse. Understanding what structures fail and how to go about investigating this is imperative to reporting outcome and planning management appropriately. The key components of pelvic floor structure and function are the pelvic floor organs, the ligaments, musculature, vaginal wall dimensions, paravaginal attachments and higher neuronal control as well as the
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effects of pressure differentials between atmospheric and intra-abdominal pressure. These parameters have been discussed briefly below. Biomechanically we know that pressure (i.e. intra-abdominal) multiplied by area (of the vaginal wall) is equal to force (on suspensory ligaments). Anatomically translated in the context of levator ani damage, this means that displacement of the pelvic floor muscles (due to a pressure differential created between intra-abdominal and atmospheric pressure) leads to an increase in area of vagina exposed to atmospheric pressure and subsequently a downward traction on the uterus with rise in ligamentous tension of the cardinal and utero sacral ligaments. Exposed vaginal wall area is therefore important in the study of suspensory ligament tension and force. One way this can be studied is by the bladder base’s displacement from its normal anatomical position to its new location on Valsalva. Studies have shown that once the bladder base descends to below the hymenal ring (around 4cm displacement) there begins to be a linear relationship between increases in bladder descent with increases in area of vagina exposed. This correlates to symptoms experienced by women when the bladder base begins to become exposed beyond the hymenal ring (and levator ani muscles). There also exists a strong linear relationship between the size of the urogenital hiatus; the greater the exposure of the vagina, the greater the size of the genital hiatus. The mechanical properties of the ligaments has also been assessed via applying an external force on the uterus to assess its downward displacement to measure the stiffness of the ligaments. What has been shown in this study is that the actual stiffness of the suspensory ligaments varies relatively less than change in location of the cervix before and after the force is applied. This infers that the ligaments in a resting uterus are relatively slack with allowing some degree of downward descent before they actually become tight. Once the ligaments become tight then the stiffness should be properly assessed. The width and length of the vagina along with the attachments of the suspensory ligaments and paravaginal attachments can also be assessed via 3D Stress MRI. This allows an accurate study of comparison of
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the dynamic changes of the pelvic organs, ligaments, vaginal wall dimensions and attachments in normal individuals to those with a pelvic organ prolapse. All these parameters must be inter-related to contribute to prolapse, rather than have individual and independent effects on the structure and function of the pelvic floor. If these parameters of symptomatic groups can be compared to control groups with normal ranges, then individual surgical treatment options for women whose parameters lie outside the normal range can be tailored accordingly. Hence, reporting specific reproducible measurements of pelvic floor structure and function (e.g. attachments, vaginal wall dimensions, levator ani tension) for individuals symptomatic of prolapse could greatly improve and guide treatment strategies. Successful clinical outcome following interventions based on these findings will largely determine clinical adoption of these investigatory strategies.
A group of audience members from the debate pose for a photo
Debate: “You Can’t Fix Everything at the Same Time - Continence Surgery Should not be Performed Concomitantly with Reconstructive Pelvic Floor Surgery” The Friday debate at the combined AUGS/IUGA meeting in Washington DC, You Can’t Fix Everything at the Same Time- Continence Surgery Should Not be Performed Concomitantly with Reconstructive Pelvic Floor Surgery, was filled with humor and punctuated by data. Mark Slack and Kim Kenton made the argument that midurethral slings should never be placed at the time of prolapse repair and Mimi Lukacz and Peter Dwyer argued that one could consider a concomitant sling. Humor was the theme of Dr. Slack’s argument discussing planes, trains and automobiles. Well, perhaps just planes and life jackets and how the minute chance of surviving
a water landing has very little to do with whether you have a life jacket. This was just one of the humorous metaphors he used to convey his point that a sling is not the answer when you are repairing prolapse. Dr. Kenton took a more evidencebased approach to her argument from the perspective of the patient. She emphasized that patient satisfaction is low with complications after midurethral sling, especially when patients had no incontinence complaints preoperatively. “There is no patient angrier than the woman who had a prophylactic sling for occult incontinence and returns in retention,” she argued. In contrast, Mimi Lukacz and Peter Dwyer jam-packed their rebuttal with data. Dr. Lukacz barely took a breath as she attempted to discuss all of the studies in support of her view. Among them, she cited the OPUS trial (A midurethral sling to reduce incontinence after vaginal prolapse repair) which suggested that a prophylactic midurethral sling inserted at the time of prolapse surgery resulted in lower urinary incontinence rates. Rebuttal from both sides centered around the “supersize me” mentality suggested by Dr. Slack. He likened supersizing a McDonalds’ meal to adding a sling to a prolapse surgery: “would you also like your ovaries removed with that?”