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Incontinence: The Engineering Challenge XII

Pete Culmer and Alan Cottenden, Organising Committee Chairs, BMED

Campaign image for Incontinence - The Engineering Challenge XI 800
Campaign image for Incontinence - The Engineering Challenge XI 800

Like all its predecessors in the series, the 12th biennial Incontinence: The Engineering Challenge conference aimed to inspire, inform, challenge and encourage those keen to use – or draw on - engineering skills to diagnose, treat or manage incontinence more effectively.

As usual, the speakers and those gathered to hear them were wonderfully diverse in their backgrounds and, as ever, the meeting was characterised by lively discussions in which those with wisdom to share or a problem to solve worked hard to communicate fruitfully with those having complementary engineering, scientific, mathematical, clinical or other expertise.

Following a successful experiment in 2017, most speakers were, again, restricted to 10 minutes to describe their work - long enough to prompt fellow enthusiasts to seek them out during the breaks, but not so long as to bore those hoping to find the next speaker more interesting! This proved an effective strategy for providing informative overviews of much more work than the plenary elements of the conference could possibly cover in detail. Sessions comprising sets of such presentations – each gathered round a common theme – were interspersed with longer keynote talks: some of them by experienced clinicians invited to describe healthcare problems in need of engineering solutions; some providing reviews on topics of generic interest, such as interfaces between medical devices and skin; while still others tackled such contextual issues as addressing the environmental challenges of single-use plastics.

One of the key values of the conferences has always been to keep the needs of end users central and, as usual, it was enormously helpful to hear from – and be able to question - a panel of people who have to manage their own incontinence day by day, or look after an incontinent family member. It’s always very powerful to hear about the challenges and needs of incontinence directly rather than just vicariously through clinicians or written accounts. For many early-career participants, this was their first experience of speaking with people about their incontinence, providing invaluable context, and motivation, to drive their research. One of the conference’s two workshops had a similar focus, challenging us to work out how best to work effectively with the intended end-users of the technology that we develop. In our second workshop – which was on biomimicry – Denise DeLuca (from the Minneapolis College of Art and Design) provoked much laughter and fresh thinking as we sought – under her guidance – to learn from the myriad ways that nature receives, transports, absorbs, retains  and dispels water, all with potential relevance to the management of urinary incontinence.

As usual, we benefitted from a number of delegates reporting on their work by poster. In a plenary session, they were each given a minute and the use of a single slide to communicate their key messages and encourage delegates to visit their poster during the breaks. Several authors were enabled to attend through sponsorship generously provided by Coloplast for which we, and they, were very grateful. A panel of judges selected notable contributions to award four prizes. We also enjoyed working with members of ENIUS (the European Network of multidisciplinary research to Improve Urinary Stents) who contributed some fascinating papers that provided interesting insights on urine flow in various incontinence contexts, as well as through stents.

A number of interesting themes arose from the talks and interaction of the delegates at the conference. There was a fascinating array of theoretical and experimental modelling methods used to better understand some fundamental aspects of incontinence. For example, focusing on fluid flow regimes within catheters and stents in order to reduce blockages or encrustation – a persistent challenge in this area. A recurring theme was sustainability and how this can, and should, relate to the incontinence product market. While concerns were raised about the prevalence of single-use absorbent pads, it was evident that this is a complex topic; reusable or compostable alternatives are only viable if they offer comparable performance to the wearer. During his keynote, Prof. Mark Miodownik (UCL) underlined this message “There are no sustainable materials, only sustainable systems”, underlining that achieving a sustainable future requires consideration of better waste management. There remains a huge global need for absorbent products to manage incontinence and no one product meets everyone’s needs. Indeed, patient panel discussion highlighted both the diversity of people’s needs and their ingenuity in using or adapting products to address them, succinctly captured by Brenda Cheer of ERIC, “People managing incontinence are ‘Entrepreneurs in their own world’”. This is perhaps most apt in Lower and Middle Income Countries (LMICs) where people may not have access to, or be able to afford, basic management products such as absorbent pads. This highlights an often overlooked dimension: we should be conscious of bringing improvements and innovation to a global audience. Easier said than done, but a worthy aspiration and challenge to look to in the future!

It was altogether an excellent meeting. The delegates were engaged throughout and brought real enthusiasm to proceedings. If the volume of animated discussion at the breaks -and the lack of delegates catching up on their email – are good indicators of success, this one scored well.


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