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Monday, June 29, 2009

IUGA 2009, Como

IUGA 2009, Como came and went. In the world of the Uro-gynaecologist- or as some would prefer the pelvic organ reconstructive surgeon – the annual IUGA congress is the highlight of the year. This is a time where one recharges your knowledge- sometimes it is more a reassurance of one’s competence to practise.

Compared to previous IUGA congresses, IUGA 2009 was different. The programme was changed in many ways- the workshops were well planned and well attended, the main programme interlinked review lectures with the scientific programme- to such an extent that the lecture halls were still full on the last day! The overdose of industry seminars of the past was not there- the biggest plus point of IUGA 2009. Whereas the congresses of 2006 2007 and 2008 were dominated with all kinds of innovations on the different synthetic mesh kids, on this one, one needed to hunt to find any. The scientific programme was central and the rest more peripherally.

The feel of this congress was that a new era is dawning: the joy of the fantasy of mesh kits having the answers to all our problems is being replaced with the reality that the cracks in the wall are appearing. As time go by the synthetic meshes are giving rise to a new science: how to diagnose complications caused by them and how to rectify that. The focus had been in the past on the successes and failures to cure prolapse- now it is shifting to not only the failure rates, but also the harm done to those who had failures and more importantly, the long term complications even in those who had initial good results. The pendulum is still on the move.

No wonder that at this congress 5 workshops highlighted complication of synthetic meshes: how to diagnose, classify and treat them. This is to my mind going to be one of the main attractions in IUGA congresses to come. IUGA 2009 was the starting point. The last few drops in the synthetic mesh innovations bucket was a few introductions of, what someone called, the stamp size mesh kits. Increase the pore size, or decrease the mesh size- both leading to less and less mesh, until nothing remains. Those who (still) do not want to hear will, unfortunately, stay deaf, and those who do not want to see, blind.

One aspect of the IUGA 2009 experience which needs to be underlined is the video sessions. At this congress, in contrast to IUGA 2006 and 2007, these proved to be poorly attended. A pure organizational blunder- the EUGA was given the responsibility of having video sessions as part of their poorly advertised pre-congress meeting. The few videos accepted were more accepted on the base of the Names who subjected these than on the basis of content. Videos not accepted for this meeting were introduced as a “digital poster” session- some fantastic idea, but poorly advertised, if advertised at all. I am sure few attendees knew about this. Video with data was a new addition to the main programme, and well attended. Unfortunately the excluding criteria of not mentioning industry names or advertising was not adhered to in quite a few of these. Some videos were also of very poor quality. The vast majority of attendees to IUGA are experienced surgeons- they want to see other surgeons operate and compare. Videos of surgical procedures- it do not need to be “surgical innovations” all the time; a simple rerun of a well known procedure in the hands of an expert- is always good to watch.

A fantastic introduction to IUGA 2009 was the lunch with experts. To be able to speak with your heroes and idols at a congress is always one of the reasons why normal mortals attend. At IUGA 2009 this was possible, not only due to this lunch meeting, but also in between lectures. One of the responsibilities of being leaders in your field is that you must be available to your piers during meetings like this. This initiative by the organisers must be applauded.

Out of the perspective of someone who has English as a second language, I do want to make a suggestion to organisers of Congresses where the only language is English. At this congress, as in others, it came once again apparent the advantage speakers with English as first language have. The poor Greek, Italian, French speaker is at a distinct disadvantage: he has to put his message forward in the same time frame as his English/American colleague, has to answer questions –which he/she normally did not fully grasps- off the cuff under the same pressures as the English/American colleague. Is it possible to lend these people a hand? In the days leading up to an international congress like this a special workshop session can easily be arranged to coach interested speakers. I am certain a lot of good knowledge and new perspectives get lost due to the language barriers.

IUGA 2009 was a better experience to me personally, compared to the last one I attended in 2007- the fact that I did not bother to go to Taiwan in 2008 says it all.

My thanks and congrats to the Italian organisers.

Andri Nieuwoudt: IUGA 2009: Some perspectives from a neutral corner. International Urogynecology Journal: Volume 20, Issue 9 (2009), Page 1007.