Female sexual dysfunction - International Urogynecological
Transcription
Female sexual dysfunction - International Urogynecological
Volume 7, Issue 1, 2012 IN THIS ISSUE: • The Treatment of Female Sexual Dysfunction by Dorothy Kammerer-Doak, MD - page 1 - 3 • Letter from the SecretaryTreasurer - page 12 • The History of Sacral Neuromodulation - page 9 • Controversial Corner: Are Minislings Effective? Kocjancic v. Nilsson - page 4-5 • Training of Trainers on the Global Competency-based Fistula Surgery Training manual - page 11.....and more S exual health is defined by the World Health Organization as the integration of somatic, emotional, intellectual and social aspects in ways that are positively enriching and that will enhance personality, communication and love. Female sexual dysfunction (FSD) is recognized as a widespread problem, with prevalence ranging from 25-63%. Low libido is the most common complaint, and other sexual dysfunction categories include problems with arousal and orgasm, and pain disorders. The Official Newsletter International Urog ynecological Association THE TREATMENT OF FEMALE SEXUAL DYSFUNCTION By Dorothy Kammerer-Doak, MD cular, endocrine and psychosocial factors. Male sexual dysfunction most commonly involves erectile problems, and medications that increase penile blood flow are effective treatments. FSD more commonly occurs in the arousal phase involving difficulties with libido and orgasm. Unfortunately, simply increasing clitoral and vaginal blood flow with medications does not usually result in improved desire, arousal, or orgasm. Treatment of FSD usually involves an individualized approach using a combination of education, psychosoThe advent of new therapies to cial intervention, and mediations. treat male sexual erectile dysfunction with “just a pill”, and the A first step for women with sexual media attention this has received, problems is education. It is imhas led to widespread attention of portant that women know that FSD. However, both female sexual there is no medical expected level function and dysfunction are more of sexual activity or function, and complex than the male, and FSD that lack of libido or ability to cliis more difficult to treat. Impor- max does not represent a sexual tantly, the female sexual response dysfunction as long as the woman is complex and involves neurovas- experiences no personal distress. Simple reassurance that media portrayals of female sexual activities do not accurately represent the average experience can be very helpful. Specifically, average frequency of sexual activity is 6 times per month, and 80% of women report the inability to achieve orgasm with vaginal intercourse and require direct clitoral stimulation. Also, most women do not experience orgasm with every sexual encounter. Only 30% of women climax with almost every sexual activity. An anatomy lesson regarding clitoral location as well as techniques for stimulation such as the vibrator may be helpful in giving the woman with psychosocial barriers medical permission to treat her sexual difficulties in this way. The context in which women experience desire, arousal, and orgasm incorporates physical, psycho- Page 2 logical and emotional aspects. No medical treatment will improve a bad situation or relationship. Psychosocial intervention may be necessary based on the woman’s relationship, current life stressors, and sexual problems. As a strong impetus for female sexuality is intimacy, the woman and her partner need to improve communication, reduce relationship strains when present and simply make protected time for sexual relations. The only medication proven in randomized placebo controlled trials (RCT) to improve female FIGURE 1-1: sexual function is testosterone. Male sexual response cycle de�ined by Masters and Johnson. The best studies come from the Masters WH and Johnson VE: Human Sexual Response, Boston, 1966, Little, treatment of postmenopausal and Brown & Co. surgically castrated women. The addition of testosterone, either oral or transdermal to estrogen replacement therapy (ERT) resulted in significant improvement in sexual function, including desire, arousal and orgasm, compared to ERT alone. The use of androgens in premenopausal women with FSD has been poorly studied. One small RCT reported improvement in arousal with use of testosterone gel administered 4-8 hours before planned sexual activity compared to placebo. Unlike estrogen, androgen levels gradually decrease with age starting at about 30 years, but there is no abrupt drop at the time of menopause. Therefore, premenopausal women with serum free testosterone levFIGURE 1-2 els below the lowest quartile of The interrelatedness of intimacy, sexual arousal, desire and satisfaction. normal range and with FSD may Female Sexual Response Cycle be offered testosterone but need Copyright 2001 from “Complexities of Woman’s Sexual Function” by Basson R. to be counseled on the absence of efficacy data and safety. Blood levels should be monitored to sistent in randomized controlled The ability of systemic HRT to achieve physiological levels in the trials, including RCT. Since estro- enhance sexual arousal, desire mid-upper level of normal range. gen improves vaginal and clitoral and ability to achieve orgasm is blood flow, vaginal administra- not definitive, but recent RCT The effects of systemic hormone tion best improves lubrication for have reported beneficial affects of replacement therapy (HRT) on the treatment of pain disorders. ERT on sexual desire, enjoyment, female sexual function are incon- Volume 7, Issue 1, 2012 orgasmic frequency and vaginal lubrication, but no difference in coital frequency. Many experts do initiate systemic HRT in the absence of contraindications in postmenopausal women with FSD. Tibolone is a synthetic steroid with estrogenic, progesterogenic and androgenic properties with possible positive effect on sexual function utilized in Europe for more than 20 