UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

INTERDISCIPLINARY APPROACHES

Esra Ayanoğlu1 Furkan Kayabaşoğlu2

1University of Health Sciences; Prof. Dr. İlhan Varank Sancaktepe Training and Research Hospital, Department of Gynecology and Obstetrics, İstanbul, Türkiye
2Private Practice of Gynecology and Obstetrics, İstanbul, Türkiye

Ayanoğlu E, Kayabaşoğlu F. Interdisciplinary Approaches. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.69-80.

ABSTRACT

Pelvic floor disorders, including urinary incontinence, pelvic organ prolapse (POP), and chronic pelvic pain (CPP), pose significant clinical challenges due to their multifaceted nature, often involving several anatomical compartments and functional systems simultaneously. The complexity of these conditions has prompted a shift away from traditional, isolated specialty management towards comprehensive interdisciplinary collaboration. Current evidence strongly supports the establishment of multidisciplinary treatment teams, comprising specialists from urogynecology, urology, colorectal surgery, pelvic floor physiotherapy, specialized nursing, neurology, pain medicine, and psychology. Such multidisciplinary teams facilitate a holistic diagnostic and therapeutic approach, ensuring that the intricate interplay of anatomical, neurological, and psychological factors in pelvic floor disorders is effectively addressed.

Collaborative surgical practices involving general surgery, urology, and gynecology have gained acceptance as safe and effective means of managing multi-compartmental pelvic disorders in a single surgical session. Conditions such as simultaneous rectal and vaginal prolapse, complex fistulas, and combined urinary incontinence procedures highlight the advantages of coordinated surgical teams. Recent data indicate that carefully selected patients benefit significantly from combined operations, demonstrating comparable complication rates to individual procedures, but offering improved patient experience, decreased hospitalization times, reduced cumulative anesthetic risk, and enhanced functional outcomes. The integration of minimally invasive and robotic techniques has further enabled these combined surgeries to be performed more efficiently, facilitating collaborative interactions between surgical specialties.

Neurological considerations in CPP have increasingly become central to clinical management strategies. A growing body of evidence highlights the critical role of peripheral neuropathies, central sensitization, and systemic neurologic disorders in persistent pelvic pain syndromes. Neurological evaluation and management-including nerve conduction studies, neuroimaging, pharmacotherapy with neuropathic pain modulators, nerve blocks, and neuromodulation therapies-are now fundamental components of comprehensive CPP management. Interdisciplinary clinics that integrate urogynecology, neurology, pain management, pelvic physical therapy, and psychological services have shown improved diagnostic accuracy and treatment effectiveness, underscoring the essential role of neurologic collaboration.

Clinical guidelines from international bodies such as the National Institute for Health and Care Excellence (NICE), the American Urogynecologic Society (AUGS), and the European Association of Urology (EAU) strongly endorse interdisciplinary approaches as standard practice, particularly for complex or refractory cases. Continued evolution in multidisciplinary care models, advancements in surgical technologies, and enhanced recognition of neurological dimensions in pelvic floor disorders promise further improvements in clinical outcomes and patient quality of life.

Keywords: Multidisciplinary care; Urogynecology; Chronic pelvic pain

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