An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction
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Introduction and hypothesis
Next to existing terminology of the lower urinary tract, due to its increasing complexity, the terminology for pelvic floor dysfunction in women may be better updated by a female-specific approach and clinically based consensus report.
This report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. Appropriate core clinical categories and a subclassification were developed to give an alphanumeric coding to each definition. An extensive process of 15 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus).
A terminology report for female pelvic floor dysfunction, encompassing over 250 separate definitions, has been developed. It is clinically based with the six most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific imaging (ultrasound, radiology, and MRI) has been a major addition while appropriate figures have been included to supplement and help clarify the text. Ongoing review is not only anticipated but will be required to keep the document updated and as widely acceptable as possible.
A consensus-based terminology report for female pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
KeywordsFemale pelvic floor dysfunction Terminology Consensus Symptomatology Urodynamics Diagnosis
No discussion on terminology should fail to acknowledge the fine leadership shown by the ICS over many years. The legacy of that work by many dedicated clinicians and scientists is present in all the reports by the different standardization committees. It is pleasing that the ICS leadership has accepted this joint IUGA/ICS initiative as a means of progress in this important and most basic area.
This document has involved 12 rounds of full review, by co-authors, of an initial draft, with the collation of comments (and figures—version 14). Following website publication, there have been a further two rounds to review the comments made. Versions 7, 9, 11, and 17 were subject to live meetings in London (June 2008), Taipei (September 2008), Cairo (October 2008), Lake Como, Italy (June 2009) and San Francisco (September 2009). The co-authors acknowledge the input to an early version of the document by Professor Don Wilson and Dr. Jenny King. Versions 9, 10, and 12 were subject to external review. The extensive comments by those reviewers, Professor Gunnar Lose (version 9), Dr. Sǿren Brostrǿm (version 10), Mr. Philip Toozs-Hobson (version 10), Mr. Ralph Webb, Dr. Kristene Whitmore, and Professor Cor Baeten (version 12) are also gratefully acknowledged. The comments by the following reviewers in response to website publication (December 2008–January 2009) are also much appreciated: Dr. Kiran Ashok, Dr. Rufus Cartwright, Dr. Johannes Coetzee, Professor Peter Dietz, Dr. Howard Goldman, Mr. Sharif Ismail, Mrs. Jane Meijlink, and Professor Don Ostergard. Version 16 was subject to a further invited external review by Professor Ted Arnold, Professor Jacques Corcos, Dr Harry Vervest, and Professor Jean-Jacques Wyndaele and the consideration of comments by Professor Paul Abrams and Professor Werner Schaefer. Version 17 will be for website and dual journal publication.
Conflicts of interest
BT Haylen: assistance from Boston Scientific to attend London Terminology Meeting.
D De Ridder: Advisor for Astellas, Allergan, Ipsen, Bard, American Medical Systems, Xention; Speaker for Astellas, Allergan, American Medical Systems, Bard, Pfizer; and Investigator for Ipsen, American Medical Systems, Allergan, Astellas, Johnson & Johnson.
RM Freeman: Past Advisory Boards: Lilly/BI, Astellas, and Pfizer.
SE Swift: no disclosures.
B Berghmans: no disclosures.
J Lee: no disclosures.
A Monga: Consultant for Gynecare and Advisor for Astellas and Pfizer.
E Petri: no disclosures.
DE Rizk: no disclosures.
PK Sand: Advisor for Allergan, Astellas, GSK, Coloplast, Ortho, Pfizer, Sanofi, Aventis, and Watson; Speaker for Allergan, Astellas, GSK, Ortho, Pfizer, and Watson; Investigator for Boston Scientific, Pfizer, Watson, Ortho, and Bioform.
GN Schaer: Advisor (in Switzerland) for Astellas, Novartis, and Pfizer
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