years. In RCT, Tibolone demonstrates significant improvement in clitoral circulation and sexual function scores as compared to conventional HRT in postmenopausal women with FSD. Medications used to treat male erectile dysfunction such as sildenafil have also been studied in women with FSD. These medications increase genital blood flow by inhibition of phophodiesterase thereby facilitating nitric oxide mediated relaxation of clitoral and vaginal smooth muscle. In several large trials of women with FSD, despite increased vaginal and clitoral blood flow and increased lubrication and engorgement caused by sildenafil, there is no consistent improvement in sexual function. Unlike the male, there is poor correlation between subjective and objective arousal in the female, and increased genital blood flow does not translate into improved subjective arousal. There does not appear to be any clear benefit to the use of sildenafil in FSD. However, in women with isolated arousal disorders who have low vaginal engorgement as measured by vaginal pulse amplitude with photoplethysomography, a few RCT have reported significantly increased subjective arousal and improvement in sexual function. Women who benefit from this class of drugs may be those who Page 3 have an underlying medical cause for deficient genital engorgement and not those with deficient subjective arousal, such as type I diabetes or following genital radiation. Other medications used to treat FSD include topical and oral medications which are available over-the-counter. These preparations utilize a combination of herbs and botanicals, and some contain L-arginine, a precursor for nitric oxide, which facilitates genital smooth muscle relaxation. Small RCT demonstrating improved sexual function have been conducted using these medications. Prostaglandins topically applied to the genitals have also been studied for the treatment of FSD. While topical prostaglandins increase genital vasocongestion and lubrication, this does not translate to consistent improvement in female sexual function. In summary, women with sexual dysfunction commonly have problems which overlap the different stages of FSD, arousal, desire, orgasm, and pain. Management involves assessment of the level of dysfunction, education of average sexual practices, ways to improve intimacy, treatment of pain, evaluation for need for psychotherapy, and medical management when indicated. Hormone replacement therapy, including testosterone, is probably beneficial in the postmenopausal woman, but the role of androgens in premenopausal women with sexual dysfunction is still under investigation. Call for IUGA Grant Proposals for 2013 Coming Soon In February, IUGA will be announcing a Call for Proposals for IUGA-sponsored grants that have been developed to provide hands-on training, promote research and development, and prompt exchange of knowledge and ideas: Research Grants: Designed to fund development of the proposed research project including all materials and testing, statistical analyses, and services required to complete the research. 3 types of grants in the amount of US$20,000 each will be awarded for 2013: •Basic Science •Clinical •Least Developed Countries Fellowship Grants (US$30,000): Allow for increased dissemination of urogynecological knowledge by funding travel and living expenses for a trainee to visit a renowned Urogynecology Center and perform a Fellowship as well as formulate and complete a research study. Observership: Offset costs of visiting an approved host site which has proven expertise for a specific specialty (selected by applicant). Recipients will spend 2 to 4 weeks at an approved site, with the agreement that a formal report of the observer’s experience will be submitted and published in the IUJ. Five grants in the amount of US$4,000 each will be awarded for 2013. For additional information about these grants, including due dates, please visit http://www.iuga.org/?page=education. Page 4 Controversies in Urogynecology By Ervin Kocjancic, Illinois Minislings: A Molecular Cuisine M inislings can be viewed as the molecular cuisine where the essence of a certain food is taken, re-elaborated and served. The essence of the stress urinary incontinence surgery is mid urethra, the re elaboration is the piece of tape placed only at that area and voila’ a new dish is prepared. If we keep in mind all the possible risks of incontinence surgery it does not seem a bad idea to minimize the hazardous steps of the procedure and preserve only the essential portion, which is the piece of mesh under mid urethra. So, with this new technique there are no more blind passages through the retropubic area with risks of bladder perforation, major vascular injuries or even worse bowel penetration. Additionally, the procedure can be done with only one incision minimizing the risk of infections due to skin incisions. Minislings have another potential advantage, a lesser amount of mesh placed in the patient’s body. The procedure is quick and can be performed under local anesthetic and patients are usually able to go home within a few hours after having the procedure. The recovery time is also short; patients should have little interference with daily activities. It seems that we finally have an ideal procedure that can address all the uncomplicated incontinence cases. When I am talking of uncomplicated urinary incontinence I have in mind the one associated with excessive urethral mobility and a good quality urethral wall and sphincter muscles. I am excluding Intrinsic Sphincter Deficiency (ISD)! The type of patient I am referring to is a relatively young patient, in the prime of her life that is having some occasional urine leaks while golfing, dancing or exercising and uses few mini pads a day to manage their problem. This is a woman with uncomplicated urinary incontinence who I believe is the ideal candidate for a minisling procedure. Unfortunately we are not there yet! We