AUGS-IUGA executive summary:Foundational science and mechanistic insights for a shared disease model: An expert consensus

Developed by the Joint Writing Group of the International Urogynecological Association and the American Urogynecologic Society

Pelvic floor disorders (PFDs) are complex conditions that impact millions of women worldwide. It is estimated that PFDs will affect approximately 30%–50% of women older than 50 years and incur a 20% lifetime risk of undergoing at least 1 surgical procedure to repair either pelvic organ prolapse (POP) or stress urinary incontinence (SUI) by age 80 years.1 The surgical costs alone are estimated to exceed $10 billion annually,1–6 and this does not account for the cost of nonsurgical and conservative treatments. Although a large body of epidemiological literature provides important information regarding the risk factors for PFDs, the pathogenesis of POP and SUI continues to be poorly understood. Consequently, POP and SUI are associated with significant health care expenditure primarily due to lack of preventive measures, high failure rate of available interventions, and the need for retreatments.

Furthermore, the long-standing gaps in mechanistic insights into the pathophysiology of POP and SUI represent one of the major barriers to the development of scientifically rational preventive and therapeutic strategies. Women's health across the life span depends on a better understanding of the anatomy and physiology of the female pelvic floor (PF) and the causal links between the multifactorial epidemiological risk factors and POP/SUI.

PURPOSE In this first edition of the e-book, we present a comprehensive review of the mechanistic insights centered around the priorities identified during a “think tank” brainstorming session (see below). The overarching goal of the e-book is to synthesize and interpret the available mechanistic data and to build a shared disease model of 2 PFDs—POP and SUI—that will serve to (1) further our understanding of the pathogenesis of these PFDs, (2) recognize important knowledge gaps and pinpoint research priorities, (3) identify novel targets for interventions, and (4) facilitate economically viable cross-disciplinary research initiatives.

Various scientific advances in molecular biology, -omics (eg, genomics, proteomics, metabolomics), and bioengineering enabled significant advances in the study of cancer, cardiovascular disease, neurological disorders, and men’s health. However, as the full-text report (or e-book) will highlight, women’s health advances in pelvic medicine lag behind even much less prevalent disorders (click here to access the e-book:https://www.augs.org/assets/1/6/AUGS_IUGA_eBook.pdf). Understanding how the various risk factors for PFDs (eg, POP and SUI) interact is particularly important to inform a shared disease model that can be leveraged to design scientifically robust preventive strategies and effective treatments for POP and SUI. This book is intended to be a “living e-book”; as scientific advances continue to broaden our understanding of these disorders and other PFDs (eg, accidental bowel leakage, sexual dysfunction, etc), this book can be updated to further develop a “shared disease model.”

The main goals of this volume of our shared e-book are (1) to review the existing fundamental knowledge and mechanistic insights relevant to POP and SUI and (2) to highlight the need to engage in more robust interdisciplinary research to fully elucidate the disease model for these disorders. Overall, there is a clear need to dive deeper into the mechanisms responsible for pathogenesis of POP and SUI along women's life span. Each chapter underscores the importance of applying the existing contemporary research tools, as well as developing and validating novel instruments, to generate physiologically relevant multidimensional data that will allow clinicians to personalize preventive and therapeutic interventions to counteract POP/SUI. Interdisciplinary research, which integrates information, data, techniques, and tools of 2 or more disciplines to advance understanding beyond the scope of any single discipline or practice, will greatly facilitate bridging the gaps underscored in each chapter.7 The value of this approach is having multiple experts from different fields collaborate to answer critical questions that will have the greatest impact on the field. While a multidisciplinary approach requires that fields remain separate—arguably what has already occurred in the studies of POP and SUI—interdisciplinary research allows each group to expand beyond a single point of view to explain more complex phenomena and generate innovative therapeutic options. Rigorous interdisciplinary studies will lead to transdisciplinary research, which is defined as creating a new discipline from 2 or more.8 Transdisciplinary research enables innovations not possible within a single discipline and may ultimately lead to a unique discipline. The field of urogynecology is an example of a transdisciplinary field as it is defined by the core principles of gynecology, urology, gastroenterology, colorectal surgery, biomechanics, and physical rehabilitation. As our field moves to further advance our mechanistic understandings of PFDs and to identify novel therapeutic paradigms, embracing transdisciplinary team science would allow multiple stakeholders to capitalize on their combined expertise and innovations from various areas of science and medicine to make substantial leaps forward in FPMRS, while potentially affecting policy changes relevant to women's health.

REFERENCES

1. Hunskaar S, Burgio K, Diokno A, et al. Epidemiology and natural history of urinary incontinence in women. Urology 2003;62(4 Suppl 1):16–23. doi: 10.1016/s0090-4295(03)00755-6.

2. Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979–1997. Am J Obstet Gynecol 2003;188(1):108–115. doi:10.1067/mob.2003.101.

3. Chong EC, Khan AA, Anger JT. The financial burden of stress urinary incontinence among women in the United States. Curr Urol Rep 2011; 12(5):358–362. doi:10.1007/s11934-011-0209-x.

4. Wu JM, Kawasaki A, Hundley AF, et al. Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050. Am J Obstet Gynecol 2011;205(3):230.e1–230.e5. doi:10.1016/j.ajog.2011.03.046.

5. Subak LL, Waetjen LE, van den Eeden S, et al. Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol 2001;98(4):646–651.

6. Wilson L, Brown JS, Shin GP, et al. Annual direct cost of urinary incontinence. Obstet Gynecol 2001;98(3):398–406.

7. Committee on Facilitating Interdisciplinary Research, National Academy of Sciences, National Academy of Engineering, Institute of Medicine. Facilitating Interdisciplinary Research. Washington, DC: National Academies Press; 2004.

8. Rosenfield PL. The potential of transdisciplinary research for sustaining and extending linkages between the health and social sciences. Soc Sci Med 1992;35(11):1343–1357.

(Female Pelvic Med Reconstr Surg 2022;28: 347–350)

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