University of Toronto

Research Spotlight


May Alarab and Oksana Shynlova, Obstetrics and Gynecology Associate Professors at the University of Toronto and team of world-renowned experts from various disciplines have written the full-text report (or e-book) called “Pelvic floor: foundational science and mechanistic insights for a shared disease model”, that highlights women’s health advances in pelvic medicine (to access the e-book:  

At the American Urogynecologic Society (AUGS)/International Urogynecological Association (IUGA) Joint Annual Scientific Meeting in Nashville, Tennessee, in 2019, clinicians, and researchers from around the world (Basic Science Special Interest Group) joined their efforts to identify what was known and unknown about the pathophysiology of Pelvic Floor Disorders (POP and SUI). The e-book  focused on different aspects of the female pelvic medicine and reconstructive surgery (FPMRS), urology, biomechanics, muscle physiology, bioengineering, immunology, cellular and molecular biology, steroid hormones, and aging science. In particular,  (1) pelvic floor structural anatomy and the mechanism of disease, (2) biomechanics of the female pelvic floor, (3) the impact of hormonal milieu on the female pelvic floor structure and function, and (4) the role of aging and immunity in the pathogenesis of POP and SUI. The e-book highlights anatomical, biomechanical, hormonal, aging and inflammation-related pathways and underscores the interdependence of these factors with respect to their impact on the pelvic floor and lower urinary tract. 

Congratulations to Dr Alarab (section editor of “The impact of hormonal milieu on the female pelvic floor structure and function”) and her writing team on publishing the e-book that will improve our understanding of the various risk factors for PFDs to design scientifically robust preventive strategies and effective treatments for POP and SUI. The expert consensus paper summarizing the e-book is published in  

Int Urogynecol J. 2022 Jun; 33(6): 1387–1392.  

View Publication: 

2020-2022 Publication List

1.    Brito LGO, Pereira GMV, Moalli P, Shynlova O, Manonai J, Weintraub AY, Deprest J, Bortolini MAT. Age and/or postmenopausal status as risk factors for pelvic organ prolapse development: systematic review with meta-analysis.  Int Urogynecol J. 2022 Jan;33(1):15-29. doi: 10.1007/s00192-021-04953-1. Epub 2021 Aug 5. PMID:  34351465. 

2.    Deprest JA, Cartwright R, Dietz HP, Brito LGO, Koch M, Allen-Brady K, Manonai J, Weintraub AY, Chua JWF, Cuffolo R, Sorrentino F, Cattani L, Decoene J, Page AS, Weeg N, Varella Pereira GM, Mori da Cunha de Carvalho MGMC, Mackova K, Hympanova LH, Moalli P, Shynlova O, Alperin M, Bortolini MAT. International Urogynecological Consultation (IUC): pathophysiology of pelvic organ prolapse (POP).  Int Urogynecol J. 2022 Mar 10. doi: 10.1007/s00192-022-05081-0. Online ahead of print. PMID: 35267063. 

3.    Anglim BA, Phillips CD, Shynlova O, Alarab M. The effect of Local Estrogen Therapy on the urinary microbiome composition of postmenopausal women with and without recurrent urinary tract infections.   Int Urogynecol J. 2022 Aug;33(8):2107-2117. doi: 10.1007/s00192-021-04832-9. Epub 2021 May 18. PMID: 34003309 

4. ZY, Lovatsis D, Gagnon L, Wang S, Huszti E, McDermott CD. Optimal ureteric visualization at the time of pelvic reconstructive surgery: vitamin B2 versus 5% dextrose in water. BJOG. 2022 Dec 12. doi: 10.1111/1471-0528.17363. Online ahead of print. PMID: 36504349  

5. Bushra M, Anglim B, Al-Janabi A, Lovatsis D, Alarab M. Long-term experience of modified technique of McCall culdoplasty in women undergoing vaginal hysterectomy for pelvic organ prolapse. J Obstet Gynaecol Can. 2021 Oct;43(10):1129-1135. doi: 10.1016/j.jogc.2021.04.012. Epub 2021 May 11. PMID: 33984523. 

