Diaa E. E. Rizk

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction.

Next to existing terminology of the lower urinary tract, due to its increasing complexity, the terminology for pelvic floor dysfunction in women may be better updated by a female‐specific approach and clinically based consensus report.

An International Urogynecological Association (IUGA) International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction

Introduction and hypothesisNext to existing terminology of the lower urinary tract, due to its increasing complexity, the terminology for pelvic floor dysfunction in women may be better updated by a female-specific approach and clinically based consensus report.MethodsThis report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. Appropriate core clinical categories and a subclassification were developed to give an alphanumeric coding to each definition. An extensive process of 15 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus).ResultsA terminology report for female pelvic floor dysfunction, encompassing over 250 separate definitions, has been developed. It is clinically based with the six most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific imaging (ultrasound, radiology, and MRI) has been a major addition while appropriate figures have been included to supplement and help clarify the text. Ongoing review is not only anticipated but will be required to keep the document updated and as widely acceptable as possible.ConclusionsA consensus-based terminology report for female pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.

An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) & grafts in female pelvic floor surgery

Introduction and hypothesisA terminology and standardized classification has yet to be developed for those complications arising directly from the insertion of synthetic (prostheses) and biological (grafts) materials in female pelvic floor surgery.MethodsThis report on the above terminology and classification combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS) and a Joint IUGA/ICS Working Group on Complications Terminology, assisted at intervals by many expert external referees. An extensive process of 11 rounds of internal and external review took place with exhaustive examination of each aspect of the terminology and classification. Decision-making was by collective opinion (consensus).ResultsA terminology and classification of complications related directly to the insertion of prostheses and grafts in female pelvic floor surgery has been developed, with the classification based on category (C), time (T) and site (S) classes and divisions, that should encompass all conceivable scenarios for describing insertion complications and healing abnormalities. The CTS code for each complication, involving three (or four) letters and three numerals, is likely to be very suitable for any surgical audit or registry, particularly one that is procedure-specific. Users of the classification have been assisted by case examples, colour charts and online aids (www.icsoffice.org/complication).ConclusionsA consensus-based terminology and classification report for prosthess and grafts complications in female pelvic floor surgery has been produced, aimed at being a significant aid to clinical practice and research.

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) and grafts in female pelvic floor surgery.

A terminology and standardized classification has yet to be developed for those complications arising directly from the insertion of synthetic (prostheses) and biological (grafts) materials in female pelvic floor surgery.

International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related to native tissue female pelvic floor surgery

A terminology and standardized classification has yet to be developed for those complications related to native tissue female pelvic floor surgery.

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related to native tissue female pelvic floor surgery

Introduction and hypothesisA terminology and standardized classification has yet to be developed for those complications related to native tissue female pelvic floor surgery.MethodsThis report on the terminology and classification combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS) and a Joint IUGA/ICS Working Group on Complications Terminology, assisted at intervals by many external referees. A process of rounds of internal and external review took place with decision making by collective opinion (consensus).ResultsA terminology and classification of complications related to native tissue female pelvic floor surgery has been developed, with the classification based on category (C), time (T), and site (S) classes and divisions that should encompass all conceivable scenarios for describing operative complications and healing abnormalities. The CTS code for each complication, involving three (or four) letters and three numerals, is likely to be very suitable for any surgical audit or registry, particularly one that is procedure-specific. Users of the classification have been assisted by case examples, colour charts and online aids (www.icsoffice.org/ntcomplication).ConclusionsA consensus-based terminology and classification report for complications in native tissue female pelvic floor surgery has been produced. It is aimed at being a significant aid to clinical practice and particularly to research.

Urolithiasis in pregnancy

Urolithiasis is the most common cause of urological-related abdominal pain in pregnant women after urinary tract infection. The disease is not uncommon during pregnancy occurring in 1/200 to 1/2,000 women, which is not different from the incidence reported in the nonpregnant female population of reproductive age. During pregnancy, the frequency of stone localization is twice as higher in the ureter than in the renal pelvis or calyx, but there is no difference between the left and right kidney or ureter. Urinary stones during pregnancy are composed mainly of calcium phosphate (hydroxyapatite) in 74% of cases and calcium oxalate in the remaining 26% (Ross et al., Urol Res 36:99–102, 2008). In conclusion, urolithiasis during pregnancy can be serious, causing preterm labor in up to 40% of affected women. The pathogenesis, diagnosis, and management are analyzed.

