* At the time of this consultation, these definitions are not included in the current ICS terminology. RECOMMENDATIONS OF THE INTERNATIONAL SCIENTIFIC COMMITTEE 2. EVALUATION The following phrases are used to classify diagnostic tests and studies: • A highly recommended test is a test that should be done on every patient. This section should also be read in conjunction with the relevant committee reports. RECOMMENDATIONS OF THE INTERNATIONAL SCIENTIFIC COMMITTEE 6. ANORECTAL PHYSIOLOGY TESTING Endocoil MRI has high accuracy for detecting anal sphincter injury but is second line after endoanal ultrasound. Patients with faecal incontinence may benefit from assessment with MRI, particularly those with anorectal malformations and/or previous anal sphincter surgery. Defaecography may be useful and is recommended in patients with faecal incontinence, who have failed conservative therapies, and are possible candidates for laparoscopic ventral rectopexy. * Consider CONTINENCE PRODUCTS for temporary support during treatment Recent VVF Primary simple Consider Catheter, evaluate weekly Established VVF Primary complex Healed Persistant leakage Recurrence Post-irradiation Vaginal repair Consider timing Surgical repair Consider timing Consider interposition material If small, consider catheter, evaluate weekly Surgical repair 6-12 months Consider interposition material Surgical repair Consider timing Consider interposition material Assess fistula closure & assess continence status MANAGEMENT OF IATROGENIC URETERIC FISTULAE HISTORY CLINICAL ASSESSMENT MANAGEMENT* PRESUMED DIAGNOSIS Extra-urethral vaginal urinary leakage and/or signs of ureteric obstruction Clinical examination Urethro-cystoscopy Imaging (Xray/CT/ MRI, US) Evaluate upper urinary tract obstruction * Consider CONTINENCE PRODUCTS for temporary support during treatment Ureterovaginal fistula Endoluminal technique (stenting, nephrostomy) for at least 6 weeks Unable to stent (initially)... Re-evaluate for fistula closure, ureteric obstruction Persisting fistula or ureteric obstruction Ureteric reimplantation (open, laparoscopic or robotic) Healed Long-term follow-up for stricture and hydropephrosis * Consider CONTINENCE PRODUCTS for temporary support during treatment Patient education, adequate fibre diet and fluid intake; regular bowel care, preferably ± 3 times a week

clinicaltrials.gov Identifier: NCT01166373.

Objective To characterise the bladder microbiota of continent adult women.Design Cross-sectional study of adult women who contributed catheterised urine samples, completed validated symptom questionnaires, and provided demographic data.Setting US academic medical centre.Population Well-characterised continent adult women.Methods Participants contributed symptoms questionnaires, demographic data, and catheterised urine samples that were analysed by enhanced urine culture methodology and 16S rRNA gene sequencing.Main outcome measures Associations between demographics and microbial community state structures (urotypes, defined by the dominant taxon of each specimen). ResultsThe bladder microbiota (urobiome) of a control group of 224 continent women were characterised, demonstrating variability in terms of urotype. The most common urotype was Lactobacillus (19%), which did not differ with any demographic. In contrast, the Gardnerella (P < 0.001) and Escherichia (P = 0.005) urotypes were more common in younger and older women, respectively.Conclusions For urobiome research, enhanced culture methods and/or DNA sequencing are the preferred techniques for bacterial detection. The interpretation of clinical tests, such as the standard urine culture, should incorporate the knowledge that some women have Gardnerella or Escherichia urotypes without evidence of any clinical disorder. Clinical care strategies should preserve or restore the beneficial effects of the native urobiome, as disruption of that microbial community could result in unintended vulnerability to uropathogen invasion or opportunistic pathogen overgrowth. Longitudinal studies of urobiome responses to therapies should be encouraged.Keywords Bladder health, female bladder, urinary microbiome, urinary microbiota, urobiome.Tweetable abstract In continent adult women bladder microbiome composition differs by age, with relevance for clinical practice.

Despite the complexity and challenges inherent in the US health care system and the unprecedented demands in and disruptions of clinical practice created by the coronavirus disease 2019 (COVID-19) pandemic, it remains a privilege to be a physician. This privilege comes with many responsibilities, including a responsibility to reflect on the profession and address the entrenched dysfunctional ways of the work involved in medicine. The medical profession has missed opportunities to establish reasonable demands and expectations for physicians. Instead, physicians are often asked to do more that moves them away from the deep thinking that is needed for patient care. This has led to a loss of professional fulfillment and a moral crisis for an increasing number of physicians. 1,2 Even before the COVID-19 pandemic, physicians have been affected by systemic issues that foster unhealthful work environments, with expectations of 24/7 availability and a persistent life-work imbalance. 3 While some younger physicians are making intentional changes to their personal and professional lives, far too few physicians have effectively prioritized commitments to the personal roles they value. These preferences and other human factors that each physician brings to their vocation in medicine are framed by their personal experiences. This mix of personal attributes and professional skills can keep physicians healthy and thriving.

Background: Urinary incontinence is common in women. Because treatments differ, urge incontinence should be distinguished from stress incontinence. To make this distinction, current guidelines recommend an extensive evaluation that is too time-consuming for primary care practice.