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.
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