. Dr. Lukacz responded that she was none the worse for supersizing her meals. At the conclusion of the jocular debate, the moderators Marie Paraiso and Linda Cardozo took a vote from the crowd to see if opinions had shifted in light of the arguments made. The split at the start of the debate had been about 50/50 with perhaps a slight lean towards the pro argument (that slings should not be put in concomitantly). In the end, Drs. Slack and Kenton had recruited perhaps a few more to their side, winning the crowd over with their humor, if not the data. The debaters would likely agree, however, that the reality lies somewhere between the two arguments with individualization of treatment for patients. Debate: “The Uterus is the Victim and Should be Preserved During Pelvic Floor Surgery” The final debate of this year’s combined AUGS/IUGA conference was “The Uterus is the Victim and Should be Preserved during
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Pelvic Floor Surgery.” This was a heated “discussion” in which Roger Goldberg MD, MPH (USA) and Simon Jackson MD (UK) presented “For the Motion” and Michael Heit MD (USA) and Karl Tamussino MD (Austria) argued “Against the Motion”. This lively debate was moderated by Miles Murphy MD (USA) and Robert Freeman MD (UK). Dr. Goldberg began this session referring to hysterectomy as “deconstructive” rather than “reconstructive” surgery and presented historical beliefs that hysterectomy was related to anxiety, regret and “hysteria” in women. In addition he cited evidence of increased urinary incontinence as well as the future development of vault prolapse as long term physical risks of hysterectomy. Dr Goldberg contended that preservation of the uterus was “culturally sensitive”, preserves fertility, and avoids the increased surgical morbidity associated with hysterectomy. Dr. Heit followed “against the motion” and presented Level I and other peer reviewed literature demonstrating improved surgical outcome with concomitant hysterectomy at the time of prolapse repair when compared to hysteropexy. He also contended that there is a current ongoing randomized controlled trial (the SUPER trial by the Pelvic Floor Disorders Network) randomizing patients with pelvic organ prolapse to transvaginal hysterectomy with native tissue reconstruction compared to hysteropexy with the use of an apical synthetic transvaginal mesh. Dr. Heit also cited a 62.5% rate of cervical elongation (Up To Date/ February 2014) noted with sacrospinous hysteropexy. Dr. Jackson proceeded for the motion emphasizing that “definitions matter” and citing high reoperation rates with native tissue repairs. He also stated that performing a transvaginal hysterectomy treated a “symptom” and not the “disease” as the uterus was a passive passenger and not the cause of pelvic organ prolapse. The debates ended with a lively question and answer session with plenty of audience participation. An audience vote showed that Dr. Heit and Dr. Tamussino won the debate by a small margin. Fellows’ Activities This year’s landmark joint AUGS/IUGA meeting in Washington, D.C. saw more than 170 Urogynaecology fellows and trainees from around the world enjoy a stimulating educational programme that included innovative speakers and state of the art hands-on training.
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The highlight of the fellows activities, the anatomy and surgical skills cadaver workshop was a huge success, attracting some of the most renowned urogynaecologists and urologists in the field as facilitators, and a huge group of fellows from around the globe, who were offered the opportunity to refresh their knowledge on anatomy and practice their skills in urogynaecological procedures on fresh cadavers. Dr. Robert Gutman, from Washington, D.C., and a group of AUGS/IUGA fellows developed and organised a highly demanding lab training course, which included interactive anatomy lecture by Dr. Geoff Cundiff and a clay lab led by Dr. Deb Myers, where fellows reconstructed the whole pelvic floor anatomy from scratch. The impressive cadavers’ lab allowed each fellow the opportunity to perform two different surgical procedures on fresh cadavers under the guidance of an AUGS and IUGA expert in the field.
moderated its own workshop on Systematic Review and Meta-analysis in collaboration with the Cochrane Group. Participants had an excellent opportunity to understand the concepts behind Cochrane systematic reviews through well-constructed talks delivered by world-class faculty and mock practice sessions using the appropriate software. Finally, the IUGA Fellows’ Research Network meeting attracted more than 30 international fellows who were updated on the progress of the inaugural FRN Grant project and discussed future collaborative multi-centre research to involve unfunded chart and database reviews that will address less explored topics in urogynecology.
