Introduction The Australasian Pelvic Floor Procedure Registry (APFPR) was established in 2019 to monitor safety and efficacy of pelvic floor procedures (PFP) that use prostheses. This followed increased international and Australian regulation of mesh for PFPs, resulting in an overall reduction in PFPs and changes to the procedure profile. The aim of this study was to determine contributing factors and clinician responses to clinical practice trends, and implications for the APFPR. Methods An online clinician survey was developed and distributed between July and October 2022 to APFPR contributing clinicians and USANZ and UGSA members. Descriptive statistics were calculated and stratified analysis performed. Results Seventy-nine valid responses were received. Approximately two-thirds of respond-ents reported a decline in procedures to implant mesh slings; forty percent reported a decline in mesh sacrocolpopexy; and 40% and 50% reported an increase in explantations of mesh used for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) respectively. Contributing factors for SUI procedure changes were patient preference (83%) and litigation concerns (59%), for POP procedures it was mesh non-availability (81%). Clinician responses included changing to other procedures (SUI 54%; POP 71%); conservative management (SUI 17%); and upskilling and onward referral (14%, 10%) for POP. Responses varied by specialty group. A majority recommended adding native tissue SUI procedures to the APFPR. Conclusion The survey provides insights into the impact and implications of the reduction in pelvic prostheses over the last 5 years. The addition of native tissue SUI procedures to the APFPR will ensure it maintains clinical relevance in a changing landscape.

AimsTo evaluate the medium term efficacy and safety of Altis and Solyx single incision slings (SIS) compared with tension-free vaginal tape (TVT) Abbrevo trans-obturator sling. We hypothesize that both SIS show little difference in efficacy and safety and perform similarly to TVT Abbrevo.MethodsWe conducted an ambispective comparative cohort study of women with stress urinary incontinence who received a SIS in comparison to matched TVT Abbrevo subjects from a concurrent randomized controlled trial (RCT). Subjects were identified retrospectively, and prospectively invited for examination and questionnaires>12 months post-operatively. Exclusions included intrinsic sphincter deficiency, previous sling surgery, and others. Primary outcome was subjective cure [negative response to International Consultation Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) question 6, leakage during coughing/activity]. Secondary outcomes include objective cure (negative cough stress test), functional outcomes, and adverse events.ResultsBetween 2012 and 2018, a total of 113 women received one of two SIS surgeries; Solyx (n ​= ​50) followed by the Altis (n ​= ​63); 104 were available for final efficacy analysis. Mean follow-up was 21.7 (Altis), 46.0 (Solyx), and 29.0 (Abbrevo) months. Baseline characteristics were comparable between the groups. There was no significant differences in the subjective or objective cure rates between the groups, and no differences in functional outcomes such as patient global impression of improvement, and post-operative ICIQ-UI SF score. There was a low rate of mesh related complications and no differences seen between the groups.ConclusionsDespite being an underpowered study, Altis and Solyx SIS have favourable efficacy and safety profiles which are comparable to an established trans-obturator mid-urethral slings (MUS).

The objective was to determine whether levator contraction during Valsalva (i.e. levator co-activation), as visualised on four-dimensional translabial ultrasound (4D-TLUS), is associated with obstructed defecation (OD). This was a retrospective study including patients attending a tertiary urogynecological unit. All underwent an interview, clinical examination and 4D-TLUS. Frequent straining at stool, digitation or sensation of incomplete emptying during defecation were considered symptoms of OD. Archived 4D-TLUS volumes were evaluated, blinded to all other data. Hiatal anteroposterior (AP) diameter (cm) and hiatal area (cm2) were measured at rest and on maximal Valsalva. Patients with anatomical explanations for OD (rectocele, enterocele and/or rectal intussusception) were excluded. Reduction of hiatal AP diameter and hiatal area on Valsalva were tested for association with symptoms of OD. Overall, 1,383 women attended the unit from May 2013 to July 2016. Seven hundred and eight were excluded because of rectocele (n = 645), enterocele (n = 116) or rectal intussusception (n = 41) and 10 owing to missing data, leaving 665. Mean age was 53 years (16–89), mean body mass index (BMI) 27.3 kg/m2 (15.7–64.4). OD symptoms were reported by 368 (55.3%) patients. On imaging, a reduction in hiatal AP diameter on Valsalva was seen in 11.7% cases (78 out of 665) with a mean reduction of 3.5 mm (0.2–17). A mean reduction in hiatal area of 1.9cm2 (0.03–14.8) on Valsalva was seen in 9.8% cases (65 out of 665). These sonographic measures of levator co-activation were not associated with OD symptoms or bother caused by them (p > 0.05). Levator co-activation seen on TLUS is not associated with obstructed defecation.

