Editor's Note: The 2024 Annual Meeting of the Urological Surgeons Branch of the Chinese Medical Association (CUDA) was held in Xi'an from August 8 to 11, 2024. The conference was hosted by the Chinese Medical Association and the CUDA Urological Surgeons Branch, with the Air Force Medical University Xijing Hospital serving as the organizer and the Shaanxi Provincial Medical Association Urological Surgeons Branch as a co-organizer. Under the theme "Healthy China, Urology First," the conference showcased the latest achievements in urology. At the event, Dr. Xiangjun Lyu from the Chinese PLA General Hospital spoke with Urology Frontier about the importance of correcting patient perceptions regarding urinary incontinence and pelvic floor diseases, emphasizing the benefits of early diagnosis and intervention. She also discussed the role of robotic surgery in improving treatment outcomes for these conditions and its future prospects.1. Urology Frontier: Many women silently endure urinary incontinence and pelvic floor diseases due to embarrassment, neglecting the importance of treatment. Could you discuss when patients should seek timely treatment and which cases require surgical intervention?
Dr. Xiangjun Lyu: Urinary incontinence and pelvic floor diseases in middle-aged and elderly women include various causes of incontinence, with the most common being stress urinary incontinence, urgency incontinence, and pelvic organ prolapse. These conditions manifest as leakage during physical activities like exercise, coughing, sneezing, or laughing, as well as urgency, frequency, and inability to hold urine. In severe cases, the vaginal walls or uterus may protrude from the vagina, causing pain and hindering walking and daily activities.
In China, traditional beliefs often lead women to view incontinence and pelvic organ prolapse as private issues, considering them as inevitable problems of aging that are “difficult to treat or not treatable at all.” Many women start experiencing symptoms like incontinence during late pregnancy, especially after vaginal delivery, and these symptoms often persist for decades or longer. Regardless of the type of urinary incontinence or pelvic floor disease, early intervention and treatment are crucial. Patients should not wait until the condition becomes unbearable before seeking medical attention. Timely diagnosis and treatment can improve quality of life and pelvic floor health at any stage of the disease.
Severe urinary incontinence and pelvic floor diseases require surgical treatment, and we assess surgical indications based on the degree of incontinence. For instance, if a patient experiences leakage every time they cough, leaks multiple times daily, or needs to wear pads regularly, with noticeable urine on the pads, surgery is indicated. Urgency incontinence is typically managed with medication, but severe cases may require sacral nerve modulation. For pelvic organ prolapse, conservative treatments such as pessaries are generally used when there is no pain, mucosal damage, or impact on walking and daily activities. However, if conservative treatment is ineffective or intolerable, surgical intervention may be necessary.
2. Urology Frontier: How has the development of robotic surgery impacted the treatment of urinary incontinence and pelvic floor diseases in women?
Dr. Xiangjun Lyu: Various surgical methods exist for treating urinary incontinence and pelvic floor diseases, with the main approaches being transvaginal and transabdominal surgery. Compared to traditional open or laparoscopic surgery, robotic-assisted transabdominal surgery offers a shorter learning curve, more precise surgical access, higher magnification, greater arm flexibility, and finer dissection and suturing. In terms of surgical outcomes, robotic surgery has shorter operation times, fewer intraoperative complications, better pelvic floor reconstruction, and less impact on the patient. The development of robotic surgery has driven advancements in transabdominal surgical techniques, bringing significant benefits to patients undergoing these procedures. Moreover, we have observed that robotic surgery has distinct advantages in suturing and reconstructing during pelvic floor repair procedures.
3. Urology Frontier: What areas of robotic surgery for urinary incontinence and pelvic floor diseases do you believe still need improvement?
Dr. Xiangjun Lyu: There are various surgical techniques for pelvic floor reconstruction, all of which can achieve effective results. Robotic surgery is not yet the mainstream approach for pelvic organ prolapse surgery due to the high cost. However, robotic surgery has shown promising results in complex multi-chamber prolapse cases and for patients with cosmetic concerns, reducing trauma and meeting aesthetic needs. Regarding cost, the development and application of domestic robots will further lower overall treatment expenses and increase accessibility. These are potential directions for further optimizing robotic surgery in the future.
Dr. Xiangjun Lyu
- MD, Associate Chief Physician
- Department of Urology, General Hospital of the People’s Liberation Army
- Head of the Subspecialty for Urinary Incontinence and Pelvic Floor Diseases
- Deputy Chair, Professional Committee for Urinary Incontinence and Pelvic Floor Diseases, China Health Science and Technology Promotion Society
- Youth Committee Member, Sino-German Urology Academic Committee
- Committee Member, Female Urology Group, Urology Branch of the Chinese Medical Association
- Committee Member, Urology Group, Postpartum Rehabilitation Professional Committee, Chinese Rehabilitation Medical Association
- Committee Member, Medical Robotics Professional Committee, Chinese Society of Automation
- Committee Member, Reproductive Health and Pelvic Disease Branch, China Geriatric Care Association
- Editorial Board Member, CUA Guidelines for the Diagnosis and Treatment of Female Stress Urinary Incontinence
- Recipient of the “Da Vinci Robot China Outstanding Contribution Award”