Prof. Bob Shull accepts the IUGA Lifetime Achievement Award from President Willy Davila
A bird’s eye view of the President’s Reception
Social Events
Fellows construct the pelvic floor anatomy using clay
The fellows’ research forum featured a dynamic and motivating lecture by Dr. Rebecca Rogers, where she gave her personal experiences and pearls of wisdom in how to succeed in a research career. Breakout sessions followed where faculty mentors moderated 52 fellow presentations. The fellows enjoyed hearing the feedback on the presentations from their mentors and peers. The IUGA Fellows’ Committee also
President’s Reception, hosted by IUGA President Willy Davila and AUGS President Charles Nager featuring delicious tapas, drinks, and even a gelato stand. This reception offered not only fine cuisine but also breathtaking artwork and lively company to boot! During the event, Prof. Bob Shull was presented with the IUGA Lifetime Achievement Award for his contributions to Urogynecology and his dedication to IUGA throughout the years.
This year’s annual meeting, a combined effort between IUGA and the American Urogynecologic Society (AUGS), was held in Washington, DC and featured outstanding social events. After two days of excellent workshops, the meeting kicked off on Wednesday evening with a Welcome Reception in the Exhibit Hall of the Convention Center where the meeting was held. This large open space was very conducive to mixing and mingling, with bars strategically located in various corners and industry sponsors offering assorted treats at their booths. The following evening, invitees headed to the National Portrait Gallery for the
In stark contrast to our usual formal Gala Dinner to conclude IUGA’s Annual Scientific Meeting, this year we headed to a nightclub called the Dirty Martini for a night of costumed entertainment and debauchery: the Friday Night Global Connection Event. Inspired by the AUGSome Karaoke Event, various world-renowned urogynecologists donned Depends and glow stick necklaces and entertained us with dance routines and renditions of popular songs with professionally-relevant adapted lyrics. The University of Michigan crew was awarded Best Original Song for their rendition of ABBA’s Dancing Queen (titled Prolapse Queen), The Best Performance Award went to Team Down Under from Australia, and the Most Donations Raised went to Vault N’ Bladda, the Southern California group, who performed “Let’s talk about mesh, baby.” All in all, the meeting proved to be incredibly stimulating from both the scientific and the entertainment perspectives.
Visit the Mentorship Registry online to sign-up as a mentor, search for a mentor or simply see what's all about
Click here for more info
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PHOTO GALLERY
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The 2013 impact factor and a new section "Images in Urogynecology"
CONGRATULATIONS TO THE 2014 AWARD WINNERS!
I hope all of you have enjoyed the recent AUGS/IUGA meeting in Washington, D.C. as much as I have. After the meeting, the impact factors for 2013 were released by Thomson Reuters. The new impact factor for the International Urogynecology Journal is 2.161, virtually unchanged from the previous year 2012.
Lifetime Achievement Award Bob Shull; USA
We all know that the impact factor is calculated as the number of citations in a given year (for example 2013) divided by the number of citable articles in the preceding 2 years (for example 2012 and 2011). In the case of the Blue Journal the impact factor for 2013 was calculated as 1005/465 = 2.161. The IUJ is now ranked 27 out of 78 in Obstetrics & Gynecology and 26 out of 75 in Urology & Nephrology, also practically unchanged from 2012.
Award for Best Abstract Emanuel C. Trabuco; USA Award for Best Video Presentation Sara M. Lenherr; USA
At the IUJ we believe that we can be proud of these numbers keeping in mind that the Blue Journal is a subspecialty journal. However; in order to make it even more attractive we decided to introduce a new section. The new section “Images in Urogynecology” will follow the proven format already in use by other journals familiar to readers. An Image in Urogynecology will consist of one to three pictures (photographs or diagrams or other illustrations) with up to 300 words of text and up to 3 references.