have a good answer to address mid urethral hyper mobility, but our due diligence to reduce the amount of mesh is still in progress. Minislings are a pretty heterogeneous category and the only common factor among the various available minislings is the fact that they all require a single incision for placement. We should call them single incision slings and roughly divide them in 3 categories based on anchoring mechanism. Some of them are using a Velcro effect (as the TVT secure), whereas the Needless, are using a pocket at the end of the tape where the tissue is supposed to enter and fixate the mesh. This particular tape can not really be called minislings with its 12cm of length! The majority of the other single incision slings are using anchors for their attachment. Another variability is also represented by the anatomical structure where these slings should be attached. The range goes from the periosteum of the pubis, the obturator internal muscle to the obturator membrane. Keeping in mind the relatively high variability of the pelvic floor anatomy it is easy to understand that not all these products are feasible for all patients. For instance, if we consider the variability of the size and tonus of the muscles in different ages we cannot expect good, “juicy” biceps in a 70 year old lady compared to her nephew who is 25 years old and plays tennis every day. Why would the obturator internal muscle be any different? In my mind this is the main disadvantage of the anchor-based minislings that are relying only on the insertion of the anchor in this muscle. The other critical point of these procedures is the fixed length of the mesh that has to be used. There are only two single incision slings available worldwide, that are providing a good anchoring mechanism, where the anchors are inserted in a more reliable structure than an atrophic muscle. I am talking about two slings that should be called as mini trans obturators (mini TO’s) and these are Ajust and Altis. The anchoring structure is represented by the obturator membrane, the anchors are solid and built in such a fashion that in my animal study we were not able to remove them once implanted without breaking the mesh (this was not the case with all the other minis that we tested). The other peculiarity of these two products is represented by the fact that they can be easily and truly adjusted after they’re positioning. Yes, I know that we need some science behind all this, and we need appropriate length prospective randomized studies to confirm that these new products/procedures are as good in providing cure rate and that they are really reducing the incidence of complications. But, if we are thinking of the anatomical facts, the only difference between mini TO’s and the old fashion trans obturator tapes is represented by the skin and the fatty tissue that covers the obturator foramen. To my knowledge skin and fat does not represent a valid anchoring mechanism. In summary, I do like minislings, but the ones that allows me a good and reliable anchoring and ones with an easy adjustability. PRO Volume 7, Issue 1, 2012Page 5 Controversies in Urogynecology By Carl Gustaf Nilsson, Finland Minislings: Advantages Few! T he first modern minimally invasive surgical procedure for treatment of female stress urinary incontinence, the original retropubic Tension-free Vaginal Tape (TVT), was launched for clinical use in 1998, at a time when several prospective observational trials with a follow-up of one to two years had been published in peer reviewed journals. Now more than eleven years of follow-up has confirmed the safety and durability of the TVT operation. The efficacy of the TVT procedure has been shown to be superior to more recent modifications of this mid-urethra sling in randomized trials including under more demanding circumstances such as intrinsic sphincter deficiency, recurrent incontinence and in patients with severe stress urinary incontinence. Comprehensive registries from at least five different countries revealed low rates of complications, the most common being bladder injury with a rate of 2.7-3.8% when the procedure was performed under local anesthesia and 7.3% when performed under spinal or general anesthesia. Major organ injury was found at a rate of 0-0.07%. Due to these rare complications the blind passage of the TVT trocars retropubically has aroused concerns and been substituted by a different blind passage through the obturator membrane and muscles including the adductor muscles of the thighs. These trans-obturator procedures have different complications, some of which are major in nature. Bladder perforations have been reported with all obturator procedures. Superiority of the transobturator procedures over the TVT regarding efficacy, safety and durability has not been shown by randomized trials to date. slings were developed to further decrease invasiveness by limiting the amount of blind passage of the trocars. Theoretically they should maintain efficacy and reduce the risks of complications. Similar to the original TVT studies many reports on minislings stated that the operation can be performed under local anesthesia. Yet a great number of the single incision slings have been performed under spinal or general anesthesia according to published literature. Invasiveness of a procedure is not only accounted by the procedure itself but also by the mode of anesthesia. In addition, it is a mistake to think that the single incision sling operations do not involve blind passages of instruments or devices. The only difference compared to the traditional mid-urethral slings is the extent or length of the blind passage, being shorter with the minislings. A recent meta-analysis along with a few randomized trials indicated that the mini-slings are inferior to the traditional mid-urethra slings regarding efficacy. Interesting bladder injuries, heavy bleeding, hematomas, thigh pain, voiding difficulties and de