I recently went to a conference.

The joint AUGS (American Urogynecologic Association) and IUGA (International Urogynecological Association) conference to be exact.  A few years ago, a good friend asked me why doctors go to conferences thinking that we learn everything in medical school.  And the answer is pretty simple.  The science is always evolving, and we need to stay current.

I need to know what’s new.  What the latest research shows.  If there are new tools that make surgery easier.  And if there are new tools, like videos or leaflets, that help me inform my patients.  I want to try the new VR trainers for robotic surgery.  And I need to network and look for opportunities to collaborate- because that’s always fun.  All of this helps me to practice evidence-based medicine and to make sure I’m offering everything I can to my patients.

So here are the three things I learned this year.

Midurethral slings are the best options for stress incontinence surgery.

This is always a very interesting conference because there are many different points of view.  The European View is frequently different than the US view.  There are participants from Australia, New Zealand, India, and Africa, too- all with different outlooks.  There are urologists and urogynecologists.  Each specialty tends to look at things a little bit differently.  This means that there is a lot of healthy debate.

I love listening to different points of view.  Sometimes it strengthens what I think, and sometimes I change my opinion.  Either way, I think this is healthy, and you should always be able to support your opinion.  During one of the sessions, there was a lively debate on the best surgery for stress incontinence.

For a little background, midurethral slings (commonly called mesh slings) are on a pause in the UK and Australia.

This means that they are not performed.  This was a political decision and not based on medical data.  But for the past four years, if you lived in London and wanted a mesh sling for your stress incontinence, you would have to travel to Paris to have it placed.  During this time, surgeons in these countries have resumed doing incontinence procedures that don’t use mesh.  I was very interested to hear what they thought.  Would they miss the mesh sling?  Would they think their current procedures worked just as well?

The answer wasn’t unanimous,, but there was a hefty majority of all participants who agreed that mesh slings worked the best.  This is what the data shows.  And surgeons from all around the world agree- a midurethral sling is the best surgical option for stress urinary incontinence.

But let me just pause a minute to focus on the word “best.”  Surgically, we think that mesh slings have the highest cure rates and last the longest.  But this does not mean that they are the right surgery for all women.  As the wise Cheryl Inglesia from MedStar pointed out, this may not be what every patient wants.  Choosing the right and best surgery for each individual woman is the most important goal and should involve a robust informed consent process.

There aren’t enough pelvic floor physical therapists.

As a urogynecologist, I rely on pelvic floor physical therapists to be part of my team.  Physical therapy is often the first line of treatment.  Optimizing muscular function can reverse prolapse and cure incontinence.  And even if it’s not the “whole” answer, it is often part of the answer.  There is considerable research demonstrating that physical therapy works better for strengthening than other modalities.

I am lucky to be surrounded by excellent pelvic floor physical therapists.  But that is not the case in much of the US.

Work by Crystal Cisneros showed that no state has more than one pelvic floor physical therapist per 100,000 residents.  And most therapists are clustered in cities.  So, it is hard to find a therapist, particularly if you live in the country or outside of a town.

I think this is a really important point.  There is a lot of talk about women not going to a physical therapist.  But physical therapy has to be convenient for it to work.  There are so many barriers to treatment.  And if we add in long wait times and inconvenient drives, it is not surprising that many women do not go to physical therapy.  It is up to us to figure out how to make it more convenient.  We have to think outside of the box.  This conference also focused on diversity, equity, and inclusion which should always be considered when offering an array of solutions that work for all women.

There are new virtual pelvic floor physical therapy practices popping up.

Many of these practices will give you products so they can monitor your progress and work remotely with you.  These practices work through urogynecology offices, so we can provide any hands-on teaching you might need.  However, there aren’t enough urogynecology practices either.

There is new data coming out showing that peri-trainers and digital therapeutics can work for pelvic floor training.

At this conference, I saw my first randomized controlled trial data on high intensity focused electromagnetic therapy (the emsella chair).  And while the numbers in the study were small, the data was very favorable.  We can’t just rely on pelvic floor physical therapy.  We have to find a way to scale these treatments and find the right treatment for each woman.

We’re starting to work on personalized medicine.

There’s a lot of work being done on personalizing treatments.  And this is different for different conditions.  The brilliant Shayanti Mukherjee talked about using stem cells to create personalized biomaterials for prolapse repairs.  She is doing this collaborative work in her lab in Australia.  And even though this work is still very early, the idea of using a personalized biograft rather than a generic mesh is a complete game-changer.

John DeLancey and Henry Lai talked about the work that is being done to personalize treatments for stress urinary incontinence and urgency urinary incontinence.  This work would use different risk factors and medical factors to estimate what treatment would work the best for an individual (based on their unique factors).  We currently use a lot of trial and error, like trying different medications to see which one works the best.  Having a researched algorithm would fast-track treatment for patients and be more rewarding for all.  This more scientific approach would minimize failures and improve patient quality of life and satisfaction.

Science moves forward slowly.  But it is amazing to me how much progress we have made over the past ten years.  And how much this work improves the health and quality of life of women.  That is the whole reason that I love my job.  Pelvic floor research is so very important but often overlooked.  There is little federal money dedicated to pelvic floor research when compared to other medical conditions like orthopedic surgery.  This slows progress, but I anticipate even more success over the next decade.