The Department of Urogynaecology is located at St George Hospital in Sydney and encompasses the Pelvic Floor Unit and Detrusor Muscle Laboratory. The Department was first established in 1992 by Professor Kate Moore.
The Pelvic Floor Unit is now the largest facility in the southern hemisphere for the management of urinary incontinence and provides approximately 6,000 patients episodes of care per annum and employs 11 full time staff. The treatment of Detrusor Overactivity (DO) is the major focus of the Unit. Professor Moore has been chief investigator in all major pharmaceutical trials of new agents for DO in the last 20 years.
The Detrusor Muscle Laboratory works in close collaboration with the laboratories of: Professor Elizabeth Burcher (UNSW), Prof Russ Chess-Williams (Bond University) and Dr Kylie Mansfield (University of Wollongong), and Professor Mark Schembri (University of Qld).
Bladder overactivity occurs in 17% of the population; the incidence rises with increasing age. Patients suffer from debilitating symptoms of urgency (i.e. strong desire to urinate), frequency (urinating 8 or more times a day) to urge incontinence (i.e. uncontrollable urine leakage). Such bladder dysfunction impacts upon every facet of life - patients suffer social withdrawal and loss of productivity due to their condition. Current treatment are often ineffective and having limiting side effect such dry mouth; blurred vision and constipation. The lack of satisfactory treatment is due to inadequate understanding of the physiological mechanisms that govern bladder function. We seek to understand the cause of urinary incontinence called detrusor overactivity.
In the Detrusor Muscle Laboratory, the role of neuromodulators in control of detrusor muscle contractility including functional and histochemical studies is studied. We collaborate with neuroscientists and pharmacologists in order to investigate Refractory Detrusor Overactivity. Initially organ-bath pharmacological studies of biopsy specimens were a major focus, this work led to several important publications in the 1990’s regarding disturbance of detrusor innervation and contractility in biopsies from refractory DO compared to controls. Prof Moore was responsible for the definition of the term “refractory” in research circles, based upon her longstanding clinical and scientific efforts to understand the natural history of DO.
Recently a dedicated tissue culture facilities has been established, where human detrusor and urothelium are cultured. Characterisation via immunohistochemistry continues, but functional studies are also performed including ATP release by urothelial cells in cell cultures. Even more exciting is the discovery that bladder washings taken from routine patient cystometry studies contain sufficient urothelial cells to enable measurement of ATP release, which has extended the research possibilities from a small number of biopsies to hundreds of cystometry specimens per annum.
More recently Prof Moore established a collaboration with leading microbiologists, Professor Scott Hultgren at St Louis Missouri and Prof Mark Schembri (CIC) at UQ in pursuit of a novel discovery that 35-40% of patients with refractory DO have bacterial cystitis, either classical or “low count”. Ongoing research (which has been abstracted to relevant scientific meetings) shows exciting promise for the concept that Refractory DO patients appear to develop intracellular bacterial communities.
Ms Wendy Allen
Ms Wendy Hayes
Ms Josephine Oryszczyn
Ph (02) 9113 2054
Ms Nicole Ryan
Our department has very close ties with the Continence Foundation of Australia (CFA), which is aiming to foster the promotion of knowledge about incontinence in the community, to improve awareness of available treatments thereby increasing the likelihood that more patients will access these treatments; and to promote research into the causes of specific types of incontinence.
Professor Moore serves on the editorial board of their journal and regularly speaks at their Annual Conference.
Professor Moore is Chair of the Urogynaecological Society of Australasia
- Professor Moore is Deputy Chair of the St George & Sutherland Medical Research Foundation
The Pelvic Floor Unit and/Detrusor Muscle Laboratory has a worldwide reputation for excellence, attracting 1-3 international fellows annually. Researchers have come from England, Scotland, Sweden, Germany, Malaysia, China, Ireland, South Africa and New Zealand, including completion of 6 MD/ PhD degrees.