novo urgency symptoms have been reported for the mini-slings at a rate equivalent with the traditional mid-urethral slings, perhaps with the exception of bladder perforations. fore had to be withdrawn from the market. Withdrawal of devices is not only an economical loss for the industry but, more importantly, it affects a woman’s quality of life, confidence in the medical profession and possibility of final cure as repeat procedures have a poorer outcome than primary ones. Additionally it represents a waste of limited health care resources. Therefore “Why launch the mini or single incision slings at a stage when no evidence, what so ever, exists on the superiority of these over well documented procedures regarding efficacy, safety and durability?” Although nothing is perfect and one should always seek improvements, my suggestion is that innovations should not be spread to general clinical use outside ethically approved research projects until an improvement has been established by findings from robust clinical research. As long as no improvement has been shown let’s stick to the procedures that we know can easily be performed as a day-case on the majority of women who might benefit from surgery and result in a safe and durable cure! CON The mini-slings or single incision Most if not all the available minislings have been launched with hardly any documentation on efficacy beyond short follow-up of a few weeks to a year. A lesson should have been learned from the initial experience with traditional mid-urethral slings when it became evident that several modifications of the TVT procedure and the initial transobturator procedures, launched at an early state of experience, did not fulfill expectations of efficacy and safety and there- Page 6 felloWs Commitee UPdate T he Fellows Committee would like to pay tribute to the outgoing chair Sylvia Botros. Thanks to her innovations, in the last 12 months the Fellows Committee has undergone a complete reorganization, which has had a remarkable effect on the productivity of the committee. During the most recent annual IUGA meeting in LisRufus Cartwright, MD bon, the committee met Incumbent Committee to consolidate a new set of Chair bylaws, outlining a mission and aims, defining the membership specifications, and formalizing new subcommittees. The new mission of the IUGA Fellows Committee is to contribute to the academic development of fellows/ trainees in the field of Urogynecology/Female Pelvic Medicine and Reconstructive Surgery by fostering international collaboration and scholarship. All IUGA membership holders in training or in a fellowship program are welcome as members of the Fellows Committee. New members will be added yearly at the annual IUGA meeting and are invited to stand as Chair or co-Chair or join one of five subcommittees (Membership, Fellows Research Network, Communication, Social Planning and Mentoring). By Rufus Cartwright The IUGA Fellows Mentoring Subcommittee was created this spring, and is collaborating with the Education Committee to create a resource document for those who are preparing for clinical clerkships or observerships to help with visa and licensure issues. An assessment survey to better understand the necessity and to prioritize the activities regarding the mentoring program was completed by the IUGA members at the Lisbon meeting last summer. The most commonly cited priorities were: 1. To coordinate clinical training clerkships for physicians-in-training at other institutions, 2. To coordinate research collaboration between physicians with similar interests and varying levels of expertise, and 3. To teach visiting physicians treatment methods (surgical or non-surgical) that are unique to a particular site. The Mentoring Subcommittee plans to create a resource to connect interested mentors and mentees based on these priorities. The Fellows Social Planning Subcommittee coordinated a variety of events at the 2011 Lisbon meeting. Fellows Day, held a day prior to the start of the meeting, was an absolute success. This program involved fellow-directed lectures from world experts in the field, a hands-on pelvic model session for mesh implants, and a fellow’s paper session where fellows had the chance to receive feedback from well-published authors on oral presentations and research design for studies. At the end of the day, there was a special dinner for fellows to network and meet IUGA Volume 7, Issue 1 2012Page 7 leaders. New this year was a Fellows Lounge with access to model demonstrations, 3-D videos, computers with WiFi access, snacks, and beverages. This lounge was a great spot for fellows to network and prepare their talks. Lastly, an interactive Stump the Professor session was coordinated in the General Session. IUGA past presidents were challenged with interesting cases presented by fellows. This session was well attended and sparked stimulating discussions. The Fellows Committee hopes to continue providing similarly robust activities for fellows in the upcoming annual meeting. In previous years, the Fellows Committee has had difficulty contacting first year trainees and fellows ahead of the annual meeting. If you have new trainees starting this fall who would like to get involved, please encourage them to join the IUGA Fellows Group via www.iuga.org. We look forward to welcoming them to the Fellows Day activities in Brisbane, and hope as many as possible will put themselves forward as members of either the Committee or the new Research Network. Sylvia Botros, MD Outgoing Committee Chair IUGA Research Fellows Committee Research Fellows Network (RFN) Call for Proposals In 2012, the IUGA Fellows Committee are forming a new Fellows Research Network (FRN), intended to foster innovative international studies across the breadth of Urogynecology. Ahead of the next meeting in Brisbane 2012, the Fellows Committee would like submissions for potential multi-centre studies, with the intention of adopting