Helen O’Connell is a Professor, Department of Surgery, at the University of Melbourne and the Director of Surgery and Head of Urology at Western Health, Victoria. She is a leading researcher in the area of female pelvic anatomy and was the first woman to complete training as a urologist in Australia. Prof O’Connell is the Chair for the 2021 International Continence Society meeting in Melbourne.
What led you to the field of urology and incontinence?
My mother inspired an interest in helping people with bladder problems when I was quite small. I recall her talking in glowing terms about Dr Catherine Hamlin and the work she and her husband were doing in Africa. Dr Hamlin is an Australian gynaecologist and obstetrician who founded the Catherine Hamlin Fistula Foundation – dedicated to repairing obstetric fistulas.
Helping people was highly valued. The fact that problems affecting women particularly seemed to be internationally neglected was all the more reason to become interested. When I was working in a urology outpatient department as a second-year resident doctor hoping to do surgery, patients would say: “It’s great to have a woman to talk to about this.” It was rare, in those days, to be given an example where my being female was seen as an advantage.
How has your work in the area of female sexual anatomy informed your work with the urinary system and pelvic surgery?
The nerves managing female sexual function are too small to see on scans and typically hidden from view. But we know their position and therefore can work backwards and consider the effect of surgery. In removing the urethra, for example due to cancer, I may see the nerves on the under-surface of the vaginal wall and consider whether or not in removing the cancer, the nerves can be pared safely. This depends on the position of the tumour.
My view is that there’s a long way to go, generally speaking, for sexual health to be good for the majority of women. Consideration of sexual anatomy in relation to surgery is one aspect of this that was never considered in the past. Most specialist surgeons now place emphasis on considering the impact of surgery on sexual function.
Often people experiencing pelvic and incontinence problems, particularly women, float from specialist to specialist in search of a solution. This can get very costly and time-consuming. What are your thoughts on how we can resolve this issue?
In my field we have seen, as you say, women seeing multiple specialists in search of a solution. Unfortunately, sometimes they have had a negative journey rather than a path to repair.
It is really important that surgery is seen as only one option to help people with these complex problems. Pain medicine, grief and sexual counselling, and physiotherapy are very important specialties when conditions have worsened after the second procedure, rather than improving.
Conditions and problems involving a number of factors, such as areas like oncology, have benefited immensely from a multi-disciplinary approach with a team of different health professionals. That is going to be critical to helping people with such complex continence disorders. An accurate diagnosis drawn from careful clinical attention and examination helped by imaging (including MRI) is an important starting point.
Are there particular areas of research that are fascinating you at the moment? What is on your research bucket list?
We are still completing a study of female urethral anatomy at present.
Anatomical nerve studies require very fresh tissue. Donor tissue is not something many people think about but there are people in our community who promise their organs to research before they die, when they know they are terminally ill. This is an extraordinary gift from incredibly generous people. The gift of this tissue will enable us to know more about the sort of tissues that become cancerous in women. At the same time, we will also learn about the nerve supply and therefore the function of the urethra.
My main clinical focus is on native tissue repairs and minimising harm where problematic mesh means intervention is required. I am involved in work to track the outcome of minimally invasive approaches to mesh removal. In conjunction with Monash University registries, the Federal Government is supporting the establishment of a registry for all pelvic floor repairs.
This is a wonderful opportunity to track all procedures into the future and improve practice going forward.
This story was first published in Bridge Magazine. Subscribe to Bridge online.