Best Basic Science Paper Holly Richter; USA Best Epidemiology/QoL Paper Salomon Zebede; Canada Best Paper Non-Surgical Gunvor Hilde; Norway
There is no doubt that with the advent of digital technology images have become much more popular. All “Images in Urogynecology” will be in color in the digital version of the IUJ, and the accompanying text should illustrate an unusual case or an important or new teaching point. At the same time we want the images to replace the case reports which have a high rejection rate (over 70%) and detract from the impact factor because they are rarely cited.
Best Presentation by a Physician-in-Training Abigail Ford; UK
As always I invite you to follow me on twitter at @iuj_eic (Paul Riss IUJ). At least once a week I try to tweet an interesting article from the IUJ with a short teaser. Paul Riss Co-Editor-in-Chief International Urogynecology Journal Email: paul.riss@gmail.com
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An Introduction to the Israeli Society of Urogynecology and Pelvic Floor Medicine (IUPFM). By Gil Levy MD, FACOG, FPMRS and Lior Lowenstein, MD 5. In April 2014 we conducted the first regional urogynecology meeting in Istanbul. The Israeli and Turkish societies met for a two day conference to discuss controversial issues in Urogynecology. Future meetings with regional societies are planned.
The Israeli Society of Urogynecology and Pelvic Floor Medicine was founded in 1997 to promote pelvic floor health awareness for patients and care givers. During the last five years the society significantly increased its activities to include meetings with other medical disciplines like colorectal surgery, physical therapy, geriatrics, gyn- endoscopy and urology. These meetings resulted in the establishment of several multidisciplinary pelvic floor units in Israel’s large medical centers all of which now provide high quality urogynecologic care. During the last year under the chairmanship of Dr. Yuval Lavy, we conducted several new and innovative projects:
6. Robotic surgery: In the last 3 years 6 DaVinci robotic surgery systems were acquired by major Israeli hospitals. We have witnessed increasing numbers of sacrocolpopexies being performed by urogynecologists through use of the robotic approach, which has proven to be a practical alternative to vaginal surgery.
1. Quality of Life (QoL) questionnaires in Hebrew: under the leadership of Prof. Lowenstein the main QoL questionnaires (PISQ-12, PFDI, MESA and USIQ) were validated in Hebrew. This project allows clinical research in urogynecology to step into the academic arena and create an equal ground to compare our work to colleagues all over the world.
7. Three years ago the society presented the sacral neuromodulation treatment for recognition by the National Health Basket. In January 2014 sacral neuromodulation was recognized for the first time by the government as part of the basic treatments for fecal incontinence. Governmental HMO’s can now cover the costs of this procedure. Currently the procedure is performed mainly by urogynecologists.
2. Upgrading the international program: The only international IUGA fellowship program in the Middle East is located at the Division of Urogynecology at the Maynei Hayeshua Medical Center under the directorship of Dr. Gil Levy. This year the program was improved by adding rotations at The Rambam Medical Center to allow program fellows exposure to two diverse Israeli communities.
8. This year, following a debate on the importance of urodynamic studies in the assessment of patients with urinary incontinence, the Society established a urodynamic workshop. The workshop was conducted by Prof. Grutz and Dr. Stav, and it aims to educate physicians and nurses with basic urodynamic concepts.
3. A new website was launched: The society’s website serves both physicians and patients by offering an official and balanced source of information regarding pelvic floor health and clinical information. 4. OASIS program: This program was established 3 years ago and it includes hands on workshops and training for gynecologists who are training in repair of 3rd and 4th degree obstetrical injuries in the delivery room. The program is lead by Dr. Ginath, and provides each participant with a porcine sphincter or a bovine heart to practice the technique of overlap sphincter repair. The program has already made a national impact on the quality of surgical repairs in delivery rooms across Israel.
9. Following the FDA warning regarding vaginal mesh devices, the society drafted a detailed informed consent document for patients who are candidates for reconstructive surgery with mesh implants. It is our belief that by promoting more educational activities the society will better serve urogynecologic patients. Our future plans include: recognition as a subspecialty by the Israeli Health Ministry and the establishment of more centers for fellowship training in Israel. We believe that our new affiliation with IUGA will enable us to contribute to the field of Pelvic Floor Medicine and demonstrate our worthiness to our colleagues from around the world. Our society has made many steps forward during the past several years, yet we envision even greater strides forward in the coming years.