one or two studies. In the first year of the FRN, a total of US$20,000 is available. All proposals will be screened by the FRN Steering Committee and Advisory Board prior to the annual meeting. Selection of projects will be made by vote of the IUGA-FRN members with input from the Advisory Board Members present at the meeting. If you have a study idea that you feel would benefit from this international collaborative approach we would welcome a one page structured summary, outlining the background, aims, target population and likely outcomes. Submissions can be made to [email protected] with a deadline of May 16th, 2012. For more information about the Fellows Research Network and to download an application form and IUGA-FRN bylaws, please visit http://www.iuga.org/?page=frncallproposals (IUGA login required). Page 8 The highlight of this 3-day Symposium is the Pre-Symposium Workshop on Ultrasound Pelvic Floor Imaging conducted by Prof Peter Dietz (Australia). He will be delivering 4 lectures: anterior and posterior compartment, slings and pelvic trauma, and performing 2 live scanning sessions. After lunch Prof. Azmi Md Nor (Malaysia) will conduct the Endoanal Ultrasound Workshop for Beginners with a lecture and live scanning demonstration. The rest of the first day is dedicated to faecal incontinence, obstetric anal sphincter tear and irritable bowel syndrome. The symposium proper over 2 days is equally proportioned between pelvic organ prolapse (POP) and urinary incontinence. Other highlights of the symposium include: • • • • Didactic lectures covering a wide range of topics from basic and clinical pelvic anatomy to investigations and management. Management of POP including conservative treatment, uterine conservation, conventional surgery, self-cut meshes and mesh kits, laparoscopic surgery and female sexual dysfunction. Management of urinary incontinence including conservative treatment, OAB, recurrent UTI, painful bladder syndrome, colposuspension (open & laparoscopic), mid-urethral tapes, minislings, fistulae and urinary tract injuries. Q&A sessions The regional IUGA Symposium for North America will be held in Southern California and is being hosted by University of California, Irvine. This unique 2-day symposium is designed for practicing urologists, gynecologists and colorectal surgeons who are seeking solid knowledge and basic skills in female pelvic disorders. It is a multidisciplinary program presented by experienced international and U.S. faculty in the fields of female urology, urogynecology, geriatrics, colorectal surgery and physiotherapy. Highlights of the symposium include: • • • • • Focus on basics of female pelvic medicine and reconstructive surgery. All day Friday with didactic sessions and Saturday for the hands-on laboratory cadaveric and inanimate surgical skills workshop taught by expert surgeons. Basics and innovative hands-on training sessions that participants will not have in any other program Six stations that provide cystoscopy training using bulking agents injections in a model very close to the human bladder and urethra. Parallel to the endoscopy training, an anatomy session will be held proctored by the expert faculty using several fresh frozen female cadaver pelves. Course Director: Gamal Ghoniem, MD To register to attend these symposiums, visit www.iuga.org Volume 7 Issue 1, 2012Page 9 The History of Sacral Neuromodulation By Sohier Elneil E lectrical neuromodulation of the lower urinary tract began over a century ago, but it was the pioneering work of Tanagho and Schmidt in the late 1980s that demonstrated electrical activation of efferent fibres to the striated urethral sphincter inhibited detrusor contractions. Stimulation of the third sacral root (S3) has been shown to be effective in stimulating the urethral sphincter. A large multicentre (Medtronic MDT103 - USA, Canada and Europe) prospective randomised clinical trial was set up to look at efficacy and safety of chronic neuromodulation to the S3 nerve (sacral neuromodulation or SNM). Results of this study led to approval by the Food and Drugs Administration in October 1997. Over 25,000 neuromodulators (Interstim® and Interstim II®, Medtronic Inc, Minnesota, Minneapolis, USA) have so far been implanted for approved urinary indications, paradoxically including both overactive bladder syndrome and functional nonneurogenic urinary retention or chronic urinary retention (CUR) and voiding dysfunction secondary to urethral sphincter overactivity (USO). Indeed, SNM has been shown to be a most effective therapy in women with these conditions. How SNM works remains to be clearly determined, but it is the work on women with CUR and USO that has shed some light on the matter. It is thought to restore normal micturition habits in these women, by resetting brainstem function. SNM was first described as a treatment for CUR in the mid-1990s. The first stage of SNM was an initial test procedure, known as a percutaneous nerve evaluation test (PNE) which if found to be positive and restore voiding ability, was followed by the implantation of a permanent sacral electrode. Success rates for women with retention for this method were reported at 40 – 50% for the PNE, with approximately 60% voiding to completion with formal implantation. At Queen Square our experience has been comparable, with two thirds of patients continuing to void without need for catheterization at a follow up of 5 years. However, we no longer use PNE as an evaluation test, as our results with the staged procedure are superior. Various theories abound regarding its mode of action. Two components have been identified (i) activation of efferent fibres to the urethral sphincter with negative feedback to the bladder (pro-continence reflex) and (ii) activation of sacral spinal afferents resulting in inhibitory reflex efferent activity to the bladder. Reflex pathways at the spinal cord and supra spinal levels are thought to be modulated