6. Anglim B., ZY Zhao, D. Lovatsis, C. McDermott. The extended pessary interval for care (EPIC) study: a failed randomized clinical trial. Int Urogynecol J. 2021 Apr;32(4):937-944. doi: 10.1007/s00192-020-04489-w. Epub 2020 Aug 12. PMID: 32785749. 

7.     Anglim BC, Tomlinson G, Paquette J, McDermott CD. A risk calculator for postoperative urinary retention (POUR) following vaginal pelvic floor surgery: multivariable prediction modelling. BJOG. 2022 Dec;129(13):2203-2213. doi: 10.1111/1471-0528.17225. Epub 2022 Jun 14. PMID: 35596931.  

8.     Kciuk O, Li Q, Huszti E, McDermott CD. Pelvic floor symptoms in cisgender women with Ehlers-Danlos syndrome: an international survey study. Int Urogynecol J (IF 2.894). 2022 Jun 25. doi: 10.1007/s00192-022-05273-8. Epub ahead of print. PMID: 35751670.  

9.     Benseler A, McDermott CD. Use of Prophylactic Antibiotics to Prevent Urinary Tract Infection after Urodynamic Testing and Cystoscopy in Women: A Practice Pattern Study. Gynecol Obstet Invest (IF 2.031). 2022;87(2):116-123. doi: 10.1159/000524266. Epub 2022 Mar 30. PMID: 35354149.  

10.     Kulkarni A, McDermott CD. What Do Nurses Prefer? A Cross-sectional Study of Catheter Preference After Pelvic Organ Prolapse Surgery. J Wound Ostomy Continence Nurs (IF 1.97). 2021 Jul-Aug 01;48(4):319-324. doi: 10.1097/WON.0000000000000773. PMID: 34186550.  

11.     Paquette J, McDermott CD, Acquaviva B, Faghani N, Lovatsis D. Real-World Effectiveness of Pelvic Floor Muscle Training for Women With Urinary Tract Symptoms and/or Prolapse. J Obstet Gynaecol Can (IF 0.97). 2021 Nov;43(11):1247-1253.e1. doi: 10.1016/j.jogc.2021.05.008. Epub 2021 May 26. PMID: 34048957. 


12     Chaikof M, McDermott CD, Brennand E, Sanaee M. Patients Seeking "Vaginoplasty" Deserve Assessment and Treatment by Experts in Female Pelvic Medicine and Reconstructive Surgery. Aesthet Surg J (IF 4.485). 2021 Mar 12;41(4):NP148-NP149. doi: 10.1093/asj/sjaa286. PMID: 33165577; PMCID: PMC7954535.  

13.     Anglim B, Zhao ZY, Lovatsis D, McDermott CD. The extended pessary interval for care (EPIC) study: a failed randomized clinical trial. Int Urogynecol J (IF 1.932). 2021 Apr;32(4):937-944. doi: 10.1007/s00192-020-04489-w. Epub 2020 Aug 12. PMID: 32785749.  

14. Gold S, Paquette J, Sobel M, Alarab M. Residual Defects of the Anal Sphincter Complex Following Primary Repair of Obstetrical Anal Sphincter Injuries at a Large Canadian Obstetrical Centre. J Obstet Gynaecol Can.  2021 May;43(5):596-600. 

15. Alperin M, Abramowitch S, Alarab M, Bortolini M, Brown B, Burnett LA, Connell KA, Damaser MS, de Vita R, Gargett CE, Guess MK, Guler Z, Jorge RN, Kelley RS, Kibschull M, Miller K, Moalli PA, Mysorekar IU, Routzong MR, Shynlova O, Swenson CW, Therriault MA, Northington GM. Foundational Science and Mechanistic Insights for a Shared Disease Model: An Expert Consensus: Developed by the AUGS Basic Science Subcommittee and IUGA Special Interest Group.   

