eP488 - What to Expect When Starting a Multi-Disciplinary Combined Clinic with Colorectal & Uro-gynecology Surgery

Purpose/Background: Pelvic floor disorders are a broad range of conditions primarily impacting women and include rectal prolapse, pelvic organ prolapse, pelvic floor dysfunction, obstructed defecation syndrome, and urinary/fecal incontinence. Historically the management involved different specialties of gastroenterology, gynecology, urology, colorectal surgery, psychiatry, radiology, pain specialists and physical therapy. Given the complex etiology, challenging diagnostic and management decisions required there are often unsatisfactory outcomes. A few institutions across the country have implemented a multi-disciplinary method in a patient centered approach. A urogynecology and colorectal surgery combined clinic was established at our institution. We aim to look back at the number of cases seen, what were their diagnoses and what treatment they received since the establishment of the clinic.Methods/Interventions: Retrospective chart review from a single center of patients who attended a combined urogynecology and colorectal surgery clinic between 2019 – 2023.Results/Outcomes: 208 patients were seen in the clinic. 100% of them were female. 37 separate diagnoses were managed. The most common diagnoses were rectocele 72 (35%), full thickness rectal prolapse 54 (26%), obstructed defecation syndrome 49 (24%), constipation 40 (19%), pelvic floor dysfunction 28 (13%), vaginal vault prolapse 26 (13%), internal prolapse 25 (12%), and fecal incontinence 23 (11%). 83 (40%) of patients went on to have surgery for their pelvic floor disorder and 57 (27%) were referred for pelvic floor physiotherapy. 62 (30%) of the surgeries were combined cases between colorectal and urogynecology surgery while 9 (4%) were completed by colorectal alone and 12 (6%) by urogynecology alone. The most common surgery completed was ventral rectopexy with sacrocolpopexy 36 (44%). For the combined cases the average operative time was 224 mins (SD: 90 mins), estimated blood loss was 55 mL (SD: 38 mL), and length of stay 1.72 days (SD: 1.5).Conclusion/

Discussion: The implementation of a multidisciplinary clinic between urogynecology and colorectal surgery allows for complete care of pelvic floor disorders at one location and results in a high collaborative operative volume.