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Catch Up On ICS 2021 Highlights

Monday 18 Oct 2021 {{NI.ViewCount}} Views {{NI.ViewCount}} Views

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We think these stats speak for themselves!

  • 1670 Delegates from 101 countries
  • 15,289 Views on YouTube / Vimeo
  • 3,837 Hours watch time
  • 65 Hours of live streaming
  • 52 Live Sessions
  • 15 Live Webinars
  • 58 On Demand Sessions
  • 5.9 Million website requests (avg 47ms)
  • 65,587 Page views

The ICS 2021 Melbourne Online was a great success but impossible for you to watch everything over the weekend. All our content is ready and waiting for you online (webinar workshops coming soon...) Just simply log back in and access all the content you missed. Why not expand your knowledge and dip into some sessions that you might not normally attend. The Scientific and Local Organising Committee worked hard to ensure the sessions were multi-disciplinary and international to provide you with relevant content.

If you are unsure what to listen/watch then here are some summaries provided by our amazing 2021 Local Organising Committee

Podcast Summary of Round Table Cancer Treatment and Pelvic Floor Function

Robyn and Helena discuss the round table session in this ICS Podcast episode.

Listen to the podcast

Watch Cancer Treatment and Pelvic Floor Function

It is Never ‘Just Constipation’ Round Table Summary

"This roundtable pushes your clinical thinking. Starting with gut motility. High amplitude propagated contracts as well as cyclic motor patterns are affected by eating, sleeping, waking, emotions, exercises and chemicals, and affect gut motility in different ways. Assessment of constipation should focus on the client’s symptoms and what bothers them. Treatment should focus in education and communication. It should be individualised using a range of strategies that may change over time. The aim being normal defaecation. Diet, fluids, bowel routine, toilet position, biofeedback, relaxation, pelvic floor rehabilitation, laxatives, enemas, suppositories and transanal irrigation are some of the treatment options."

Watch It is Never ‘Just Constipation'

How can imaging and computer modelling help improve our pelvic floor surgery?

"So many pearls in Professor John DeLancey’s State of the Art Lecture It suggests moving from the describing what fell (“e.g. bladder, uterus”) to why it fell “lengthened ligament, paravaginal defect, failed hiatus”) What can we see on MRI imaging during maximal strain in women with pelvic organ prolapse and what were the differences in women who subsequently had a recurrence? Apical and paravaginal descent are closely correlated. In anterior vaginal wall prolapse, the anterior vaginal wall is longer but not actually wider. The urogenital hiatus is abnormal in 2/3rds but levator avulsion is responsible for only about 25 % of the enlarged levator hiatus indicating 75% is unexplained. Imaging could help us tailor our surgery by establishing cut-off measures to determine who needs repair in specific levels and who does not.. Women who subsequently went on to have a prolapse recurrence had a larger pre-operative resting urogenital hiatus and larger levator hiatus. The postoperative failure sites in recurrent prolapse were apical 38 %, paravaginal 62 % and urogenital and levator hiatal in 77%. This helps us move from empirical decision making to having measurements with normal ranges that can be used to see which levels need repair. We need more research into the mechanism of hiatal failure and how to correct this? Imaging and computer modelling is paving the way for surgery based on failure site planning."

Watch How can imaging and computer modelling help improve our pelvic floor surgery?