2015 Nice, France
Upcoming
In conjunction with WCAPP
June 9 - 13
2016 Cape Town, South Africa Joint meeting with SAUGA July 5-9 2017 Vancouver, Canada June 20 - 24
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www.IUGA.org
AFFILIATE SOCIETY CALENDAR British Society of Urogynecology (BSUG) Understanding Urodynamics October 7-8, 2014 - London
Mediterranean Incontinence and Pelvic Floor Society (MIPS) Annual Meeting November 26-29, 2014 – Nimes
Annual Scientific Update in Urogynaecology November 3-4, 2014 - London
Sociedad Chilena de Uroginecología y Piso Pelvico (SODUP) January 8-9, 2015 - Santiago
Australasian Gynecological Endoscopy and Surgery Society (AGES) Focus Meeting November 1-2, 2014 - Auckland
Urogynaecological Society of Australasia (UGSA) Annual Meeting March 14-15, 2015 - Melbourne
Sociedad de Obstetricia y Ginecología de Venezuela (SOGV) Annual Meeting November 4-7, 2014 -Valencia
Sociedad Mexicana de Urologia Ginecologica (SMUG) Annual Meeting May 13-16, 2015 - Jalisco
Austrian Urogynecology Working Group (AUB) 2014 Annual Meeting November 14-15- Location: Wels
Other Meetings: Society of Gynecologic Surgeons December 3-5, 2015 - Celebration, Florida http://www.sgsonline.org/winter-post-graduate-course
COMMITTEE CORNER - Public Relations Committee By Lynsey Hayward, PR Committee Chairperson
For the last 5 years the public relations committee has been working hard preparing the IUGA patient information leaflets. There is now a comprehensive suite of 28 leaflets ranging from pelvic floor exercises to sacral neuromodulation, all beautifully illustrated. To access the leaflets visit www.iuga.org/?patient info where they are available to download at no cost. The collection is expanding all the time so keep checking! The leaflets are steadily translated and are now available in up to 13 languages. The committee is very interested in anyone who would like to help in the translation exercise thus making leaflets available for their country. The IUGA store was created three years ago where members can purchase posters, pamphlets, IUGA apparel, etc. Members are entitled to a 50% discount on advertised prices so please check it out! The PR committee launched the Pelvic Floor Dysfunction Anatomical & Surgical flip chart in February 2014, which is available for sale on the IUGA
store site. This has proven to be a hit with over 200 having been sold to date. Feedback has been that this is a very useful patient education tool. In order to spread the word about pelvic floor dysfunction, the PR committee has developed a press package for the media and ran a very successful press conference at the IUGA regional symposium in Shanghai and at the recent joint meeting in Washington. The Washington session highlighted some of the work that IUGA members do through the presentation of a range of abstracts and also the international role IUGA plays in education and research. In addition to this, the PR committee has organized successful public forums at the Dublin and Brisbane meetings, which were well attended events attracting positive media attention. The committee looks forward to hosting a similar event at the 2015 Annual Meeting in Nice. Lynsey Hayward, PR Committee Chairperson
Visit to the IUGA Office in Washington, DC. -USA
Three of IUGA’s Past Presidents and IUGA’s current President visited the IUGA office following the meeting in Washington, D.C. From left to right: Harry Vervest, Linda Cardozo, Paul Riss and Willy Davila.
