2020 was a year without precedents. The COVID 19 pandemic hit the entire world, forcing us to rethink our way of living, working and interacting with each other.
The ICS community was also forced to adjust as for the first time our annual meeting went virtual. Thanks to the dedication of the organising committee, and the enthusiasm and spirit of ICS faculty and committees, this meeting managed to deliver delegates an outstanding scientific program with communications by the top experts in each field.
Although everything was done to ensure the maximum interactivity, all while respecting social distancing, the face-to-face discussion between sessions and experts/ speakers, usually occurring in the corridors of venues, this year, unfortunately could not take place.
As it represents one of the most appreciated aspects of our annual meeting, to give delegates the opportunity to receive more insights from experts, we asked members of the Scientific Committee to tell us which talks, communication and research particularly caught their attention.
ICS members will be able to access all on-demand sessions indefinitely via the ICS website, it will give them the opportunity to re-watch and catch up with what they may have missed.
In this first episode of the highlight Series, Elise De reports the various sessions which got her talking!
Elise De's Recommendations
We had an outstanding program for 2020, and the creativity of the online format allowed for some revolutionary changes, while incorporating the aspects of ICS we all enjoy the most.
In spotlight 5, Drs. Cardozo, Greenwell, and Whitmore debated the ethics of surgery on the obese. There is a high prevalence of obesity in certain countries and a higher incidence of prolapse and incontinence in those who are obese. Ethical principles of autonomy, intentionality, informed consent, justice, control over one’s domain were discussed. Dr. Whitmore pointed out that incontinence and prolapse surgery is slightly less effective but there are no higher complications. Presenting alternatives to surgery is very important. A 2-year observational study of 112 morbidly obese patients reported satisfaction in 90% of patients and surgeons.
Dr. Greenwell cited higher overall surgical risks in morbid obesity complication rate rises from 7 to 15%, and increases if super obesity (wound dehissense, seroma, anastomotic leak in bowel, PE. In addition, there is resolution of incontinence in 44-88 % after bariatric surgery. The improvement in SUI QOL after TVT = improvement after bariatric surgery.
See the session to find out who won!
Abstract #1: G. Lane Best Abstract in Urology: Treatment of Urethral Stricture Disease in Women: A Multi-Institutional Collaborative Project. This was a retrospective cohort study of women with a history of stricture s/p surgery. The authors excluded cancer, mesh, and gender affirmation. 210 were in the final cohort after 1051 charts reviewed. Endoscopic versus urethroplasty with free graft (eg buccal) versus urethroplasty with local tissue (vaginal advancement, tubularized flap).
At 12 mos: Endoscopic recurrence-free rate was 68%, Free graft: 77%, Local Tissue 83%.
There was a 36% recurrence overall at 15 months, with 50-60% less risk of recurrence in urethroplasty vs endoscopic.
In Workshop 9, Chris Chapple, Rizwan Hamid, and Roger Dmochowski discussed the state of the art of stress incontinence surgery, including why autologous slings and colposuspension have stood the test of time.
Anton Emmanuel provided a state-of-the-art talk on neurogenic bowel in “bugs brain and the gut”.
The workshop #22, Vaginoplasty: The Good, The Bad and The Ugly in Trans Female Affirming Surgery – was an extraordinary, technically beautiful and emotionally honest session of experts conveying experience on how to set up a proper clinic, how to perform a great vaginoplasty rather than just a good one, hoe to avoid complications, and how to manage them. A must-see.
Abstract 429, Omer Acar Inflatable Penile Prosthesis Reimplantation Following Gender-Affirming Phalloplasty with Radial Forearm Free Flap. Excellent description including securing of rear tip extender to pubic bone, and intraop fluorescence angiography to assess perfusion.
Abstract 215, Kian Ahmadieh Robotic-Assisted Sacrocolpopexy Utilizing a Posterior Rectus Fascia Graft. Here eroded synthetic mesh is removed from the vaginal cuff. The posterior rectus sheath is dissected robotically and used to replace the eroded mesh. The sacral segment of the synthetic mesh is utilized for securing the graft. Clever restorative technique.
Workshop 5: The Challenge of Managing Chronic Pelvic Pain:
Guldzhan Vorona Gave a beautiful lecture entitled: Mesh and Chronic Pelvic Pin: A Self Made Problem. Whereas mesh erosion can be addressed by reoperation the pain is not necessarily corrected. she provided very useful anatomic images as well as graphics and data on information. Would recommend to all pelvic surgeons.