Vesico-uterine fistulas (VUFs) are rare in modern gynecological practice. We aim to demonstrate with a video the surgical techniques involved in laparoscopic repair of a vesico-uterine fistula (Youssef’s syndrome).

Introduction and hypothesisObstetric anal sphincter injury (OASIS) rates are reported to be higher in Asian women living in Western countries than in those living in Asia, but the reasons for the differences remain unclear. The objectives of this study were for a single examiner to prospectively compare OASIS rates in primiparous Asian women in an Asian and Western birth unit and determine potential birth factors that may influence the possible difference in OASIS incidence.MethodsThis was a prospective observational study based in Hong Kong, China, and Sydney, Australia, involving primiparous women > 36weeks gestation of Asian descent undergoing vaginal delivery. A single examiner recorded basic patient demographics, observed all the deliveries at both sites, noting birthing techniques, and then examined the women, including a rectal examination, to determine OASIS incidence.ResultsSeventy births in Hong Kong and 66 in Sydney were studied. The incidence of OASIS was 34% in Sydney and 10% in Hong Kong (p=0.001). Birthweight, epidural rate, body mass index, and instrumental delivery were higher in Sydney. Episiotomy rates were higher in Hong Kong (59.2% vs. 82.9%; p=0.007). When comparing OASIS with no-OASIS, perineal length (OR=0.36, 95% CI 0.17 to 0.76, p=0.004) and birthweight (OR=1.14, 95% CI 1.00 to 1.30, p=0.039) were independent risk factors for OASIS.ConclusionsThe incidence of OASIS in Asian women is significantly higher in a Western than in an Asian setting. In Asian women, perineal length and birthweight can affect the risk of OASIS at the time of vaginal delivery.

Midurethral slings are the mainstay of treatment for stress urinary incontinence. The role of cystourethroscopy to detect lower urinary tract injury following retropubic midurethral slings is well-established; however, its role following transobturator or single-incision sling placement remains controversial. Some advocate "routine" whereas others advocate for "selective" cystourethroscopy. This paper reviews the arguments for and against cystourethroscopy to detect lower urinary tract injury following transobturator and single-incision slings.

Objective: A case review by specialist diagnostic pathologists as part of a Gynecologic Oncology Multi-disciplinary Tumor group has the potential to influence the management of patients with cancer. The primary aim of this study was to determine the frequency of diagnostic discrepancies between the initial (nonspecialist) and final pathological diagnoses in cases referred to the Gynecologic Oncology Tumor Conference (TC) inWestern Australia and the impact of such revised diagnosis on clinical management. A secondary aim was to assess the evolving workload encountered by the TC during a 5-year interval. Methods: The records of the weekly TC for the 2 calendar years 2008 and 2013 were examined, and histological and cytological specimens that had been initially assessed by ‘‘outside’’ (nonspecialist) pathology departments, and subsequently reviewed by specialist pathologists, were assessed. The initial and final diagnoses were compared, and where the pathological findings were amended upon review, it was determined whether the change affected clinical management. Diagnostic discrepancies that resulted in a change in patient management were classified as major, whereas discrepancies that did not affect patient management were classified as minor. Results: A total of 481 outside cases were included among 2387 cases presented for histological review at the TC during the 2 years. For outside cases alone, the incidence of major diagnostic discrepancies was 3.4% in 2008, 5.5% in 2013 (no significant difference, P = 0.3787), and 4.6% for the 2 years combined. A recommendation for surgery was the most common change in clinical management as a result of major discrepancy. The minor discrepancy rate was 4.4% of outside cases for both years combined. Pathological discrepancies (major and minor) of the uterine corpus and cervix were most frequent, followed by those of the vulva and ovary. Therewas a 48.4% increase in total case discussions at the TC during the interval period with a significant rise in nonmalignant cases, 29.8% of the total cases in 2008 compared with 36.8% in 2013 (P = 0.0004). Conclusions: Nonspecialist pathology departments maintained a high level of reporting accuracy during the interval period, with the major discrepancy rate not changing significantly between 2008 and 2013. Specimens from the uterine corpus and cervix in particular may prove diagnostically challenging on occasion. A pathology review of outside cases by a tertiary-based laboratory in conjunction with a TC can identify a small but clinically significant number of cases that lead to a change in clinical management. It is uncertain whether this affects patient outcomes.

Podcasts are an emerging social media phenomenon in medicine, originating from critical care specialities and now expanding to other domains. Aided by the rapid increase in popularity of social media platforms and the advantage of accessibility, universality and portability, there has been a slow but significant expansion of podcast use in gynaecology. Current literature suggests that there is potential for digital communication to enhance dissemination of information, however there is conflicting evidence on its ability to increase users’ knowledge. Emerging interest in urogynaecology presents an opportunity for the subspeciality to tailor podcasts to the needs of its users. In this review, the origins, current evidence and future trends in the use of podcasts in urogynaecology are explored.