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www.IUGA.org
THE COCHRANE INCONTINENCE REVIEW GROUP CORNER By Dr. Imran Omar The Cochrane Incontinence Review Group was widely covered by the social media in the last few months. Many of our reviews were covered in different blogs. Sarah Chapman, from the United Kingdom Cochrane Centre (UKCC), wrote an excellent blog about pelvic floor muscle training for the management of women with urinary incontinence. The blog is based on our series of systematic reviews on pelvic floor muscle training. The blog can be accessed by clicking below: Women, embrace the power of your pelvic floor! Elaine Miller wrote another great blog on urinary incontinence featuring six reviews from the Cochrane Incontinence Group. You can access this blog by clicking below. “Don’t make me laugh” – incontinence isn’t funny You can get all the recent news and information about our group by following us on Twitter @C_Incontinence or through our website http://incontinence.cochrane.org. We are delighted to announce that the National Institute for Health Research (NIHR), United Kingdom, has extended the
funding of the editorial base of our group up to March 2020. This will help us to continue our mission of disseminating evidence based information through our systematic reviews. We organized a workshop on systematic review training during the joint annual scientific meeting of the International Urogynecological Association and the American Urogynecologic Society. We have plans to organize similar workshops in the future to train young healthcare professionals. Some of the recent reviews published by our group can be viewed by clicking on the title of the review: Dumoulin C, Hay-Smith EJC, Mac Habée-Séguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Nambiar A, Cody JD, Jeffery ST. Single-incision sling operations for urinary incontinence in women. You may contact us by email at m.i.omar@abdn.ac.uk if you require more information about our reviews or the group. Dr. Imran Omar MBBS (DOW), MD (USA), MSC (UK), MMEd (UK) Managing Editor Cochrane Incontinence Review Group, & Research Fellow Academic Urology Unit, University of Aberdeen
FIUGA CORNER - YOUR FOUNDATION IS MOVING FORWARD By Peter K. Sand, MD, FACOG The Foundation for International Urogynecological Assistance (FIUGA) was incorporated in January of 2013, but it was not until during our annual meeting this summer that we received our letter of determination from the US Internal Revenue Service. This now allows the Foundation to give donors tax credit in the USA and to solicit support from charitable foundations. However, the Foundation has been able to raise support for our initial project, the Ghana Project. The Foundation, in cooperation with the Ghana College of Obstetrics & Gynecology, has been working to support education in Female Pelvic Medicine and Reconstructive Surgery for the urogynecology Fellows, residents and faculty. The goal of this project is to establish a center of excellence in urogynecology in Ghana to improve the quality of care of women throughout the country and then to use this center as a training site for
the entire region. While their gynecological and urological faculty has expertise in fistula repair, they have limited experience in treating stress urinary incontinence, detrusor overactivity and prolapse. This has already changed dramatically with IUGA faculty visiting the Korle Bu and Kumasi medical centers in the past year. Laborie has generously donated Urodynamics equipment and T-doc catheters for both medical centers in Accra and Kumasi to facilitate the education of the urogynecology fellows. This was delivered recently and their medical director and our member, Tim McKinney, will be visiting both sites to train the Fellows, faculty and nurses in the use and care of the Urodynamics equipment.
The Foundation has also received a generous $10,000 grant from Allergan to support our second project- the funding of our eXchange programs and regional symposia. We will also be seeking funding to support the research grants awarded by the Research & Development Committee. Our goal is to raise $200,000 over the next year and $600,000 over the next 3 years. We welcome any and all contributions and would appreciate any leads for possible funding sources from IUGA members. Please visit our website at www.FIUGA.org and the Ghana project page at http://www. iuga.org/?ghana for more information. Peter K. Sand, MD, FACOG FIUGA President
Our membership has also contributed to this effort with $805 raised by sale of the FIUGA pins and $10,650 raised during the silent auction at the annual meeting. This is a wonderful start to support the work being done in Ghana.
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www.IUGA.org
IUGA PHOTO CONTEST FIRST PLACE PRIZE
Nazura bt Karim, Tsia-Shu Lo and Eileen Feliz Cortes In July 2014, the IUGA office hosted a Facebook photo contest and challenged members to show us, in photos, what they are doing for women’s health around the world. The photos were posted on the IUGA Facebook page and voted on through “likes”. Nazura bt Karim, Tsia-Shu Lo and Eileen Feliz Cortes submitted the following photo and won first place in the contest with over 1,400 “likes”. A rise in the aging population brought a rise in factors involved with aging, which include urinary and pelvic floor muscle abnormalities. Being one with the longest history of Urogynecology specialty in Asia, we continually play a role in medical education and have dedicated our energy to improving the lives of others through international collaboration. The Chang Gung International Urogynecologic Fellowship Program has more than 22 fellows coming from countries such as UK, Jordan and many other Asian countries to do their formal training and research. The center publishes most urogynecology relevant SCI cited medical papers and handles minimal wound
and reconstructive surgeries for pelvic organ prolapse and female urinary incontinence, physiotherapy, ultrasonography for urogenital tract and outpatient flexible cystoscopy. Our team was invited in Hubli, India to share the knowledge in the art and science of pelvic reconstructive surgery. In the process we also learned a valuable lesson in being resourceful, imaginative and ingenious. The collaboration embraced during the activity further strengthened our goal towards the highest level of care for women with urogynecologic problems that complement each woman's way of life and tailor it to the availability of resources in their respective countries. With the rapid growth of international cooperation we aim to provide the highest level of care for women with urogynecologic problems by being committed to designing treatments that complement each woman's way of life and overall health needs and to provide expertise in the evaluation and comprehensive treatment in the vast regions of the world.