Summary of session on Pessaries for Prolapse from the Physiotherapy Forum

"This session provided a brief overview of pessaries, which highlighted the high prevalence of prolapse (POP) and its potentially serious consequences, particularly for women in low-resource countries. The presentation covered the historical use of pessaries, and women’s knowledge and feelings about pessaries, highlighting the barriers to their use. A qualitative study illustrated that pessaries can be a lifechanging, positive experience for women (Storey 2009). Pessaries would appear to be a logical part of the conservative management of POP for physiotherapists in terms of support of the ligaments, strengthening of the pelvic floor muscles and encouraging women to engage in active lives. Pessaries are listed among the first-line therapies for POP by ICI (2017) and NICE (2019) but there is limited evidence to support their role with PFMT (Cochrane SR (Bugge 2020)The protocol for the TOPSY study (Hagen 2020), a multicentre RCT to test the clinical and cost-effectiveness of self-management of vaginal pessaries compared to standard clinic-based care to improve women’s QoL, has recently been published, and on completion will provide evidence that is sure to influence health policy. The UK CPG for pessaries for POP was presented with Appendix 4 providing information about training competencies for health practitioners (Available from of health care involved in pessary care in the UK (Brown 2020, Dwyer 2021) show around 5%-8% are physios providing pessary management and 20% in France (Pizzoferrato 2021).The need for physiotherapy training was explored, starting with the risks associated with pessary use as presented in the paper by Abdulaziz (2015), describing a classification system for pessary complications based on the Clavien-Dindo system used for surgical complications. This highlighted the need for physiotherapists to be aware of the potential for complications and have systems in place to monitor and report them. A UK survey by Dwyer (2021) found 15.2% of health practitioners had no training in pessary management and warned: “A standardised approach to pessary practitioner training is advocated to ensure women receive safe, evidence-based pessary care”. The paper by Frawley et al (2018) entitled “an argument for competency-based training in pelvic floor physiotherapy practice”, argued for competency-based training in order to produce competent pelvic health practitioners. Competency-based training would therefore be required for the more advanced clinical role of offering pessary management. The study: Development of a multi-national and multi-disciplinary competency framework for physiotherapy training in PM” (Neumann 2021) was undertaken to address the need for a training standard, particularly for physiotherapists working in private practice in Australia. This was an E-Delphi study which involved a panel of international experts from 6 countries and 3 disciplines: physio, UG and specialist nursing. It described 100% agreement on pre-requisite knowledge and training: that physiotherapists should be competent in the management of all pelvic floor disorders before undertaking pessary training, and that pessary management is an advanced practice role. The competency framework described 10 physiotherapy roles with supporting competencies. The framework presents a checklist for clinicians to self-assess their competence, identify gaps and seek training and as a guide for educators designing pessary training courses. Comments from the registrants highlighted the difference across countries where no physios in the Netherlands, Germany or California have registration that allows pessary management. "

Watch Pessaries for Prolapse from the Physiotherapy Forum

RT 8: Nocturia – Multimorbidity or Ageing

The bothersome condition of nocturia is increasingly prevalent as people age, but has also been shown to be a marker for ill health.

In this RT the mechanisms of nocturia were explained, and the outcomes of a literature review defining the causal inter-relationships were analysed. Co-morbidities include, but are not limited to, hypertension, cardiovascular and cerebrovascular disease, renal disease, many neurological conditions, diabetes mellitus, obstructive sleep apnoea, and impacts of many drugs. There is increasing evidence that addressing these co-morbidities may reduce nocturia with benefits to health. Arising from the literature review, the TANGO nocturia screening tool is a validated tool easily used by doctors, nurses and allied health professionals to prompt identification of modifiable factors to promote good outcomes. While multimorbidity is clear, the role of age-related changes was also addressed. These occur in LUT functioning, kidneys, brain and vascular supply, directly or indirectly impacting lower urinary tract symptoms. Factors contributing to nocturia include detrusor overactivity and underactivity, white matter changes in the brain, polypharmacy, changes in renal urine concentrating ability and loss of diurnal AVP excretion. Alterations in the urobiome and gut microbiome are associated with an increase in UTIs. Age-related changes generally may have implications for treatment choices and outcomes.

4/5 older inpatients in subacute hospital care were recently found to have troublesome LUTS, with nocturia the hallmark. In many, there was the onset of new LUTS, or worsening of pre-existing LUTS. The subacute hospital admission would seem an opportunity to address nocturia. The recent development of a symptom score for nocturnal LUTS is envisaged to assist symptom recognition and response to targeted treatment.

Watch Nocturia – Multimorbidity or Ageing

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