University of Toronto
Research Spotlight 2024
In our ongoing effort to highlight pelvic floor health research across Canada, the Research and Development Committee is pleased to feature the contributions from the team at the University of Toronto.
Featured Publication
Over the last two years, the team at the University of Toronto has been actively collaborating with the American Urogynecologic Society (AUGS) and the International Urogynecological Association (IUGA) to contribute to impactful publications that are set to influence the direction of pelvic floor disorders research and treatment.
Of particular interest is the recently published “National Urogynecology Research Agenda: A Path Forward for Advancing the Treatment and Management of Pelvic Floor Disorders” for which Dr. Colleen McDermott was senior author.
The document describes six (6) key areas of research interest, including:
- Lower urinary tract symptoms and urinary incontinence
- Pelvic organ prolapse
- Fecal incontinence
- Recurrent urinary tract infections
- Sexual health in women with pelvic floor disorders
- Bladder pain syndrome/myofascial pelvic pain
The authors of the Agenda highlight gaps in pelvic floor research and set clear priorities for the near future. The publication also addresses health disparities, multidisciplinary research and research training. The goals of the Agenda are to encourage and prioritize research and funding in these key areas to improve the understanding and management of pelvic floor disorders.
2024 Publication List
Mount Sinai Hospital
1. Dunivan, Gena C. MD; Ackenbom, Mary F. MD, MSc; Alperin, Marianna MD, MS; Anger, Jennifer T. MD, MPH; Antosh, Danielle D. MD; Bharucha, Adil E. MD; Birder, Lori A. PhD; Boyd, Sarah S. MD; Bradley, Megan S. MD; Brehman, Elizabeth H. DO, MS; Brito, Luiz G. O. MD, PhD; Brown, Heidi W. MD, MAS; Brown, Oluwateniola MD; Burnett, Lindsey A. MD, PhD; Caldwell, Lauren E. MD; Carter-Brooks, Charelle M. MD, MSc; Chermanksy, Christopher J. MD; Cichowski, Sara B. MD; Connell, Kathleen A. MD; DeLancey, John O. L. MD; Damaser, Margot S. PhD; De Nisco, Nicole J. PhD; Dubinskaya, Alexandra MD; Glass, Dianne H. MD, PhD; Guess, Marsha K. MD, MS; Hale, Douglass S. MD; Hannan, Johanna L. PhD; High, Rachel A. DO; Hokanson, James A. PhD; Jacobs, Kristin M. MD; Kelley, Robert S. DO, MBA; Kisby, Cassandra K. MD, MS; Kravitz, Elizabeth MD; Lowder, Jerry L. MD, MSc; Markland, Alayne D. DO, MSc; Meister, Melanie R. L. MD, MSCI; Meyer, Isuzu MD, MSPH; Moalli, Pamela A. MD, PhD; Mysorekar, Indira U. PhD; Parker-Autry, Candace Y. MD; Richter, Holly E. MD, PhD; Rogers, Rebecca G. MD; Rolston, Renee MD; Rubin, Rachel S. MD; Sheyn, David MD; Shinnick, Julia K. MD; Siddiqui, Nazema Y. MD, MHSc; Suyama, Julie A. MD, PhD; Uloko, Maria I. MD; Walter, Jens-Erik MD; Welch, Eva K. MD, M; Wolfe, Alan J. PhD; Zeno, Aldene MD; McDermott, Colleen D. MD, MSc. National Urogynecology Research Agenda: A Path Forward for Advancing the Treatment and Management of Pelvic Floor Disorders. Urogynecology. 29(11):p 851-855, November 2023. | DOI: 10.1097/SPV.0000000000001427.
2. Chaikof M, Cundiff, GW, Mohtashami F, Millman A, Larouche M, Pierce M, Brennand EA, McDermott CD. Surgical Sexism in Canada: Structural Bias in Reimbursement of Surgery for Women. Can J Surg (IF 2.089). 2023 Jul 4;66(4):E341-E347. doi: 10.1503/cjs.022121.
3. McDermott CD, Tunitsky-Bitton E, Dueñas-Garcia OF, Willis-Gray M, Cadish L, Edenfield A, Wang R, Meriweather K, Mueller ER. American Urogynecology Society Clinical Consensus Statement: Postoperative Urinary Retention. Urogynecology (IF 2.091). 2023 April; 29(4):381-396. DOI: 10.1097/SPV.0000000000001344.
4. Zhao ZY, Lovatsis D, Gagnon L, Wang S, Huszti E, McDermott CD. Comparing vitamin B2 versus 5% dextrose in water for optimal ureteric jet visualisation at the time of pelvic reconstructive surgery: A randomised controlled trial. BJOG (IF 7.331). BJOG. 2023 May;130(6):610-618. doi: 10.1111/1471-0528.17363. Epub 2023 Jan 5. PMID: 36504349.
