13 January 2024






ICS Masterclass on Pelvic Pain: Organ- Based Pain

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ICS Masterclass on Pelvic Pain: Organ- Based Pain

This 3h interactive online course was chaired by:

This educational course will provide teaching on different surgical techniques, but this does not mean an endorsement of that procedure by the ICS. Endorsement of techniques fall under the remit of national government healthcare organisations. The aim of ICS is to provide education regarding good surgical technique.


Time Title Speakers
14:30 Introduction Elise De
14:35 Multidisciplinary Care Team Building Tools and Basic Approaches Mickey Romics
14:40 Trauma Informed Care Nelly Faghani
14:50 Gyn - Internal Augusta Morgado Ribeiro
15:05 Gyn - External Rachel Rubin
15:20 Discussion All
15:35 Break - Yoga for Chair Dwellers Dustienne Miller
15:55 Urology - Bladder, Ureters, Urethra, Prostate Mickey Romics
16:10 Urology - Scrotal Content Pain Sijo Parekattil
16:20 Anorectal Pain Peter Onody
16:35 Neuro GI Contributors Barbara Nath
16:50 Imaging for Organ Based Pain Mukesh Harisinghani
17:00 Patient Engagement Jill Osborne
17:10 Discussion All
17:25 Closing Phil Bearn
17:30 END

This Masterclass is being delivered by the ICS Global Pelvic Pain Exchange Program Working Group. Below is a list of other Collaborative Case Discussions hosted by this group.

Discussion Session Date
“How-To”: Basic Approaches to Pelvic Pain Sunday, October 15, 2023
Pelvic Floor Muscle tone – Why It is Important and How to Change It Friday, November 10, 2023
Hip Causes of Pelvic Pain Sunday, December 3, 2023
ICS Masterclass on Pelvic Pain: Organ- Based Pain Saturday, January 13, 2024
Focal Neurological Pelvic Pain Sunday, February 4, 2024
Neurodiagnostics for Pelvic Pain Friday, March 8, 2024
TENS, Blocks, Stimulation, and Pumps for Pelvic Pain Friday, April 5, 2024
Systemic Pain involving the Pelvis Friday, May 10, 2024
Pharm, Psych and Patient Empowerment for Pelvic Pain Friday, June 14, 2024
Provisional: SIG Neuro-Urogynecology and Urogenital Pain August, 2024

Record of Questions and answers

Question Answer
Jane Meijlink: In Europe in recent years we have found it difficult to find rheumatologists with an interest in IC/BPS, even though many pts have a rheumatic autoimmune disease. How can we get them interested anfd involved? Elise De: In USA it has been tricky as well - some private Rheum will treat but few with an academic interest.
Mickey Romics: I would have a hard time to find a rheum who show interest in a mainly urological problem. If you find one who's interested in pain syndromes in general than you have found someone who will help you with these patients. (I would advise to look for young MDs with an open mind and (as prof De was saying) in academid centers. Also it might be useful to have the number of a pharmacologist or a anasthesiologist (in case some TCAs or neuromodulator drugs are needed) on speed dial
Jane Meijlink: Many thanks for all the comments. We need rheumatologists and immunologists involved in research projects when pts have IC/BPS or other pelvic pain syndromes + a system autoimmune disease. And to give presentations at conferences. Elise De: I will make it our next goal! Great point
Benedetto Giardulli: Hello everybody. I just wanted to comment on what Jane said. I suggest you get in touch with the European Alliance of Associations for Rheumatology (EULAR), as they have a specific Study Group on Reproductive Health and Family Planning comprising various healthcare professionals. Their names are available online. I've had some contacts with them, and I am sure they are very interested in research projects involving pelvic and sexual health with rheumatic and musculoskeletal diseases (RMD). Elise De: Thank you for this Benny! Any other resources from our attendees?
Hee Seo Son: Thank you very much for nice lectures!! Elise De : Thank you for being here!
Leonard Stephens: Who gets vaginal oestrogen for recurrent UTI? Is it only for postmenopausal women? Elise De: Perimenopausal data is there. No harm to premenopausal. OCPs Spironolactone, disordered eating can impact hormones in premenopausal
Anonymous Attendee: How do you treat patinet with breast cancer, who complains of severe vulvodynia associated with secere atrophy? Elise De: Active aromatase inhibitors may be a concern for increased risk of recurrence. Data has not shown concern for others - in fact decreased mortality. consider DHEA
Ahmad Khalifa: This session is very informative. Thanks. What is the allocation of time you give in your clinic for the patient for appropriate comprehensive history and exam. In the UK, I find 10-15 min very difficult to go through deeply Elise De: Agree! We all have our ways of making the time and finances work. Often pre-visit paperwork and splitting into multiple visits (including virtual)
Julie Ruzickova: Thank you very much for this perfect workshop. I would like to ask about whether there ary any guidelines for physiotherapist how they can ease the pain caused by pelvic congestion syndrome. Thank you Beth Shelly: As far as I know there are no offcial guidlines for pelvic congestion. Some are using manual lymph draiange but not enough research to know.
Anna Maron: Thanks the organizers for this masterclass.Q for Dr.Rubin: hoh often in your practice do you provide the surgery as a vulvodynia treatment? Looking forward to meet you in person on ISSWSH meeting Elise De: Per Dr. Rubin: Only when diagnosis of neuroproliferative vestibulodynia is suspected and they have a successful vestibular anesthesia test
Ahmad Khalifa: What is meant by (targeted) block, inj ections .. etc .. wht is meant by targeted, do you mean cord clock Sijo Parekattil: Its s modification of the standrad spermatic cord block I a targeted spermatic cord block. You can watch our youtube video on our channel at Avant Concierge Urology https://youtu.be/h66r0sbd8yY?si=aOxBb0S8h3Rqn03g
Leonard Stephens: How do you treat chronic pelvic pain post prior surgical intervention for eg epididymal cyst, hydrocelectomy, testicular torsion etc. ..meaning scrotal pain Sijo Parekattil: https://youtu.be/5oYutzY93b4?si=J9h6TRucDllM1ksJ
Phil Bearn: will ask at Q and A
Julie Ruzickova: I would like to ask about what would you recommend for a patient? Woman 37years old, 2 children, undiagnosed and untreated labour injury 3th grade during 1st delivery, then in March 2023 overlapping sphincteroplasty. Sphincter and levator ani are working well, but even though she regularly does scar massage and low energy laser therapy, she feels pain and has problems defecating, resulting in hemoroids. Thank you very much Phil Bearn: Difficult one. I suspect she has ODS due to neuropathy Defecating proctogram? If she is continent you have done v well.
Péter Ónody: I would doa defecography first. After depending on the result starting biofeedback tratment
Beth Shelly: Biofeedback bearing down training?
Péter Ónody: If the patient has a dyssinergic defecation, than as I know the biofeedback could be one of the most effective treatment.
Julie Ruzickova: Thank you very much. Continence is perfect, problem is pain. I will try to find someone who does def.proctogram in CR. Phil Bearn: let us know!
Ahmad Khalifa: is levator ano syndrome only for women, or men too, I used to see patients with pevic pain and LUTs and they are heavy cyclers, are they ? levator ani Syndrome Phil Bearn: cd be but pudendal neuralgia worth entertaing
Beth Shelly: Current accepted term is PFM tension myalgia that inlcudes a muscle that is firm to palpation and painful to palapate. This is possible in any muscle of the pelvic floor and in both genders. Assessment would specifcially identify whihc muscle(s) are involved and treat specifically Péter Ónody: Pudendal nerve entrapment and pain of the ano-coccygeal ligamant are often seen in thes heavy cyclers as well.
Julie Ruzickova: Gladly! I really struggle to help her somehow, further advice would be great for me. Elise De: This will be a great open discussion
Naheed Kapadia: wonderffull talk Mukesh Harisinghani: Shukhran
Ahmad Khalifa: how to confirm the diagnosis of pelvic congestion? Mukesh Harisinghani: combination of clinical story, exam and imaging (which can be cross sectional study); can be then confirmed with venogram treated as well
Ahmad Khalifa: Thank you very much, world class course