to achieve these effects. The prolonged beneficial effects of the stimulator, after it is switched off, support this observation. Further support for this hypothesis was provided by a functional MRI study of the brain, where brain responses to bladder filling in USO patients were abnormal. The overactive urethral sphincter was thought to generate an abnormally strong inhibitory afferent signal, thus effectively blocking bladder afferent activity at the sacral level and deactivating the higher centres. Hence, there would be a loss of bladder sensation and voiding ability. SNM is postulated to interfere with the inhibitory afferent activity arising from the urinary sphincter and thus restoring the sensation of bladder filling and the ability to void. At a central level, decreases in regional cerebral blood flow measured by PET scanning was demonstrated in the cingulate gyrus, the midbrain and other adjacent structures in chronically implanted patients with urge incontinence. SNM appears to restore activity associated with brainstem auto regulation and attenuation of cingulate activity, critical to bladder function. Unsurprisingly, SNM is now also used in chronic bowel and pelvic floor dysfunction. With the advent of other peripheral neuromodulation techniques, and an increasing scope for the application of this technology, the role of SNM in the urogynaecologist’s armamentarium is becoming increasingly important. Page 10 IT News Corner Now available on the IUGA website homepage is our new animated news slider banner. The banner will be your source for IUGA’s most recent news, events, articles, etc. The way it works is pretty simple. It contains the top 5 featured items on the website. If you are interested in a specific topic in the news slider, simply hover over the slider with your mouse pointer and the animation will stop, allowing you to click on the news story or link you are interested in. This news feature is supported in any browser, including mobile devices. Don’t forget that you can now follow us on facebook and twitter to stay up to date on the latest news, IUJ article discussions and much more. Facebook.com/iugaoffice Twitter.com/iugaoffice Mobile App We are currently working to develop an Apple App for iOS Mobile devices. Stay tuned and make sure to check back in our next newsletter for information on the progress of our mobile app development for IUGA. Carlos Molina IT Director Dear IUGA Members, The International Urogynecology Journal is introducing a new column entitled “Urogynecology Digest”, starting from the December 2012 issue onwards. The aim of the new column is to inform readers about interesting and stimulating research in Urogynecology topics published in other scientific journals. In the last couple of pages of every IUJ issue, up to three recent papers will be reviewed accompanied by a short comment highlighting the key features so as to stimulate further reading. IUJ is welcoming proposals for studies published elsewhere within the last year to be submitted to the column. Proposed studies can be published either by your own group or by other researchers. Please submit your proposed articles, with a brief review and a short comment (not more than 400 words in total), to [email protected], who is currently coordinating this new column. Final editing will be performed by Paul Riss prior to publication and of course your name will be on the column page! We are looking forward to your contribution. Volume 7 Issue 1, 2012 Page 11 FIGO and Partners Training of Trainers on Global Competency-Based Fistula Surgery Training Manual By Sohier Elneil In the last three years, there has been a worldwide initiative in developing a consensus document on standardized training for surgeons in the developing world on urogenital fistulas, sustained as a consequence Suzy Elneil, author/editor of the of obstetric trauma. Global Competency-Based FisWhilst FIGO initiated tula Surgery Training Manual the working group, the document was drawn up with input from members of different professional bodies and non-government organizations. These included the International Society of Fistula Surgeons, EngenderHealth, the Royal College of Obstetricians and Gynaecologists and the Pan-African Association of Urological Surgeons. It was funded and supported by the United Nations Population Fund. In July 2011, the final document was published and made available freely on the FIGO website. In August 2011, the first training of the trainers’ course took place in Dar-es-Salaam in Tanzania for participants from Anglo-phone Africa. The meeting was attended by members of the above organizations and of IUGA. The training took place over two days, where we held discussions about how to implement a competency-based training system within different teaching environments, how to appraise and achieve accreditation in fistula surgery and how to deal with the difficult trainee. All participants were already wellestablished fistula surgeons within their own right but who nevertheless found the training sessions very helpful in understanding how the manual should be used. The next training course is due in April 2012 for participants from Francophone Africa. Further information about the manual can be found by visiting www.figo.org and selcting the Fistula link. Pictured Below from left to right: Back Row: Esam Gaffar (Sudan), Peter Melchert (USA), Joseph Rumingo (EngenderHealth), Andrew Browning(Tanzania),HamidRushwan(CEO,FIGO), Abdelrahman Al-Fakih (Sudan), Lord Patel (Chair, FIGOFistulaCommittee),GordonWilliams(Ethiopia), Kevin Hayes (RCOG) and Tom Rassen (Kenya) Front Row: Mulu Muleta (Ethiopia), Marietta Mahendeka (Tanzania), Serigne Gueye (Senegal), Suzy Elneil (Author/Editor), Ambaye Woldemichael (Ethiopia) and Louise Knight (WAHA International) Did you know that IUGA members can view our newsletter online? Just visit www.iuga.org, log-in and look for the “Access the Newsletter” icon on our