Pelvic Floor DisordersFLOWERNCT05690555
Pelvic Floor Physical Therapy vs Standard Care in Transgender Women Undergoing Vaginoplasty for Gender Affirmation
A study testing Preoperative and Postoperative Pelvic Floor Physical Therapy (PFPT), No Pelvic Floor Physical Therapy (PFPT) and Postoperative PFPT in people with Pelvic Floor Disorders, run by The Cleveland Clinic at 1 site in United States.
Trial summary
Currently, perioperative pelvic floor physical therapy (PFPT) is not standard of care for all patients who undergo vaginoplasty surgery. While some practices have implemented these new programs, and the above data exist on outcomes associated with perioperative PFPT in transgender women undergoing vaginoplasty, no… Read more about this study
- Who is it for?
- Ages 18 years and older, men only
- Conditions the study is for
- Pelvic Floor Disorders
- What is being tested?
- Preoperative and Postoperative Pelvic Floor Physical Therapy (PFPT), No Pelvic Floor Physical Therapy (PFPT) and Postoperative PFPT
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 37 participants
- Where
- 1 siteUnited States
- Study dates
- 25 Sep 2020to 31 Dec 2022
- Phase
- Interventional
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- Men only
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Age greater than or equal to 18 years of age
- Patients scheduled for full-depth vaginoplasty surgery
Who cannot join
- Inability to speak or comprehend the English language
- Patients scheduled for no-depth vaginoplasty surgery
- Patients who have undergone previous PFPT
- Patients who are s/p prostatectomy or treatment for prostate cancer
Trial locations and contacts
1 site in 1 country.
About this study
Official title: A Randomized Trial Comparing Perioperative Pelvic Floor Physical Therapy to Current Standard of Care in Transgender Women Undergoing Vaginoplasty for Gender Affirmation
Currently, perioperative pelvic floor physical therapy (PFPT) is not standard of care for all patients who undergo vaginoplasty surgery. While some practices have implemented these new programs, and the above data exist on outcomes associated with perioperative PFPT in transgender women undergoing vaginoplasty, no study has compared implementation of perioperative PFPT to routine care (no perioperative PFPT). Therefore, the primary objective of this study was to compare the effectiveness of postoperative PFPT compared to no PFPT in transgender women undergoing vaginoplasty surgery for gender affirmation. Secondary objectives of the study are 1) to describe the incidence of preoperative pelvic floor dysfunction in transgender women undergoing PFPT and 2) to compare the effectiveness of postoperative PFPT alone to pre- and postoperative PFPT in these patients.
Read the detailed description
This was a randomized double-blind study. Both subjects and the surgeon performing the surgery as well as the personnel administering questionnaires to patients postoperatively were blinded to the randomization.
Recruitment, Enrollment and Randomization
Patients scheduled to undergo vaginoplasty surgery at Cleveland Clinic Main campus were approached about voluntary participation in this study. This occurred over the phone approximately one to three months before their scheduled surgery. Patients who agreed to participate were sent a consent form via the mail and were asked to sign consent in person. Enrollment and randomization occurred following informed consent. All patients were given a copy of their signed and dated consent.
Once enrolled, patients were randomized into one of two groups:
- Postoperative PFPT
- No Postoperative PFPT
If patients were randomized into the Postoperative PFPT arm, they were further randomized into the following sub-arms:
- Postoperative PFPT alone
- Preoperative and Postoperative PFPT
Surgery:
All patients underwent vaginoplasty surgery by a single surgeon in a standard fashion. The neovaginal cavity was created using the same technique across all patients. Postoperative care was routine and the same for all patients.
Postoperative Pelvic Floor Physical Therapy:
There was three possible PFPT regimens. All PT regimens were performed by the same two physical therapists, trained in the management of patients who have undergone vaginoplasty surgery.
- No PFPT Patients were present to see the physical therapist 3 weeks postoperatively. The following interventions were performed: Subjective assessment of bowel and bladder function. Visual and external palpation and assessment of external pelvic floor region. Intravaginal pelvic floor assessment. Pelvic floor muscle dynamics and coordination assessment. Review of pelvic floor anatomy and function.
