How Imaging and Computer Modelling Help Improve Your Pelvic Floor Surgery

John Oliver DeLancey (see full bio here)

Learning Objectives

• Describe transition from opinion-based- to evidence-based theories of prolapse based on objective data.
• Review insights gained from computer simulations.
• Discuss shortcomings of existing empirical strategies for surgical selection

All surgeons would like to improve surgical results. The gold standard operations in top clinical trials have 25% failure rates. So, how do we get better? This will come from improved diagnostics that allow surgeons to know in each woman, what structure have failed to result in prolapse so that surgical approaches can be developed to address these failures. Advanced imaging, biomechanical models and improved physiological testing is revolutionizing how we approach pelvic organ prolapse surgery and this lecture will provide an up-to-the-minute view of where we are in this revolution.

Recommended Reading
DeLancey What's new in the functional anatomy of pelvic organ prolapse? Curr Opin Obstet Gynecol. 2016 Oct;28(5):420-9. PMCID: PMC5347042

We asked John why is the ICS important for international advances and collaboration in the practice and training of clinicians involved in the care of the pelvic floor?
"The ICS provides a broadly interdisciplinary forum where the many different disciplines that are necessary to advance pelvic floor science can exchange ideas and generate new ones that are needed to improve our existing prevention and treatment efforts."

We asked John in the last 6 months, what has been one important new finding all clinicians and surgeons need to learn about?

"There has been a recent recognition that failure of the perineal complex (levator ani, perineal membrane, and perineal body) to close the pelvic floor hiatuses is far more important than previously thought. Lack of depth of our scientific understanding of this critical area and paucity of information about operations for its correction need to be addressed for progress to occur."