Pelvic floor repair: novel surgical methods, regenerative medicine, and women’s perspectives of scar-less surgery

Author: Fariba Behnia-Willison

Behnia-Willison, Fariba, 2021 Pelvic floor repair: novel surgical methods, regenerative medicine, and women’s perspectives of scar-less surgery, Flinders University, College of Medicine and Public Health

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Pelvic floor disorders (PFDs), such as prolapse and urinary incontinence, affects approximately 60% of women in their lifetime. I have been trained in advanced minimally invasive surgery for these conditions. Despite advanced surgical methods, the failure rates remained high. Moreover, recently the United States Food and Drug Administration (FDA) and the Australian Therapeutic Goods Administration (TGA) have removed synthetic mesh and biological material for vaginal repair from the market due to global mesh class-action. Consequently, gynaecologists have been left with conservative management or surgery with native tissue repair which has high failure rates, requiring repeat surgery in over 20% of cases. The current conservative management options such as physiotherapy and topical oestrogen rely on patient compliance. In addition, medication used for conditions such as urge urinary incontinence, Lichen sclerosis and genitourinary syndrome of menopause may have adverse effects or be contraindicated, leaving the patients with compromised quality of life.

The overarching theme of my work has been to introduce an innovative first-line conservative management which does not rely on patient compliance. This includes pelvic-floor physiotherapy, fractional CO2 (FxCO2) vaginal laser, Platelet Rich Plasma (PRP), and oestrogen cream. This approach will minimise the need for PFD surgery which is a burden economically on the patient and the national healthcare system. Surgery is also associated with possible complications that may negatively affect quality of life. When surgery is necessary, I seek to maximise surgical outcomes with pre-operative management followed by use of innovative autologous PRP graft intraoperatively. This approach has shown, through our initial cohort study, to reduce failure rates and possible complications. Consolidating my research in PhD-by-prior-published-work will provide a coherent narrative about improving quality of life for women with PFDs through first- line innovative methods and advanced minimally invasive surgery utilising autologous PRP graft if surgery is required.

Keywords: Pelvic floor disorders, single incision laparoscopy, platelet rich plasma, fractional CO2 laser, autologous graft, women health, quality of life.

Subject: Obstetrics and Gynaecology thesis

Thesis type: Doctor of Philosophy
Completed: 2021
School: College of Medicine and Public Health
Supervisor: Tara Brabazon