- Postoperative PFPT Only
Patients presented to the physical therapist 3 weeks and 6 weeks postoperatively. The following interventions were performed:
3 weeks:
- Subjective assessment of bowel and bladder function
- Visual and external palpation and assessment of external pelvic floor region
- Intravaginal pelvic floor assessment
- Pelvic floor muscle dynamics and coordination assessment
- Instruction of pelvic floor coordination and lengthening
- Discussion of dilator program and progression
- Home program with instructions 6 weeks:
- External scar assessment and treatment if tissue healing allows
- Instruction to patient of scar mobilizations
- Intravaginal pelvic floor assessment and treatment if indicated
- Review of pelvic floor lengthening and coordination
- Review and progression of dilator program if appropriate
- Assessment of current bowel/bladder symptoms; home program and instructions to address these symptoms
- Preoperative PFPT and Postoperative PFPT:
Patients presented to see the physical therapist 3 weeks before surgery, 3 weeks and 6 weeks postoperatively. The following interventions were performed:
Preoperative:
- Diaphragmatic breathing
- Discuss dilator positioning/introduce dilator program
- External pelvic floor assessment
- Teach pelvic floor coordination
- Assessment of current bowel/bladder symptoms; home program and instructions to address these symptoms 3 weeks:
- Subjective assessment of bowel and bladder function
- Visual and external palpation and assessment of external pelvic floor region
- Intravaginal pelvic floor assessment
- Pelvic floor muscle dynamics and coordination assessment
- Instruction of pelvic floor coordination and lengthening
- Discussion of dilator program and progression
- Home program with instructions 6 weeks:
- External scar assessment and treatment if tissue healing allows
- Instruction to patient of scar mobilizations
- Intravaginal pelvic floor assessment and treatment if indicated
- Review of pelvic floor lengthening and coordination
- Review and progression of dilator program if appropriate
- Assessment of current bowel/bladder symptoms; home program and instructions to address these symptoms
Study Questionnaires \& Exams:
All patients were administered questionnaires preoperatively and 12 weeks postoperatively. The following questionnaires were administered:
Preoperatively:
- CRAD-8 and UDI-6
- PFIQ-7
Postoperatively 1 week (at the time of routine dilation teaching):
- Vaginal length (routine exam)
Postoperatively 12 weeks:
- CRAD-8 and UDI-6
- PFIQ-7
- PGI-I
- Ease of Passing Dilator (VAS 0-10)
- Pain with Dilation (VAS 0-10)
- Largest dilator size used
- Vaginal length (routine exam)
Cross-Over Treatment:
Any patients in the No PFPT arm who were determined to have pelvic floor dysfunction or symptoms that may have benefitted from PFPT referral, were referred after the 12-week mark. Any patient in one of the PFPT arms who was determined to still need PFPT for persistent pelvic floor dysfunction or symptoms were referred for continued care.
- Conditions
- Pelvic Floor Disorders
- Being tested
- Preoperative and Postoperative Pelvic Floor Physical Therapy (PFPT), No Pelvic Floor Physical Therapy (PFPT), Postoperative PFPT
- Medical subject headings
- Pelvic Floor Disorders
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Preoperative and Postoperative Pelvic Floor Physical Therapy (PFPT)Other
Patients will present to see the physical therapist 3 weeks and 6 weeks postoperatively. The following interventions will be performed:
3 weeks:
- Subjective assessment of bowel and bladder function
- Visual and external palpation and assessment of external pelvic floor region
- Intravaginal pelvic floor assessment
- Pelvic floor muscle dynamics and coordination assessment
- Instruction of pelvic floor coordination and lengthening
- Discussion of dilator program and progression
- Home program with instructions 6 weeks:
- External scar assessment and treatment if tissue healing allows
- Instruction to patient of scar mobilizations
- Intravaginal pelvic floor assessment and treatment if indicated
- Review of pelvic floor lengthening and coordination
- Review and progression of dilator program if appropriate
- Assessment of current bowel/bladder symptoms; home program and instructions to address these symptoms
No Pelvic Floor Physical Therapy (PFPT)Other
Patients will present to see the physical therapist 3 weeks postoperatively. The following interventions will be performed:
Subjective assessment of bowel and bladder function. Visual and external palpation and assessment of external pelvic floor region. Intravaginal pelvic floor assessment. Pelvic floor muscle dynamics and coordination assessment. Review of pelvic floor anatomy and function.
