Foundational Science and Mechanistic Insights for a Shared Disease Model: An Expert Consensus

• Authors: Marianna Alperin, University of California San Diego; Steven Abramowitch, University of Pittsburgh; May Alarab, University of Toronto; Maria Bortolini, Universidade Federal de São Paulo; Bryan Brown, University of Pittsburgh; Lindsey A Burnett, University of California San Diego; Kathleen A Connell, University of Colorado Anschutz Medical Campus; Margot S Damaser, Cleveland Clinic, OH; Raffaella de Vita, Virginia Tech; Caroline E Gargett, Monash University; Marsha K Guess, The University of Colorado Anschutz Medical Campus; Zeliha Guler, University of Amsterdam; Renato Natal Jorge, University of Porto, Portugal; Robert Kelley, Emory University; Mark Kibschull, Mount Sinai Hospital, Toronto; Kristin Miller, Tulane University; Pamela A Moalli, University of Pittsburgh; Indira U Mysorekar, Baylor College of Medicine, TX; Megan R Routzong, University of California San Diego; Oksana Shynlova, University of Toronto; Carolyn W Swenson, University of Utah; Marrisa A Therriault, University of Pittsburgh; Gina Northington, Emory University
• Journal Title: FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY
• Volume: Volume 28, Number 6
• Publisher: LIPPINCOTT WILLIAMS & WILKINS | 2022-06-01, Pages 347-350
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/SPV.0000000000001216
• Subjects: Health Sciences, Obstetrics and Gynecology; Engineering, Biomedical
• Keywords: Science & Technology; Life Sciences & Biomedicine; Obstetrics & Gynecology; aging; biomechanics of the female pelvic floor; impact of hormonal milieu on the female pelvic floor structure and function; pelvic floor disorders; pelvic organ prolapse; pelvic floor structural anatomy and mechanism of disease; stress urinary incontinence; PELVIC ORGAN PROLAPSE; URINARY-INCONTINENCE; ESTROGEN; WOMEN; EXPRESSION; MENOPAUSE; IMPACT; COST; RISK

Abstract

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.