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Looking Towards 2020

 
Menefee

It is with great pleasure that I write my first President’s Perspective. First, I want to thank everyone for contributing to the successful AUGS/IUGA Joint Scientific Meeting in Nashville. This meeting was our largest to date, with 2,237 in attendance. While the sheer size of the joint meeting can be intimidating, the Program Committee did an excellent job developing a program that balanced a wide range of topics while providing both large- and small-group opportunities to learn, discuss, and collaborate.

As we finish our Thanksgiving celebration and prepare for the New Year, I want to reflect on the past one. The national conversation in 2019 was again dominated by mesh, with the FDA decision in April to halt sales of transvaginal mesh kits for prolapse in the United States. Although difficult and at times divisive, the mesh controversy has allowed AUGS to focus on concerns from each other, but also from patients and multiple other sources. With controversy comes opportunity and in response, AUGS developed strategies that included a prolapse consensus conference, a soon to be published joint statement by AUGS and IUGA on mesh complications, as well as the launch of an AUGS patient advocacy group.

While I was hoping for an uneventful year, we will continue to have new hurdles that will potentially impact us all. The Relative Value Scale Update Committee (RUC) recently notified AUGS that it would resurvey three common apical procedures. On short notice, the AUGS Coding Committee, led by Dr. Mitch Schuster, quickly worked to define the language of the survey and hosted a webinar to explain the process. I want to thank those of you who responded to the survey as our collective voices are important to obtain an accurate assessment of the current effort involved with these procedures.

As our subspecialty matures, we continue to struggle with the optimal treatment options for our patients whether it is the long-term use of anticholinergic medications, use of synthetic mesh or management of recurrent urinary tract infections, to name a few. The need for continued evidence-based research in FPMRS ranging from basic science, translational research, clinical trials and big data has never been more essential in our journey to advance care for our patients and develop best practices for the treatment of pelvic floor disorders. However, our need for increased research comes at a time when funding for medical research is only decreasing.

The AUGS Mission Statement states, “As the leader in Female Pelvic Medicine and Reconstructive Surgery, AUGS promotes the highest quality patient care through excellence in education, research and advocacy.” While the annual scientific meeting is a venue to promote important research in FPMRS, and the Pelvic Floor Disorders Research Foundation generously supports research grants, funding for medical research, especially from governmental sources, continues to decline and remain very competitive across specialties. While AUGS has partnered with other societies in the Women’s First Research Coalition to advocate for funding in women’s health broadly, AUGS alone is uniquely positioned to advocate for pelvic floor research. The Eunice Kennedy Shriver NICHD has been a leader in supporting research related to pelvic floor disorders, however, the NICHD Strategic Plan 2020 appears to focus primarily on human development, childhood and reproductive issues.  

While undeniably important areas of concentration, the obvious lack of emphasis on conditions such as pelvic floor disorders is concerning. It also appears that all networks including Maternal-Fetal Medicine Units (MFMU), Reproductive Medicine Network (RMU), and Pelvic Floor Disorders Network (PFDN) will be eliminated from the NICHD structure. At this time in our specialty with increasing concerns regarding the safety and efficacy of procedures for urinary incontinence and prolapse, our field must have adequate funding to determine optimal care pathways for our patients. AUGS will continue to actively advocate for all forms of pelvic floor research funding moving forward.

You, the AUGS membership, can help! Much work will be needed to make sure that our specialty continues to receive the appropriate funding. This may range from grassroots advocacy to governmental lobbying, often partnering with other societies. For those who believe our specialty has benefited from NIH multicenter networks and trials, the NICHD is now taking open comments through December 20, 2019 about the need for networks and how multicenter clinical trials should be structured moving forward.

This is your opportunity to share your thoughts and concerns about the need for continued support of multicenter trials. In the spirit of full transparency, I have been fortunate to have participated in numerous multicenter trials supported by the NIH and others over the course of my career. As such, I understand how very essential this type of support is to overcome the complexities involved in PFD clinical trials which often involve large number of participants and relatively long-term follow-up.

Continued funding for pelvic floor research through the NIH will only become available through the federal appropriations budget process if your legislators know that pelvic floor disorders are common and have a significant impact on women’s quality of life. As AUGS develops a strategic plan for research advocacy, we will share resources on how we collectively can advocate for PFD research funding.

As has been the case in recent years, our specialty will continue to face challenges. However, I know that with continued advocacy on behalf of our patients, joined by our patients and other partners, we will continue to make advances in the treatments for pelvic floor disorders.

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