Postoperative PFPTOther
Preoperative Diaphragmatic breathing Discuss dilator positioning/introduce dilator program External pelvic floor assessment Teach pelvic floor coordination Current bowel/bladder symptoms; home program and instructions 3 weeks Assessment of bowel and bladder function Visual and external palpation and assessment of external pelvic floor region Intravaginal pelvic floor assessment Pelvic floor muscle dynamics and coordination assessment Instruction of pelvic floor coordination and lengthening Discussion of dilator program and progression Home program with instructions 6 weeks External scar assessment and treatment if tissue healing allows Instruction to patient of scar mobilizations Intravaginal pelvic floor assessment and treatment if indicated Review of pelvic floor lengthening and coordination Review and progression of dilator program if appropriate Current symptoms; home program and instructions
| Study group | Role | What they receive |
|---|---|---|
| Preoperative and Postoperative Pelvic Floor Physical Therapy (PFPT) | Experimental | If patients were randomized into the PFPT arm, they were further randomized into the following sub-arms: Preoperative and Postoperative PFPT Receives: Other: Preoperative and Postoperative Pelvic Floor Physical Therapy (PFPT) |
| Postoperative Pelvic Floor Physical Therapy (PFPT) | Active comparator | Patients will present to see the physical therapist 3 weeks postoperatively. The following interventions will be performed: Subjective assessment of bowel and bladder function. Visual and external palpation and assessment of external pelvic floor region. Intravaginal pelvic floor assessment. Pelvic floor muscle dynamics and coordination assessment. Review of pelvic floor anatomy and function. Receives: Other: Postoperative PFPT |
| No Pelvic Floor Physical Therapy (PFPT) | Active comparator | Patients were not assigned to physical therapy. Receives: Other: No Pelvic Floor Physical Therapy (PFPT) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Patient Reported Ease of Dilation
VAS 0-10 is a validated 10 item questionnaire. Responses to each question are scored on a 10-point Likert scale, ranging from 0 (no pain) to 10 (worst pain). A response of 10 is considered to be a worse outcome.
Measured: 12 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted19 Jan 2023
- Study start25 Sep 2020
- Primary completion11 Sep 2022
- Study completion31 Dec 2022
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Other trials for Pelvic Floor DisordersStudies of the same condition, open and under way.
- More trials run by The Cleveland ClinicThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Investigator
- Enrolment
- 37 participants (actual)
Sponsor and investigators
- Lead sponsor
- The Cleveland Clinic
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Cecile Ferrando, M.D., Principal investigator, The Cleveland Clinic
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05690555
- Sponsor's protocol ID
- 20-917
- Acronym
- FLOWER
- Status last verified
- Jul 2025
- First submitted
- 10 Jan 2023
- Last updated
- 15 Jul 2025
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 15 Jul 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomized Trial Comparing Perioperative Pelvic Floor Physical Therapy to Current Standard of Care in Transgender Women Undergoing Vaginoplasty for Gender Affirmation
- ClinicalTrials.gov ID
- NCT05690555
- Acronym / sponsor ID
- FLOWER / 20-917
- Conditions
- Pelvic Floor Disorders
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 37 participants (actual)
- Lead sponsor
- The Cleveland ClinicUniversity, hospital or other
- Study start
- 25 Sep 2020 (actual)
- Primary completion
- 11 Sep 2022 (actual)
- Study completion
- 31 Dec 2022 (actual)
- First posted
- 19 Jan 2023 (actual)
- Results
- Posted 15 Jul 2025
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Currently, perioperative pelvic floor physical therapy (PFPT) is not standard of care for all patients who undergo vaginoplasty surgery. While some practices have implemented these new programs, and the above data exist on outcomes associated with perioperative PFPT in transgender women undergoing vaginoplasty, no study has compared implementation of perioperative PFPT to routine care (no perioperative PFPT). Therefore, the primary objective of this study was to compare the effectiveness of postoperative PFPT compared to no PFPT in transgender women undergoing vaginoplasty surgery for gender affirmation. Secondary objectives of the study are 1) to describe the incidence of preoperative pelvic floor dysfunction in transgender women undergoing PFPT and 2) to compare the effectiveness of postoperative PFPT alone to pre- and postoperative PFPT in these patients.
