Continence Research - Urogynecology and Pelvic Floor Disorders

One of the things that clearly distinguishes GBMC from its community hospital peers is the wealth of clinical trials offered to patients. The trials, many of which potentially have significant clinical impact, are open to all patients and are an important contribution to the advancement of medical care. Following are synopses of studies that are currently open under the auspices of the Department of Gynecology. This Division includes subspecialty-trained physicians including Joan Blomquist, M.D. and Michelle Germain, M.D. as well as three fellows in training. Sue Aumiller RN is the nurse in charge of research in the Division of Urogynecology/Reconstructive Pelvic Surgery. 

1. Vaginal Uphold Hysteropexy and Laparoscopic Sacral Hysteropexy for the Treatment of Uterovaginal Pelvic Organ Prolapse (UpHold) 

PRINCIPAL INVESTIGATOR(S) Joan L. Blomquist, MD 
This study is being done to compare the effectiveness of 2 surgical techniques for treatment of uterovaginal prolapse. We are comparing laparoscopic sacral hysteropexy and vaginal uphold hysteropexy. Both procedures leave the uterus in place and use mesh to support the uterus and vagina. Mesh is commonly used in reconstructive pelvic surgery to increase the strength of the repair in order to decrease the high risk of recurrent prolapse. Studies show that mesh is better for curing and preventing recurrent cystoceles (support problems at the front wall of the vagina). Mesh can be inserted onto the vaginal walls through incisions in the vagina or abdomen. Placement of mesh vaginally (vaginal mesh repair) is quicker and technically easier but carries a higher risk of mesh complications compared to placement through the abdomen laparoscopically. However, both approaches are minimally invasive. In this study, we are following women over time who choose to have one of the two surgical procedures (this is not a randomized study, that is, the patient chooses which procedure they want to have) to compare effectiveness as well as complications. 

This study is being done in collaboration with other urogynecologic centers at Washington Hospital Center, Cleveland Clinic, Duke, Stanford, and Brown. 

2. Mothers' Outcome After Delivery (MOAD) 

Started in 2008, the Mothers' Outcomes After Delivery (MOAD) study is a collaborative research effort of physicians at Greater Baltimore Medical Center (GBMC) and The Johns Hopkins University School of Medicine. The study focuses on whether health problems are affected by the events that occur during pregnancy and delivery. The primary goal of the study (in its first year) is to find whether "pelvic floor problems" (including bladder control issues and sagging vaginal walls) are affected by events during childbirth. Additionally, this research has addressed other important health outcomes, including obesity, fertility, breastfeeding, pelvic muscle strength, menstrual problems, and pelvic pain. In the first 5 years of the study, more than 1,500 Moms joined the research (with more joining the study every year). Since joining, more than 80% of the study members have continued with the study every year. This research has led to many important scientific findings and a 2011 award from the American Congress of OB/GYN. Visit the results update to find out more about what we have found. In 2013, this study was selected by the NIH to be continued for a second term (through 2018). Additional research will focus on other aspects of mothers' health after childbirth, specifically whether health and gynecologic problems are related to either cesarean or vaginal birth. Information gained from the MOAD study could help women and their obstetricians make more informed childbirth decisions. It also will establish whether or not obstetrical care can be modified to prevent women's health problems later in life. 

Victoria Handa, MD, MHS, Professor - Gynecology and Obstetrics, Johns Hopkins University 
Joan Blomquist, MD, Chief - Division of Urogynecology, Greater Baltimore Medical Center 

This Division is committed to clinical research to broaden the knowledge and understanding in this area.