Emanuel C. Trabuco, M.D.

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SUMMARY

Emanuel C. Trabuco, M.D., is a clinical investigator with a deep interest in women's health, specifically pelvic floor disorders in women. His work is driven by his desire to improve the evidence base for surgical treatments of pelvic organ prolapse and urinary incontinence, and to provide alternative interventions for these conditions to improve quality of life while minimizing complications.

Focus areas

• Regenerative approaches to pelvic floor conditions. Dr. Trabuco is using a cell-free regenerative platform to target the urethral sphincter as an alternative procedure to treat stress urinary incontinence (SUI). He has grown skeletal muscle in vivo and in vitro and has repaired a muscle defect in a rat model. He is presently working on a porcine SUI model. He is also evaluating this platform in the treatment of mesh exposure and to promote anal sphincter function after obstetric injuries.

• Optimal surgical treatment of SUI. Dr. Trabuco has conducted a randomized surgical trial comparing Burch retropubic urethropexy and midurethral sling surgery in women undergoing concomitant prolapse repair. Presently, he is evaluating the efficacy and safety of the two most commonly performed sling procedures (retropubic and transobturator) in a long-term multicenter investigation.

  In addition, he is investigating a cohort of women with recurrent SUI — women who had prior surgical repair but experienced recurrence of urinary incontinence necessitating a second procedure. He will use this cohort to identify factors that predict success after the secondary procedure, and to investigate which procedure works best in this population of patients. Lastly, he is evaluating the impact of prophylactic sling procedures performed in women who are undergoing prolapse repairs but do not have any urinary incontinence symptoms at baseline.

• Ovarian aging. Dr. Trabuco is using anti-mullerian hormone (AMH), a marker of ovarian function, to create a model to predict age at menopause. He previously showed that there is a decrease in AMH levels one year after a hysterectomy even if the ovaries are preserved. He is now evaluating the long-term impact of hysterectomy on ovarian reserve.

Significance to patient care

Regenerative reconstitution of the urethral sphincter may provide an alternative target for the treatment of women with recurrent SUI and may provide a mesh-free option for women with primary incontinence. This option is particularly relevant because the proportion of women seeking care for SUI has decreased since the emergence of the controversy related to the use of vaginal mesh kits to treat prolapse. Moreover, between 8% and 10% of women experience an obstetric injury to the anal sphincter that affects fecal continence. Unfortunately, despite surgical repair undertaken at the time of delivery, many women still have evidence of persistent muscle sphincter injury. The use of a regenerative platform at the time of sphincter muscle repair may benefit muscle function and continence in otherwise healthy women who sustain these injuries during childbirth.

Dr. Trabuco's investigation of the sling procedure revealed that the retropubic approach has a lower reoperation rate than the transobturator sling approach, especially in women undergoing a combined prolapse repair. Moreover, the sling procedures are safe overall, with few women needing a reoperation for a mesh-related complication. The analysis of secondary procedures should help physicians better treat women with recurrent SUI and avoid deterioration of symptoms.

Professional highlights

• Recipient, Axel Ingelman-Sundberg Award for Best Abstract, American Urogynecologic Society/International Urogynecologic Association (AUGS/IUGA), 2016
• Recipient, Axel Ingelman-Sundberg Award for Best Abstract, AUGS/IUGA, 2014