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www.IUGA.org
DIARY FROM THE MIDDLE EAST By Dr. (Mrs.) Salma I Kayani Women’s health problems are the same all over the world. The difference arises in terms of healthcare facilities and infrastructure available, in the light of financial, cultural, religious and social circumstances. Pelvic floor problems - whether continence, prolapse or pain - remain among the biggest problems worldwide, and the Middle East is no exception. Increased birthrate, obesity, diabetes and increasing life expectancy are some of the pre-dominant predisposing factors. The female life expectancy in the Middle East ranges from 65.77 years in Yemen to 81.3 years in Qatar. It is interesting to note that Thomson Reuters have reported that around 70% of global population growth over the next 30 years will be in Muslim countries as the Muslim population of 1.6 billion is growing at twice the rate of the global population thus representing the fastest growing consumer segment in the world. The Middle East and North Africa (MENA) region accounts for 30% of this growth. This growing and aging female population needs access to good pelvic floor healthcare as a matter of urgency. Unfortunately, the treatments and treatment options available in the Middle East are only few and far between. The general philosophy among patients is that of acceptance of the problem as part of being a woman and
part of old age. Of those willing to seek help, certain cultural and social barriers stand in the way. My experience in Kuwait so far has shown that the problem is two-fold. Firstly, the paucity of high quality medical services specializing in female pelvic floor problems and secondly, patient awareness and acceptance. One aspect of the background of this lack of patient acceptance is a reluctance to seek medical assistance. The most important thing which underpins the acceptance of any treatment is the awareness and understanding that there is a solution to the problem, and this clearly is the challenge in this region. The IUGA Regional Symposium in Jeddah in Nov 2012 was a great success and there is an urgent need for similar Symposia as well as patient awareness initiatives. The IUGA is well placed to be able to share this responsibility in improving women’s health in this culturally complex and diverse part of the world. In my subsequent articles I will share my experiences in more detail. Dr. (Mrs.) Salma I Kayani MSc, DFS&RH, MRCOG Head of the Department Obstetrics and Gynaecology Consultant Obstetrician and Gynaecologist Advanced Minimal Access Surgeon In Excisional Benign Gynaecology & Programme Director for Centre of Excellence in Minimally Invasive Gynaecology (COEMIG) of the Surgical Review Corporation (USA)
2014 AUGS / IUGA SCIENTIFIC MEETING EVALUATION RESULTS By Maureen Hodgson, CMM-IUGA Associate Executive Director
Thank you to everyone who completed the 2014 meeting evaluation. This year’s survey was a little longer than past years due to the joint meeting. Your feedback is very important to us so we can see what worked, as well as areas of improvement. Staff has carefully reviewed the evaluation results and are pleased to share them with you. They will be used to help in planning the 2015 meeting, which we hope to see you in Nice, France June 9 -13, 2015. 1. Please rate the following aspects of the overall program (please note rating included is average rating out of 4) The program met my expectations The program content was relevant to my work The level of program content was appropriate for my years of experience in the field I was able to participate actively in the learning experience The program met stated objectives The program was well organized I would recommend this program to my colleagues
3.38 3.53 3.46
Meeting length (5 days) 3.14 Meeting format (Tuesday-Saturday) 3.19 AUGS/IUGA staff (helpfulness, professionalism, re- 3.63 sponsiveness prior to the meeting, onsite, etc.) 3. Please rate the networking/social events Welcome reception in exhibit hall Friday Night Global Connection Overall networking opportunities Overall meeting experience
3.36 3.42 3.44 3.49
2. Please rate the meeting logistics (please note rating included is average rating out of 4) Washington Convention Center 3.22 Washington, D.C. as a location 3.51 Advanced registration process 3.6 Registration desk on-site 3.59 Speaker ready room (for presenters only) 3.59
3.15 2.81 3.25 3.36
4. How would you compare the benefits you received from attending the AUGS/IUGA 2014 Scientific Meeting to the cost of the meeting? a.
