The purpose of this competitive renewal of Dr Richter's Mid-Career Investigator Award in Patient Oriented Research in Female Pelvic Floor Disorders is to provide Holly E. Richter, PhD, MD, Professor of Obstetrics and Gynecology in the School of Medicine at the University of Alabama at Birmingham (UAB) and research director of the Fellowship in Female Pelvic Medicine and Reconstructive Surgery at UAB with significant protected time to: 1) continue and expand her ongoing female pelvic floor disorder patient oriented research activities including serving as principal investigator of a randomized surgical trial addressing apical support and perioperative behavioral therapy and a randomized trial studying the utility of urodynamics in women undergoing surgery for stress urinary incontinence (funded through NICHD and NIDDK, U01 awards). It will also provide additional effort toward initiating a randomized behavioral intervention trial in primiparous women sustaining an anal sphincter tear with fecal incontinence symptoms that will be the focus of her research plan (NICHD); furthermore, it will provide valuable time to continue to mentor residents and fellows with ongoing trials and cohort studies 2) continue her productive activities and capabilities as a mentor and facilitator of training of new investigators by continuing her liaison with faculty in the Biostatistics Department, School of Public Health in the design and statistical support of such research studies 3) continue her national and international work as an educator in pelvic floor disorders and perioperative management of the geriatric patient and utilize available resources which will expand the scope of her mentoring skills 4) continue her credible efforts in increasing the availability of research participation to minority populations 5) continue to develop a relatively new area of pelvic floor disorder research specifically through the continued support of the UAB Genitorectal Disorders Center database; few robust prospective cohort or randomized trials exist in the area of Genitorectal disorders including sequelae that result from anal sphincter tear at the time of vaginal delivery, anal incontinence in the older woman, rectoceles, defecatory dysfunction, outcomes associated with sphincteroplasty and rectal prolapse surgery. Through this fellow center, a database has been developed that will facilitate the collection of data that tracks both objective and subjective treatment outcomes on all patients receiving evaluation and treatment through the clinic. Physical evaluation and objective testing can be correlated with patients' symptoms and outcomes of therapy. This type of data will be utilized to power future trials as well as improving on patient care 6) continue her overseas service work in women with vesicovaginal and rectovaginal fistula repairs and involving interested medical students, residents and fellows. The cumulative effect of this award will allow Dr Richter to continue to make valuable contributions through high quality research and focused mentoring, to patient oriented research in women's pelvic floor health and will ensure that her education and experience will be propagated by continuously fostering other research careers. Dr Richter works in a nationally acclaimed medical center with an environment conducive to achieving her stated goals. She has the enthusiastic support of her department, UAB investigators and other nationally recognized clinical researchers to pursue her research goals. She is a credible mentor to young clinical investigators at UAB and nationally and is developing the mentors of the future. PUBLIC HEALTH RELEVANCE: As the population ages, women with pelvic floor disorders will be seeking treatment in increasing numbers. Level 1 randomized trial data is important in determining the strength of treatment approaches to pelvic floor disorders in an unbiased manner; there is a dearth of this type of data in the literature. This project provides support to an investigator committed to pursuing robust research initiatives in women with pelvic floor disorders and to mentor the clinicians and researchers of the future.