NICHD Pelvic Floor Disorders Network

描述(由申请人提供)：这份申请描述了德克萨斯大学西南医学中心和帕克兰医院的妇科和泌尿外科教职员工和研究团队的资格和经验，以及可用于执行由盆底疾病网络赞助的临床方案的设施和患者人数。2004年，共有2100多名女性盆底疾病患者在我们的诊所就诊，其中617名女性接受了手术矫正盆底疾病。自1997年以来，产科、妇科和泌尿科越来越多地合作，为患有盆底疾病的妇女提供全面护理。除了泌尿外科和泌尿外科，合作还包括来自结直肠外科、放射学、物理治疗和母婴医学的教员。本申请中描述的临床研究团队在NIH赞助的国家多中心试验中拥有成功的先前和正在进行的经验。这项申请的核心是现有的两个研究诊所，一个是针对私家病人的研究诊所(由泌尿外科经营)，另一个是专注于医疗贫困病人的研究诊所(由妇产科经营)。本申请还包括一项随机试验的概念性应用，旨在评估分娩期间撕裂的肛门外括约肌端到端修复与重叠修复的疗效。主要结果是肛门失禁，这是此类撕裂伤的严重后果。这项试验将能够准确评估特定外科手术的结果，这是导致建立盆底疾病网络的主要兴趣领域之一。我们认为，除了预防分娩期间肛门括约肌撕裂的策略外，还应研究括约肌撕裂的最佳处理方法，因为在美国，每年有20多万妇女遭受此类盆底损伤。

DESCRIPTION (provided by applicant): This application describes the qualifications and experience of the urogynecology and urology faculty and research teams at the University of Texas Southwestern (UT Southwestern) Medical Center and Parkland Hospital and the facilities and patient population available to carry out clinical protocols sponsored by the Pelvic Floor Disorders Network. In 2004, there were more than 2,100 women with pelvic floor disorders seen in our clinics and 617 women underwent surgical procedures for correction of pelvic floor disorders. The Departments of Obstetrics and Gynecology and Urology have increasingly collaborated since 1997 to offer comprehensive care of women with pelvic floor disorders. In addition to urogynecology and urology, collaboration includes faculty from colorectal surgery, radiology, physical therapy, and maternal-fetal medicine. The clinical research teams described in this application have successful prior as well as on-going experience in NIH sponsored national multi-center trials. Centerpieces in this application are two existing research clinics, one targeted at private patients (operated by the Urology Department) and the other focused on medically indigent patients (operated by the Obstetrics and Gynecology Department). Also included in this application is a concept application for a randomized trial designed to assess the efficacy of end-to-end versus overlapping repair of the external anal sphincter lacerated during childbirth. The primary outcome is anal incontinence which is a significant consequence of such lacerations. This trial would permit accurate evaluation of the outcome of specific surgical procedures which is one of the prime areas of interest leading to creation of the Pelvic Floor Disorders Network. We are of the view that along with strategies for prevention of anal sphincter laceration during childbirth, optimal management of the torn sphincter should also be studied since more than 200,000 women sustain such pelvic floor injuries each year in the United States.