Clinical advances in urogynecology.

Women with pelvic floor disorders can look forward to improved care with less morbidity over the next several years. Significant research efforts are underway to improve our understanding of an appropriate evaluation for women with all pelvic floor disorders, especially urinary incontinence and/or pelvic organ prolapse. More than ever before, research has contributed meaningful developments in treatment outcomes, including patient-reported outcomes. These advances have come largely due to the efforts of an increasing number of clinician-scientists, who design and conduct high-quality clinical trials. In addition, significant governmental resources have been committed to developing and supporting pelvic floor research networks. Population based research efforts have provided a broad understanding of the pelvic floor changes that women may experience over their lifetime, including an understanding of pelvic support over the decades. This work is augmented by the increasing number of studies that clarify the pelvic floor changes associated with pregnancy and delivery. In addition to learning more about basic pathophysiology, significant technical advances have occurred and have offered excellent treatment efficacy with reduced morbidity. New modalities of treatment are being evaluation, including botulinum toxin, for women with refractory urge incontinence due to detrusor overactivity. This work has been facilitated by the efforts of multidisciplinary teams composed of a widening group of pelvic floor specialists, including radiologists, physiotherapists and gastrointestinal specialists. A small, but extremely important, group of basic science investigators are contributing knowledge about pathophysiology using animal models, material testing and analyses of native tissue structures. The clinical advances in urogynecology are on a steep uprise and can be expected to significantly improve the well-being of women who suffer from pelvic floor disorders.