Sonthidetch Sivilaikul

• Updating Management Strategies for Pelvic Organ Prolapse
  Naoya MasumoriJapan Moderator

  Alex Tong-Long LinTaiwan Moderator
• Exploring Non-Surgical Treatments for Pelvic Organ Prolapse: What Does the Evidence Says?
  Sonthidetch SivilaikulThailand Speaker Exploring Non-Surgical Treatments for Pelvic Organ Prolapse: What Does the Evidence Says?Pelvic organ prolapse (POP) is a prevalent condition among women, particularly in the postmenopausal population, and it significantly impacts quality of life. While surgical intervention remains a definitive treatment for moderate to severe cases, non-surgical management has garnered increasing attention as a viable alternative, especially for women who are asymptomatic, medically unfit for surgery, or prefer conservative options. This review explores current evidence regarding non-surgical therapies for POP, focusing on pelvic floor muscle training (PFMT), pessary use, lifestyle modifications, and emerging modalities such as vaginal estrogen therapy and electrical stimulation. Clinical trials and meta-analyses suggest that PFMT can improve prolapse symptoms and halt progression in early-stage POP, while pessaries offer an effective mechanical solution for symptom relief and support. However, the quality of evidence varies, with many studies limited by small sample sizes and heterogeneity in outcome measures. Ultimately, non-surgical treatments serve as an important component of personalized care strategies for managing POP.
• Surgical Options for Apical Prolapse: Comparing Trans-Vaginal and Trans-Abdominal Approaches
  Sakineh HajebrahimiIran Speaker Surgical Options for Apical Prolapse: Comparing Trans-Vaginal and Trans-Abdominal Approaches Surgical Options for Apical Prolapse: Comparing Transvaginal and Transabdominal Approaches Background Apical prolapse represents a significant subset of pelvic organ prolapse cases and can profoundly impact quality of life. Surgical correction remains the cornerstone of management, with both transvaginal and transabdominal approaches offering distinct advantages and limitations. The optimal surgical pathway continues to be debated among pelvic floor surgeons. Objective To critically compare transvaginal and transabdominal surgical approaches for apical prolapse, focusing on anatomical and functional outcomes, complication profiles, and long-term durability. Methods A comprehensive review of current literature, including randomized controlled trials, prospective cohort studies, and meta-analyses, was performed. Surgical techniques assessed included vaginal sacrospinous ligament fixation, uterosacral ligament suspension, and transabdominal sacrocolpopexy (open, laparoscopic, and robotic-assisted). Outcome measures included anatomical success rates, recurrence rates, functional urinary and sexual outcomes, operative morbidity, and patient-reported quality of life. Results Transabdominal sacrocolpopexy demonstrates superior long-term anatomical durability and lower recurrence rates, particularly for advanced prolapse, but is associated with longer operative time and higher perioperative morbidity. Transvaginal approaches offer shorter recovery times, lower immediate postoperative complications, and feasibility in high-risk surgical candidates, but may have higher rates of recurrent prolapse over extended follow-up. Minimally invasive abdominal approaches, especially robotic-assisted techniques, may bridge the gap between durability and reduced morbidity. Conclusion Choice of surgical approach for apical prolapse should be individualized, balancing patient-specific anatomical, functional, and comorbidity profiles against surgeon expertise and available resources. Ongoing high-quality comparative studies are essential to refine patient selection criteria and optimize long-term outcomes. Keywords Apical prolapse, sacrocolpopexy, sacrospinous fixation, transvaginal surgery, pelvic floor reconstruction, robotic surgery
• Choosing between Laparoscopic Sacrocolpopexy and Lateral Suspension: Weighing the Pros and Cons
  Véronique PhéFrance Speaker New Artificial Urinary SphinterStress urinary incontinence remains a major quality-of-life concern, particularly following pelvic surgery. Despite being the gold standard, the AMS 800 artificial urinary sphincter (AUS) presents significant limitations, including mechanical failure, urethral atrophy, and challenges for elderly or disabled patients. Recent innovations in AUS design now incorporate mechatronics, remote control, adaptive pressure systems, and miniaturized components aimed at improving usability, autonomy, and continence outcomes. This presentation reviews the current landscape of next-generation AUS, focusing on ARTUS, UroActive®, and other devices under clinical evaluation. We discuss preclinical and first-in-human data, regulatory pathways, patient-reported preferences, and remaining barriers such as infection risks and training requirements. Intelligent, connected AUS devices hold promise to transform continence care after decades of technological stagnation.Choosing between Laparoscopic Sacrocolpopexy and Lateral Suspension: Weighing the Pros and ConsPelvic organ prolapse (POP) is a common condition requiring surgical intervention to restore apical support. Among minimally invasive options, laparoscopic sacrocolpopexy (LSCP) remains the gold standard, while laparoscopic lateral suspension (LLS) is