Record of Chat

01:25:16 Elise De: Greetings! So happy to have you all here. After Dr. Rubin's talk, we'll have a Q and A period. You may write questions in the Q and A, or raise your hand and ask questions/make comments verbally.

01:37:01 Elise De: The PGAD Paper by ISSWSH: https://www.sciencedirect.com/science/article/pii/S1743609521001752

01:40:37 Elise De: Androgens: https://www.isswsh.org/resources/publications/469-the-role-of-androgens-in-the-treatment-of-genitourinary-syndrome-of-menopause-gsm

01:43:53 Elise De: https://www.rachelrubinmd.com/

01:55:52 Elise De: Next up! https://flourishphysicaltherapy.com/about/dustienne-miller/

02:01:47 Beth Shelly: There are some good comments and links in this chat I think the particpants cannot see. Is there a way to paste them in the participant chat

02:32:27 Elise De: https://avanturol.com/

02:33:08 Elise De: There was a question to Dr. Rubin re: whether urethral pain could, in fact, be a variant of vestibuloydnia and she confirmed yes.

03:03:09 Mickey Romics: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997493/

03:03:17 Mickey Romics: About treating trigonitis

03:03:38 Mickey Romics: https://www.facingpelvicpain.org/treatment-map

03:04:01 Mickey Romics: And for facing everything else

03:04:23 Mickey Romics: There is a great therapy map you can download and give out to your patients

03:13:54 Sijo Parekattil: you can reach me with any questions at: sijo@avantconciergeurol.com

03:28:38 Elise De: https://www.ic-network.com/

03:39:51 Elise De: Discussion is open!

03:40:05 Elise De: Raise hand or send Q in Q and A

03:48:10 Elise De: We have some wonderful sessions on musculoskeltal in the ICS calendar and ICS TV for more on the pelvic floor muscles https://www.ics.org/courses/1252

03:48:49 Naheed Kapadia: thank you so much for organizing such a Fabolous master class

03:49:40 Elise De: We also have some in-depth classes on focal and systemic nerve pathology

03:49:46 Hee Seo Son: Thank you very much for such a nice in so instructive a webinar!!

03:51:09 Hee Seo Son: Hope to meet again in nerve pathology session!!

03:52:05 Miriam van Hartevelt: Thank you so much for the very interesting lectures.

03:52:58 Julie Ruzickova: Thank you very much for organization, informative lectures and helpful advices!

03:53:53 Benedetto Giardulli: Thank you!

03:53:53 Joy Hyunjeong Jang: its very informative presentation and creating wonderful webinar!! I've learned a lot today!

14/06/2024 19:23:12  26694
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