home page. Page 12 A Letter From the Secretar y -Treasurer F ive cities entered bids to host the 2015 joint annual meeting of IUGA and ICS. A joint committee of IUGA and ICS representatives reviewed the bids and shortlisted three for consideration by the members of both societies: Cape Town, Lyon and Sydney. The ballot closed just before the holidays, and after tallying the votes and working with the ICS office on duplicate votes, the winning city was Lyon, France. Co-chairs of the winning bids are Brigtte Fatton (urogynecologist) and Emmanuel Chartier-Kastler (urologist). Congratulations to the French colleagues! And thank you to the other bidders who put in a lot of effort in developing and presenting their bids to host. Throughout this process our collaboration with the ICS leadership has been excellent, and I would personally like to thank Jacques Corcos and Sender Herschorn, successive general secretaries of ICS, for the excellent collaboration, which I’m sure will continue going forward in this joint endeavor. The next topic on the agenda will be our joint search for a professional congress organizer to help us organize the meeting in 2015. By Søren Brostrøm The current office in Pompano Beach has moved to a new larger, but temporary space in Ft. Lauderdale. In the second half of 2012 we will relocate the office from South Florida to another US site which will provide a better environment of networking and resources to meet our strategic goals. The Washington DC area seems to be the best option. We will work with an executive search consultancy to hire an Executive Director with previous and extensive association and non-for-profit management experience to oversee the transition and provide strategic leadership going forward . All these measures will strain the 2012 budget, and onwards the management of IUGA’s expenses will be significantly larger than previously. The Executive Board knew that these measures were vital to the future development and growth of IUGA, and a logical consequence of the results of the strategic planning. It is the intention to keep a South Florida office going probably through most of 2012, as the search for an Executive Director and setting up a new office in DC will likely take some time. We will do our utmost to ensure that these transitions are acceptable to everybody, and we will take good care of our current staff, whilst striving to provide uninterrupted service to the membership. Kind Regards, Mark your calendars for 30, June – 5, July 2015 for the Søren Brostrøm joint meeting of IUGA/ICS. Secretary-Treasurer In the last newsletter I reported on the ongoing strategic planning and management assessment of IUGA activities and organization that we initiated in Lisbon last summer. We’ve decided on some major changes in the future management of IUGA: We have expanded the current number of staff and size of office space to accommodate the increasing numbers of tasks and projects inside IUGA, and to more properly service and retain the membership. Our new office building Volume 7 Issue 1, 2012Page 13 News from the IUGA Office By Maureen Hodgson, CMM T he IUGA staff has been very busy these last few months and we are excited to share some of our accomplishments with you: Moved from our original location in Pompano Beach to the downtown area of Fort Lauderdale. Expanded our staff by hiring a new Membership Manager, Amy Cassini and two part-time employees, Johanna Gomez who is cleaning up the membership database and Alex Marciello who is providing adminsitrative support. Updated our phone system and file server to better serve the needs of our members. Assigned staff liaisons to each of the IUGA committees. This is just a small sampling of the positive changes happening within IUGA. Our number one priority is to provide outstanding customer service to all of our IUGA Members. I am happy to report that we have compiled the evaluation forms from our 36th Annual Meeting in Lisbon. Overall the meeting was a huge success and we received positive feedback in many areas: Quality of A/V Good Services provided on site Excellent Organization of Scientific Program Good Ease of abstract submission Good Appropriate time for Q&A Good Congress website Good Ease of registration Excellent Overall organization Excellent Overall workshop programs Good Length of conference Good Social Program Excellent Facility conducive to learning Good As we plan our 37th Annual Meeting in Brisbane, we will pay careful attention to these ratings and strive to improve them. We will also do our best to implement any suggestions or feedback our members provided at the meeting. Lastly, I would like to share with you that Elektra McDermott has decided to pursue other career opportunities outside of IUGA. Elektra has been a valued team member for over 4 years and will be missed greatly. Her last day with IUGA will be Wednesday, February 29th; after that, Elektra will work for IUGA on a contract basis. In the meantime, the IUGA office will be hiring her replacement to ensure a seamless transition. Let us all wish Elektra much success in her future endeavors. Please make sure you update our new contact information: 790 East Broward Blvd, Suite 300 Fort Lauderdale, FL 33301 Office: +1954.763.1456 Fax: +1954.763.1236 Sunny Regards, Maureen Hodgson, CMM Administrative Director Page 14 Membership Ser vices Dear Members, I am so excited to be working at the IUGA office as the new Membership Manager. It’s wonderful to work for such a diverse association. With members from 40 different countries, you can imagine how challenging it can be to serve the indiviual needs of each member. Over the next year, I will be working diligently to improve communication with our members and determine how we can best serve them. Please know that your feedback and suggestions are always welcome and I may be reaching out to some of you directly for assistance! In the meantime, if you have any questions