Components of the Pelvic Floor Team

To provide comprehensive care of pelvic floor dysfunction to patients seen at a pelvic floor center, an expertise is required in numerous fields, as listed below:

• Urogynecology/Female Urology

• Colorectal Surgery

• Gastroenterology

• Physiotherapy

• Sexual Dysfunction Specialist

• Mental Health Specialist

• Nursing Personnel

Communication between the various team members is very important. At Cleveland Clinic Florida, each service obtains information regarding dysfunction in the other compartments and then schedules the patient for appropriate evaluation. Our plan is to have a triage nurse to perform the initial history-taking for patients seen with any form of pelvic floor dysfunction. This would then allow scheduling of appropriate consultation and evaluation services. Constant and accurate communication between team members is very important, especially as relates to planning combined surgical interventions. Although we do not have a combined database at this time, our clinical databases cross-reference each other in order to be able to identify patients who are being seen by multiple services. In addition, joint pelvic floor conferences are necessary and important to discuss complex cases. We hold a pelvic floor conference once a month in which joint cases are discussed and outcomes are provided. We have been able to achieve an excellent working relationship among the various subspecialists of the pelvic floor. This is crucial in the development of a close working relationship, to avoid any "turf" issues. As such, rectocele repairs are typically performed via the vaginal approach by the urogynecology service whereas anal sphincteroplasties are performed by the colorectal service. Our decisions regarding delegation of surgical duties to different services are based on existing literature. Postgraduate fellows are encouraged to participate in the surgical management of problems -especially when operated on by another service - to allow for continuity of patient care.

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