Every year, between 15 and 20 million women develop a reproductive morbidity. These morbidities affect not only the health and wellbeing of the women themselves, but also have a negative impact on their children and families. As a result, women often find it hard to live with dignity, to care for their children, to be productive, to earn income, and to manage their other daily responsibilities–which are substantial for most women.

Some of the disabilities are acute and life-changing for a woman immediately during or directly after childbirth but can be rectified relatively quickly. Other disabilities develop more slowly and become chronic conditions that a woman endures day in and day out. Pelvic organ prolapse (POP) and urinary incontinence (UI) are such examples. They are part of a whole host of conditions that affect women throughout their life. The collective name for all these conditions is Female Pelvic Medicine and Reconstructive Surgery (FPMRS), or Urogynaecology.

The purpose of this course is to:

• Provide an overview of FPMRS conditions.
• Provide an understanding of how to investigate FPMRS conditions.
• Provide a guide to managing FPMRS conditions.
• Provide an understanding of how FPMRS conditions can be prevented.
• Provide an understanding of the impact of FPMRS conditions in society and how they affects productivity, impact on economies and affect society. This is particularly important in societies where obstetric fistula and cultural practices like female genital mutilation are prevalent.

This course will help both clinicians and affiliated specialists understand what FPMRS is, how it affects women and how it can be managed. It will show the benefit in embracing a multi-disciplinary approach to providing care for women affected by FPMRS conditions. The courses will focus on incorporating evidence-based care, clinical skills development and education strategies for women affected by FPMRS that will help clinicians and affiliated specialists provide the best care for women at various stages of their care pathway.

The main aim is to effectively enhance and advance the knowledge of clinicians and affiliated specialists this complex clinical field.

Learning Outcomes:

Course Module 1:

Anatomy, Physiology and Pharmacology of the pelvic floor, Quality of Life Questionnaires, Assessments, and Investigations.

1. To demonstrate the knowledge skills and attitudes required to make an appropriate clinical assessment of a patient with an FPMRS condition.
   • Anatomy and function of the lower urinary tract and pelvic floor.
   • To understand the different facets of obtaining a history of the woman’s condition:
     • Obtain a general history.
     • Obtain a urinary/prolapse/bowel/pain and sexual history.
     • Use standardised questionnaires.
     • Use of quality of life (QoL) questionnaires.
     • Conservative management.

Course Module 2:

Conservative management of FPMRS Conditions:

1. To demonstrate a thorough understanding of the evaluation and treatment of lower urinary tract disorders using conservative measures (including recommendations of the International Consultation on Incontinence).
   • To understand the following:
     • Fluid management.
     • Physical therapies.
     • Pharmacological therapies.
     • Catheters and drug therapies for voiding difficulties.
     • Pessaries for prolapse.
     • Other therapies.

 Course Module 3:

Surgical management of FPMRS Conditions:

1. To demonstrate the knowledge and skills to understand the indications for and the ability to carry out the required surgical procedures.
2. This includes the skills and attitudes to counsel patients appropriately, to have an understanding of potential surgical complications and how to deal with them when they occur.
   • To understand the surgical management of:
     • Urodynamic stress incontinence.
     • Secondary surgery for urodynamic stress incontinence.
     • Detrusor overactivity.
     • Voiding difficulties.
     • Postoperative problems.
     • Advantages/disadvantages of different techniques.
     • Pelvic organ prolapse.

 Evaluation processes

1. Identifying outcome measures and evaluating the woman with an FPMRS condition.
2. Applying specific skills and procedures ensuring quality and safety of care for each woman.

Program Structure:

There will be an activity or set of activities for each session which will be designed to help you engage with the introduction to the theories explored within the course.

• Your facilitator will be on hand to guide you through the programme and will expect you to bring personal experience and reflection on the topics covered.
• Group work will be required for participants to engage in the course. Such activity allows participants to embed the new knowledge within their experience through active discussion and challenge.

The course consists of three modules, as outlined below:

• Anatomy, Physiology and Pharmacology of the pelvic floor, Quality of Life Questionnaires, Assessments, and Investigations.
• Conservative management.
• Surgical management.

Whilst this course will guide the attendee to enhance their knowledge in the field, they will also gain a thorough understanding of the impact of pregnancy, parturition, menopause and ageing on the pelvic floor and the lower urinary tract function.

The conditions that will be included, amongst others, are:

Incontinence:

• Urodynamic stress incontinence.
• Detrusor overactivity/Overactive bladder syndrome.
• Voiding disorders and urinary retention.

 Pelvic organ prolapse, both primary and recurrent

 Bladder and Bowel organ disorders:

• Urinary disorders in pregnancy.
• Urinary disorders in childhood.
• Urinary disorders and hormone deficiency states.
• Urinary problems secondary to medical disorders and drugs.
• Lower urinary tract and lower gastrointestinal tract fistulae.
• Obstetric anal sphincter injury (OASIS).
• Lesions of the central nervous system affecting urinary, faecal control and pelvic floor.

 Other conditions, including:

• Pelvic pain.
• Evaluation and care of the elderly.
• The physically or mentally handicapped.
• Emotional and behavioural disorders.
• Effects of pelvic surgery and irradiation on the lower bowel urinary tract and pelvic floor.
• Sexually transmitted diseases.
• Symptoms associated with sexual intercourse, e.g. coital incontinence.