Ageing of the female pelvic floor: towards treatment a la carte of the "geripause"

The study of menopause and female ageing “geripause” is receiving much attention lately from the health care community for three main reasons [1–3]. The first is the global increase in female life expectancy as a result of improved health awareness and services with continuing reduction of adult mortality, progressive transition from high to low fertility, and recent socioeconomic affluence in most countries. This unprecedented demographic change, which started in the developed world in the 19th century and more recently in developing countries, allowed women to experience menopausal manifestations during approximately one third of their lifespan and reach the geripause. Secondly, the process of medicalization within the broader context of the dominance of health as a cultural preoccupation in recent societies and women’s motivation by personal concerns and cultural forces to take more control of the effects of menopause and/or ageing on their bodies has resulted in increasing use of female sex hormones as a replacement therapy. Finally, there is a growing public and medical concern about the serious adverse effects of estrogen/progestin replacement therapy in old postmenopausal “geripausal” women that had been recently reported in the Women’s Health Initiative Trial. This is accompanied by considerable interest in the contemporary biomedical literature, in particular, about the prevalence, detrimental effects, and management of support-related pelvic floor dysfunction (pelvic organ prolapse, urinary incontinence, and fecal incontinence) in the geripausal population. There seems to be no consensus, however, whether the exact underlying mechanism is normative ageing, falling circulating estrogen levels caused by menopausal ovarian failure, or a combination of both factors [3–9]. It is widely believed that estrogen deprivation at the climacteric is primarily responsible for support-related pelvic floor dysfunction in geripausal women. This assumption is based on the detection of estrogen receptors in the components of continence-maintaining and supportive pelvic floor structures in premenopausal women and experimental animals [3–6]. In turn, estrogen replacement had been extensively used to prevent or restore the decline in pelvic floor support and/or deterioration of urinary and fecal control after the menopause but without critical analysis of the long-term cure rates or evidence-based improvement in clinical outcome after treatment in most studies [7]. Paradoxically, a recent meta-analysis and a Int Urogynecol J (2008) 19:455–458 DOI 10.1007/s00192-008-0576-0

Multicenter inter-examiner agreement trial for the validation of simplified POPQ system

Introduction and hypothesisThe primary aim of this study was to evaluate the inter-examiner agreement of a previously described simplified pelvic organ prolapse quantification (S-POP) system in a multicenter, prospective, randomized, blinded fashion. Pelvic organ prolapse quantification (POPQ) system’s use in daily practice is hampered due to perceived complexity and difficulty of use. The S-POP was introduced in order to make the POPQ user-friendly and increase its usage (Swift et al. in Int Urogynecol J 17(6):615–620, 2006).MethodsFive hundred eleven subjects underwent two separate pelvic exams in random order by two blinded examiners employing the S-POP at 12 centers around the world. Data were compared using weighted kappa statistics.ResultsThe weighted kappa statistics for the inter-examiner reliability of the S-POP were 0.87 for the overall stage, 0.89 and 0.81 for the anterior and posterior vaginal walls, 0.82 for the apex/cuff 0.89, and 0.84 for the cervix and vaginal fornix, respectively.ConclusionThere is an almost perfect inter-examiner agreement of the S-POP system for the overall stage and each point within the system.

Genetics of pelvic organ prolapse: crossing the bridge between bench and bedside in urogynecologic research

An increasing number of scientists have studied the molecular and biochemical basis of pelvic organ prolapse (POP). The extracellular matrix content of the pelvic floor is the major focus of those investigations and pointed for potential molecular markers of the dysfunction. The identification of women predisposed to develop POP would help in the patients’ management and care. This article includes a critical analysis of the literature up to now; discusses implications for future research and the role of the genetics in POP.