Chapter 3: The Impact of Hormonal Milieu on the Female Pelvic Floor Structure and Function Section Editor: May Alarab, Writing Group: Oksana Shynlova, Maria Bortolini; Caroline E. Gargett, Lindsey A. Burnett; Mark Kibschull.  

  1. Female Pelvic Med Reconstr Surg. 2022 May 25. doi: 10.1097/SPV.0000000000001216. Epub ahead of print. PMID: 35609252. 
  1. Int Urogynecol J. 2022 Jun;33(6):1387-1392. doi: 10.1007/s00192-022-05253-y. Epub 2022 Jun 8. PMID: 35674811; PMCID: PMC9266184 

16.     Nair C, Kozak R, Alavi N, Mbareche H, Kung R, Murphy K, Perruzza D, Jarvi S, Salvant E, Ladhani N, Yee A, Gagnon L-H, Jenkinson R, Liu G, Lee P. Evaluation of real and perceived risk to health care workers caring for patients with the Omicron variant of the SARS-CoV-2 virus in surgery and obstetrics. MedRxiv Oct 30, 2022 doi: 10.1101/2022.10.30.22281627  

17.    Lee P, Kozak R, Alavi N, Mbareche H, Kung R, Murphy K, Perruzza D, Jarvi S, Salvant E, Ladhani N, Yee A, Gagnon L-H, Jenkinson R, Liu G. Detection of SARS CoV-2 contamination in the Operating Room and Birthing Room Setting with Risks to attending health care workers: a cross-sectional study. CMAJ Open. 2022 May 24;10(2):E450-E459. doi:10.9778/cmajo.20210321. PMID: 35609928. 

18.    Smith MK, Paquette J, Lee P. Surgical and Pre-Operative Considerations for Managing Pelvic Organ Prolapse in a Patient with a Müllerian Duct Anomaly. Int Urogynecol J (2021). doi: 10.1007/s00192-021-05016-1.   

19.  Lemos N, Homero Faria, Corey Sermer, Gustavo L. Fernandes, Augusta M. Ribeiro, Geovanne Nascimento, Zhong Cheng Luo, Manoel J.B.C. Girão, Suzan M. Goldman. Lumbosacral plexus MR tractography: A novel diagnostic tool for extraspinal sciatica and pudendal neuralgia? Magnetic Resonance Imaging. 2021 Nov; 83:107-113. DOI:10.1016/j.mri.2021.08.003.  

20. Lemos N, Corey Sermer, Gustavo Fernandes, Augusta Ribeiro, Andrea Rossos, Zi Ying Zhao, Manuel JBC Girão, Philip Peng. Laparoscopic Approach to Refractory Extraspinal Sciatica and Pudendal Pain Caused by Intrapelvic Nerve Entrapment: report of a 10-year experience. Nature Scientific Reports. 2021 May 24;11(1):10820 DOI: 10.1038/s41598-021-90319-y.  

21. Sermer C, Adrienne L.K. Li, Gustavo L. Fernandes, Augusta M. Ribeiro, Giancarlo Polesello, Denise Tokechi, Laura Cancelliere, Nucelio Lemos. Intrapelvic entrapment of sacral nerve roots by abnormal bundles of the piriformis muscle: description of an extra-spinal cause of sciatica and pudendal neuralgia. Journal of Hip Preservation Surgery. 2021 May 19; 8(1):132-138. doi: 10.1093/jhps/hnab041  

22.Marcu I, Balica A, Gavard JA, Campian EC, Fernandes GL, Solnik MJ, Morozov V, Lemos N. Closing the knowledge gap in pelvic neuroanatomy: assessment of a cadaveric training program. BMC Med Educ. 2021 Jan 7;21(1):26. doi: 10.1186/s12909-020-02443-4.