gaining renewed interest for its reduced invasiveness and simplified technique. This presentation compares LSCP and LLS across multiple dimensions: anatomical restoration, functional outcomes, complication profiles, patient selection, and surgical learning curves. LSCP offers robust long-term results and better posterior compartment support but carries increased operative complexity. LLS provides effective anterior/apical correction with fewer vascular risks and a shorter learning curve. Both techniques have comparable mesh exposure rates and subjective success. Individualized decision-making based on patient anatomy, comorbidities, and surgeon expertise remains key. Emerging technologies and robotic assistance may further refine these approaches in the future.Robotic Novel Artificial Urinary Sphincter ImplantationThis video shows a step by step robotic artificial urinary sphincter implantation in women using AMS800 and Artus devices.First robot-assisted implantation of ARTUS (Affluent Medical) electromechanical artificial urinary sphincter in a female cadaverIntroduction Artificial urinary sphincters (AUS) are effective tools for the treatment of female stress urinary incontinence. Nonetheless, hydraulic sphincters present with some limitations: complex and time-consuming preparation, need for preserved manual dexterity and constant pressure exertion on the bladder neck. The ARTUS® Artificial Urinary Sphincter is a novel electro-mechanical device designed to overcome these limitations thanks to its rapid and straight-forward implantation, intuitive remotely controlled manipulation and continuously adjustable cuff pressure. Materials and methods The ARTUS® system is currently under pre-market investigation in men, in an interventional, prospective, single arm, multicentric, international study. A cadaver lab session was carried out in Decembre 2024 to test the technical feasibility of ARTUS® implantation in female patients. The procedure was performed by an expert surgeon with extensive experience in AUS implantation and robotic surgery. Results One female patient was successfully implanted during the session. The technique has been developed following the principles of the traditional robot-assisted AUS implantation: the patient is placed in gynecological 23° Trendelenburg position. The robot has a 4-arms configuration. The procedure starts with the dissection of the vesicovaginal plane, to approach the bladder neck posteriorly. The lateral surfaces of the bladder neck are developed on both sides. The anterior peritoneum is opened to gain access to the antero-lateral surfaces of the bladder. The separation of the bladder neck from the vagina is performed through dissection of the pre-vaginal fascia bilaterally. The cuff is introduced and it is passed through the antero-lateral peri-vesical spaces, sliding behind the bladder neck from the right side to the left side. The anterior peritoneum is opened to gain access to the anterior surface of the bladder neck. The cuff is closed anteriorly, passing the transmission line inside the hole at the distal part of the cuff. The tightening around the bladder neck is achieved by pulling the transmission cable through. An optimal adjustment of the cuff around the bladder neck is provided tightening the ARTUS cuff clamping notch. Then, a supra-pubic 4 cm skin incision is made to implant the control unit. The tip of the cuff is passed outside through the incision. A lodge is prepared incising along the external oblique muscle aponeurosis. The cuff is connected to the control unit and a test with the remote control is performed to verify the functioning of the system. Finally, the control unit is placed into the lodge, anchored with non-absorbable sutures to the aponeurosis. Conclusions Robot-assisted ARTUS® implantation is technically feasible in female patients. This straight-forward technique may reduce operative time. The device has the potential to reduce the pressure and facilitate manipulation in patients with impaired dexterity.
• Surgical Treatments for Recurrent SUI/POP
  Howard GoldmanUnited States Speaker Anti-Cholinergics: Does Treating the Bladder Put the Brain at Risk?Recent evidence suggests an association between Overactive Bladder Anticholinergic medication and dementia. Do these medications really increase one's risk of dementia. We will examine the evidence.Surgical Treatments for Recurrent SUI/POPEven the best of surgeon's will have patients who have recurrence after a stress incontinence or pelvic organ prolapse procedure. If the recurrent is bothersome the patient may need repeat surgery. How to decide on the ideal surgery for recurrent symptoms will be examined
• Female Bladder Outlet Obstruction & Urinary Retention: Considerations beyond POP
  Raymond Wai-Man KanHong Kong, China Speaker Female Bladder Outlet Obstruction & Urinary Retention: Considerations beyond POPFemale bladder outlet obstruction has been an under-recognised disease entity, however that does not imply the rarity of this condition. There are limitations in urodynamic evaluation for this condition and fluoroscopy can often help in the decision making process. Urinary retention in women shares common etiology with bladder outlet obstruction, unlike men however, these two groups of patient do not overlap as much. Management of women with bladder outlet obstruction and urinary retention should be individualised.
• Discussion