Urogynecology — a wide topic — suffice it to mention that there are more patients with urogynecological problems than with diabetes and hypertension combined.
In Poland, for some time now we have had the impression that, among other things, thanks to closer cooperation with leading European urogynecological centers, we have noticed the scale of the prevalence of problems related to urinary incontinence, fecal incontinence and pelvic organ prolaps in women, and thanks to the experience gained, transferred to our field, we are dealing with with the dynamic increase in opportunities to improve competences in our country, which is closely related to the dynamic development of domestic centers specializing in urogynecology. This results in the possibility of more effective and comprehensive treatment of urogynecological patients and the promotion of ways and methods of appropriate therapeutic procedures among gynecologists to limit the scale of iatrogenic complications in this area.
Therefore, we are observing with increasing attention and appreciation the tendencies and experiences of European pioneers of urogynecology, with particular emphasis on countries where it is an accepted subspecialty.
For the above reasons, it is impossible to omit and comment on the summary of the annual conference of the International Urological Association (Post IUGA) made jointly by representatives of the European precursors of urogynecology: the German (AGUB), Austrian (AUB) and Swiss (AUG) Urogynecological Society, which together created a coalition of national Urogynecological Societies (DACH) to analyze current trends in global urogynecology.
There is high clinical effectiveness and patient satisfaction with the use of suburethral tapes in the treatment of stress urinary incontinence (SUI), which oscillates around 80% regardless of the method of surgery. Various techniques show similar long-term effectiveness, but less pain is reported in the case of retropubic tapes. The percentage of permanent cures that is approximately halved compared to suburethral tapes is observed when periurethral fillers are used. However, it should be remembered that surgeries using periurethral fillers are a valuable alternative in young patients in whom the use of suburethral tapes may be controversial.
The importance of using botulinum toxin and neuromodulators is increasing, especially in severe forms of treatment of overactive bladder.
In the case of the impact of vaginal delivery on subsequent urogynecological disorders, it is difficult from the point of view of a physician-practitioner to see any spectacular surprises: women giving birth for the first time reported more problems with urinary incontinence after giving birth, multiparous women more often reported symptoms related to the pelvic organ prolapse. Urogynecological complaints occurred regardless of previous repair surgery — in view of the above facts, they do not constitute absolute indications for cesarean section.
The significant role of postoperative urogynecological physiotherapy in reducing pain was emphasized. Attention was paid to the development of diagnostic techniques for urinary tract infections — currently we have methods of obtaining a urine culture with an antibiogram even within two hours. More attention has been paid to the use of non-antibiotic and natural drugs in the treatment of urinary tract infections (UTIs).
The use of lasers was also discussed in the treatment of urinary incontinence. Despite the controversy on this topic, the possibilities of their effective use were noticed, paying attention to the long-term safety of the laser technique. The key issue seems to be the proper qualification of patients for procedures and the need to develop standards for the use of this technique in specific clinical situations.
Moreover, attention was also paid to the rapid development of robotic surgery techniques — however, currently it is difficult to notice their significant advantage over currently performed urogynecological surgeries.
The inevitable impact of artificial intelligence on the development of analytical and imaging techniques and their application in urogynecology was noted.
The importance of using pessaries as an alternative to complicated and risky urogynecological surgeries was emphasized, especially in patients with pre-existing conditions, at the same time emphasizing their high acceptance and effectiveness in reducing urogynecological symptoms.
Operations using alloplastic materials are still controversial. They are especially relevant to English-speaking countries and the new world. It seems that similar problems are not reported in continental European countries, where vaginal surgery has been successfully performed for many years. The lack of severe complications by authors from the Germane speaking countries is most likely related to perfect mastery of vaginal surgery techniques, the use of dedicated and tested implants and restrictive qualification of patients. In this light, cor and repair operations using the patient’s own tissues will become more important.
For the same reasons, especially in countries where the use of meshes and tapes is prohibited or severely limited, traditional repair surgery techniques are experiencing a renaissance: sacrospinous ligament fixation (SSLF), Manchester surgery and laparoscopic techniques.
By analyzing current techniques and surgical possibilities, we can now begin to be convinced that we are not lagging the leading countries in urogynecology: Germany, Austria and Switzerland.
Taking a closer look at the current developments in the global situation, we hope to constantly strengthen positive relations with the leading urogynecology centers of our European friends, with the primary aim of constantly increasing competences, improving qualifications and acquiring new skills among doctors in our country, which will directly result in lasting increasing satisfaction and contentment of our patients.
Wishing you pleasant reading, I look with hope and optimism at the development of Polish urogynecology in the context of the following analysis of trends in Europe and the world.
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Conflict of interest
The authors declare no conflicts of interest.