3.0% answered low cost for value received
b.
67.6% answered appropriate cost for value received
c.
29.4% answered high cost for value received
5. How did you hear about the meeting (top 3)?
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a.
44.0% answered IUGA web site
b.
38.1% answered AUGS web site
c.
27.9% answered the AUGS e-newsletter, FPMRS news
www.IUGA.org
6. Are you planning to attend the IUGA 40th Annual Meeting in Nice, France?
10. Did you see a product or service at the exhibit hall you would like to incorporate into your practice/institution
a.
49.4% answered yes
a.
68.7% answered yes
b.
50.6% answered no
b.
31.3% answered no
7. What did you like most about the meeting (top 3 answers)
11. What is your professional status (Top 3)?
a.
The science
a.
Physician
b.
The international component
b.
Researcher
c.
Networking opportunities
c.
Physician in Training
8. What did you like least about the meeting? a.
12. Did you download the mobile app?
Convention center layout
b. Food c.
Poster hall location
Length of presenters
time
with 51.3%
Good
Average
Poor
Did not attend
43.6%
3.8%
1.3%
8.7%
Presenter preparedness
55.1%
34.6%
6.4%
3.8%
8.5%
Relevant to my practice
53.8%
35.9%
6.4%
3.8%
11.2%
Learning environment
50.0%
34.6%
11.5%
3.8%
8.6%
Ability to interact with presenter
62.9%
30.8%
3.8%
2.6%
9.2%
62.2% answered yes
b.
37.8% answered no
13. How would you evaluate the educational value of this experience on a scale of 1 = not at all valuable, 5= extremely valuable.
9. If you attended an educational roundtable, please rate the following: Excellent
a.
a.
5 = 20.2%
b.
4= 39.9%
c.
3=29.8%
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2015
Organized by In collaboration with
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IMPORTANT DATES Call for Abstracts November 4, 2014
Abstract Closing February 1, 2015
Avec traduction simultanée / With simultaneous interpretation
www.IUGAmeeting.org
JUNE 9 - 13, 2015 Nice Acropolis Convention Center
Advancing Urogynecological Knowledge Around the World
IUGA Office Staff Charles A. Shields, Jr. Executive Director chuck@iuga.org x. 114 Maureen Hodgson, CMM Assistant Executive Director maureen@iuga.org x. 115 Amy Cassini Membership Manager amy@iuga.org x. 112 Amanda Grabloski Manager of Educational Programs amanda@iuga.org x. 116 Nailah Metwally Administrative Assistant nailah@iuga.org x.111 Carlos Molina Web Master carlos@iuga.org
IUGA Board
IUGA International Advisory Board
G. Willy Davila President willydavila@iuga.org
Stephen Jeffery Africa stjeffery@gmail.com
Bob Freeman Vice-President bobfreeman@iuga.org
Roy Ng Asia royngkw@hotmail.com
Harry Vervest Past President harryvervest@iuga.org
Yik Lim Australia yik_lim@yahoo.com.au
Anna Rosamilia Treasurer annarosamilia@iuga.org
Teresa Mascarenhas Europe tqc@sapo.pt
Ranee Thakar Secretary raneethakar@iuga.org
Bob Shull North America bshull@swmail.sw.org Enrique Ubertazzi Latin America
Enrique.ubertazzi@hospitalitaliano.org.ar
Johanna Gomez Graphic Designer johanna@iuga.org
IUGA Committees
Education Committee Chairperson Jan-Paul Roovers j.p.roovers@amc.uva.nl
Public Relations Committee Chairperson Lynsey Hayward lmhayward@middlemore.co.nz
Scientific Committee Chairperson Dudley Robinson dud@ukgateway.net
Fellows Committee Chairperson Alexandros Derpapas akderpapas@gmail.com
Research & Development Committee Chairperson Dorothy Kammerer-Doak dkd@womenspsc.com
Standardization & Terminology Committee Chairperson Bernard Haylen haylen@optusnet.com.au
Publications Committee Chairperson Alex Digesu a.digesu@imperial.ac.uk
IUGA Office 2030 M Street NW, Suite 701 Washington, DC 20036 USA Phone:+1-202.733.3234 • Fax: +1-202.733.3365 E-mail: office@iuga.org www.iuga.org