5. 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 (IF 7.331). 2022 Dec;129(13):2203-2213. doi: 10.1111/1471-0528.17225. Epub 2022 Jun 14. PMID: 35596931.
6. Benseler A, Zhao ZY, Sheikh MH, Chan B, Tomlinson G, McDermott CD. Cost Analysis of Bladder Catheterization After Pelvic Floor Surgery. Urogynecology (Phila). 2024 May 10. doi: 10.1097/SPV.0000000000001519. Epub ahead of print. PMID: 38726966.
7. Benseler A, Tomlinson G, Lovatsis D, Alarab M, McDermott CD. Optimizing practices to prevent urinary tract infection after cystoscopy and urodynamics in women: A quality improvement study. Neurourol Urodyn. 2024 Apr;43(4):883-892. doi: 10.1002/nau.25447. Epub 2024 Mar 19. PMID: 38501377.
8. Zhang S, Blokker AM, Borazjani A, Hong CX, Chaikof M, Giroux M, Edell H, Eltahawi A, Ameri G, McDermott CD. A feasibility study of three-dimensional ultrasound imaging of the vagina under distension. Med Phys (IF 3.8) 2023 Oct 31. doi: 10.1002/mp.16810. Epub ahead of print. PMID: 37905819.
9. Hong CX, Zhang S, Eltahawi A, Borazjani A, Kalami H, San AN, Sham D, Ameri G, McDermott CD. Patient-Specific Pessaries for Pelvic Organ Prolapse Using Three-Dimensional Printing: A Pilot Study. Urogynecology J (IF 2.091). 2023 Sep 1;29(9):732-739. doi: 10.1097/SPV.0000000000001346. Epub 2023 Mar 9. PMID: 36946908; PMCID: PMC10476593.
10. 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). 2023 Feb;34(2):473-483. doi: 10.1007/s00192-022-05273-8. Epub 2022 Jun 25. PMID: 35751670.
11. 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. PMID: 35354149.
12. Alperin M, Alarab M, Botros-Brey S, Drutz H, King J, Shynlova O. The Future of Basic Science: Development of the Next Generation of Mechanistic Researchers in Female Pelvic Medicine. Int Urogynecol J. 2024 Apr;35(4):775-779.
13. Giroux M, Naqvi N, Alarab M. Correlation of anorectal symptoms and endoanal ultrasound findings after obstetric anal sphincter injuries (OASIS). Int Urogynecol J. 2023 Apr 18. doi: 10.1007/s00192-023-05491-8. Epub ahead of print. PMID: 37071137.
14. Kibschull M, Nguyen TTN, Chow T, Alarab M, Lye SJ, Rogers I, Shynlova O. Differentiation of patient-specific void urine-derived human induced pluripotent stem cells to fibroblasts and skeletal muscle myocytes. Sci Rep. 2023 Mar 23;13(1):4746. doi: 10.1038/s41598-023-31780-9. PMID: 36959367; PMCID: PMC10036466.
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. Female Pelvic Med Reconstr Surg. 2022 May 25. doi: 10.1097/SPV.0000000000001216. Epub ahead of print. PMID: 35609252.
16. 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. Int Urogynecol J. 2022 Jun;33(6):1387-1392. doi: 10.1007/s00192-022-05253-y. Epub 2022 Jun 8. PMID: 35674811; PMCID: PMC9266184.
17. Anglim B, Phillips C, 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.
Sunnybrook Health Sciences Centre
1. Zakhari A, Chaikof M, Kirubarajan A, McGavin J, Sanders A, Tomlinson G and Sobel, M. (2024). A Pilot Randomized Controlled Trial Comparing Presacral Nerve Block to Sham Block in Total Laparoscopic Hysterectomy. Journal of Gynecologic Surgery. 40. 10.1089/gyn.2022.0125.
2. Nair C, Kozak R, Alavi N, Mbareche H, Kung R, Murphy K, Perruzza D, Jarvi S, Salvant E, Ladhani N, Yee A, Gagnon L, 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. J Obstet Gynaecol Can. 2023 Nov 7:102276. doi: 10.1016/j.jogc.2023.102276. Epub ahead of print.
3. McLeod L and Lee P. Pelvic organ prolapse. CMAJ. 2023 Aug 8;195(30):E1013. doi: 10.1503/cmaj.230089.
4. Lee P, Kozak R, Alavi N, Mbareche H, Kung R, Murphy K, Perruzza D, Jarvi S, Salvant E, Ladhani N, Yee A, Gagnon L, 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.
Research Spotlight 2022
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: https://www.augs.org/assets/1/6/AUGS_IUGA_eBook.pdf).
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: https://pubmed.ncbi.nlm.nih.gov/35674811/
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. https://pubmed-ncbi-nlm-nih-gov.myaccess.library.utoronto.ca/36504349/Zhao 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.
- Female Pelvic Med Reconstr Surg. 2022 May 25. doi: 10.1097/SPV.0000000000001216. Epub ahead of print. PMID: 35609252.
- 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.