or concerns regarding your membership, please feel free to reach out to me via e-mail at [email protected] or by calling 954.763.1456 x.112. I look forward to meeting some of you at the Annual Meeting in September! Amy Cassini, Membership Manager Affiliate Societies Interested in becoming an Affiliate Society? National, international or regional organizations with a focus on Urogynecology may apply by letter or email for Affiliation with IUGA through the IUGA office. This application will be reviewed by the Executive Committee and a response will be given within 30 days. A minimum of 30 paying members are required. A Society representing a small nation/interest group may apply for exception to become an Affiliate Society. For more information please contact Amy Cassini at [email protected] or visit our web site affiliate’s page at http://www.iuga.org AGES AUB BSUG CAU UGS NVOG URPSSI IUS AIUG KUGS SMUG NBUG PSURPS SPCPR PSUG SSUG SOGV TUPRA UPG Australasian Gynaecological Endoscopy & Surgery Society Michele Bender British Society of Urogynecology Atia Khan Austrian Urogynecology Working Group Dr. Dieter Koelle Colombian Association of Urogynecology Dr. Carlos Diaz Czech Urogynecological Society Dutch Society for Urogynecology Indian Society for Urogynecology Israeli Urogynecology Society Italian Society of Urogynecology Korean Society of Urogynecology Mexican Society of Urogynecology Nucleus Brazilian Urogynecology Group Phillipine Society for Urogynecology and Reconstructive Pelvic Surgery Dr. Mirek Masata Dr. Wilbert Spaans Dr. N. Rajamaheswari Dr. Yuval Lavy Maurizio Bologna Dr. Yong Min Kim Dr. Sergio Flores Rosas Rodrigo Castro [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] Dr. Lisa Prodigalidad [email protected] Portuguese Society for Pelvic Reconstructive Surgery Dr. Helio Retto [email protected] Portuguese Society of Urogynecology Slovene Society of Urogynecology Dr. Liana Negrao Society of Obstetrics and Gynecology of Venezuela - Section of Urogynecology Dr. Adolf Lukanovic [email protected] Dr. Dhelma Isabel Pellin [email protected] Dr. OnayYalcin [email protected] Turkish Society of Urogynecology Urogynecology Peruvian Group Dr. Rosa Reategui [email protected] [email protected] Volume 7 Issue 1, 2012 Page 15 2012 Membership renewal Membership starts on sign up date and is valid for 1 year $100 membership includes: • • • • 12 issues of the International Urogynecology Journal (IUJ) Substantial discount on 2012 IUGA Annual Meeting registration Members only content via www.iuga.org IUGA newsletter Complete this form or renew online at www.iuga.org To renew by FAX, please fill in the fields below and fax in to the IUGA office at +1-954-763-1236. member number _______________________________________________________________ first / last name _______________________________________________________________ address _______________________________________________________________ _______________________________________________________________ city ___________________________________________ state/province __________________ country ________________________________ zip/postal code ________________________ email __________________________________________________________________________ Please provide a current email for important correspondence and announcements from the IUGA office. Payment details □ visa □ mastercard □ american express name on card ___________________________________________________________________ billing address _______________________________________________________________ _______________________________________________________________ city ___________________________________________ state/province __________________ country ________________________________ zip/postal code ________________________ card number ____________________________________________________________________ expiration date _________________________ csc code** ____________________________ 3 digit code on signature strip of visa/mc or 4 digit code on front of AmEx **required** advancing urogynecological knowledge around the world IUGA Office 790 East Broward Boulevard, Suite 300 Fort Lauderdale, FL 33301 USA Phone:+1-954.763.1456 Fax: +1-954.763.1236 E-mail: offi[email protected] IUGA Office Staff Maureen Hodgson Administrative Director [email protected] x. 115 Kendra Busby Finance Manager [email protected] x.113 Amy Cassini Membership Manager [email protected] x. 112 Elektra McDermott Director, Educational Programs [email protected] x. 116 IUGA Executive Committee IUGA International Board Harry Vervest President [email protected] Peter DeJong Africa [email protected] G. Willy Davila Vice-President [email protected] Lisa T. Prodigalidad Asia [email protected] Peter K. Sand Past-President [email protected] Hans Peter Dietz Australia [email protected] Søren Brostrøm Secretary-Treasurer [email protected] Teresa Mascarenhas Europe [email protected] Robert Shull North America [email protected] Carlos Molina IT Director [email protected] x. 114 Enrique Ubertazzi Latin America enrique.ubertazzi@ hospitalitaliano.org.ar IUGA Committees Education Committee Jan Paul Roovers Chairperson Public Relations Committee Lynsey Hayward Chairperson Scientific Committee Michele Meschia Chairperson Fellows Committee Rufus Cartwright Chairperson Research & Development Committee Dorothy Kammerer-Doak Chairperson Terminology & Standardization Committee Bernard Haylen Chairperson Publications Committee Alex Digesu Chairperson The IUGA Newletter is published by the members of the Publications Committee Editor: Alex Digesu Associate Editors: Steven Swift & Suzy Elneil Editorial Board: Eva De Cuyper, Alexandros Derpapas, Annette Kuhn, Pallavi Latthe, Mark Malak, Luis Miguel Monteiro, Menahem Neuman, Paul Riss, Kamil Svabik, Bary Berghmans, Nathan Guerette, Kannan Kurinji, Deborah Karp, Aparecida Pacetta If you are an IUGA member who is interested in joining a Committee, please e-mail [email protected]