Detailed description
This was a randomized double-blind study. Both subjects and the surgeon performing the surgery as well as the personnel administering questionnaires to patients postoperatively were blinded to the randomization.
Recruitment, Enrollment and Randomization
Patients scheduled to undergo vaginoplasty surgery at Cleveland Clinic Main campus were approached about voluntary participation in this study. This occurred over the phone approximately one to three months before their scheduled surgery. Patients who agreed to participate were sent a consent form via the mail and were asked to sign consent in person. Enrollment and randomization occurred following informed consent. All patients were given a copy of their signed and dated consent.
Once enrolled, patients were randomized into one of two groups:
- Postoperative PFPT
- No Postoperative PFPT
If patients were randomized into the Postoperative PFPT arm, they were further randomized into the following sub-arms:
- Postoperative PFPT alone
- Preoperative and Postoperative PFPT
Surgery:
All patients underwent vaginoplasty surgery by a single surgeon in a standard fashion. The neovaginal cavity was created using the same technique across all patients. Postoperative care was routine and the same for all patients.
Postoperative Pelvic Floor Physical Therapy:
There was three possible PFPT regimens. All PT regimens were performed by the same two physical therapists, trained in the management of patients who have undergone vaginoplasty surgery.
- No PFPT Patients were present to see the physical therapist 3 weeks postoperatively. The following interventions were performed: Subjective assessment of bowel and bladder function. Visual and external palpation and assessment of external pelvic floor region. Intravaginal pelvic floor assessment. Pelvic floor muscle dynamics and coordination assessment. Review of pelvic floor anatomy and function.
- Postoperative PFPT Only
Patients presented to the physical therapist 3 weeks and 6 weeks postoperatively. The following interventions were performed:
3 weeks:
- Subjective assessment of bowel and bladder function
- Visual and external palpation and assessment of external pelvic floor region
- Intravaginal pelvic floor assessment
- Pelvic floor muscle dynamics and coordination assessment
- Instruction of pelvic floor coordination and lengthening
- Discussion of dilator program and progression
- Home program with instructions 6 weeks:
- External scar assessment and treatment if tissue healing allows
- Instruction to patient of scar mobilizations
- Intravaginal pelvic floor assessment and treatment if indicated
- Review of pelvic floor lengthening and coordination
- Review and progression of dilator program if appropriate
- Assessment of current bowel/bladder symptoms; home program and instructions to address these symptoms
- Preoperative PFPT and Postoperative PFPT:
Patients presented to see the physical therapist 3 weeks before surgery, 3 weeks and 6 weeks postoperatively. The following interventions were performed:
Preoperative:
- Diaphragmatic breathing
- Discuss dilator positioning/introduce dilator program
- External pelvic floor assessment
- Teach pelvic floor coordination
- Assessment of current bowel/bladder symptoms; home program and instructions to address these symptoms 3 weeks:
- Subjective assessment of bowel and bladder function
- Visual and external palpation and assessment of external pelvic floor region
- Intravaginal pelvic floor assessment
- Pelvic floor muscle dynamics and coordination assessment
- Instruction of pelvic floor coordination and lengthening
- Discussion of dilator program and progression
- Home program with instructions 6 weeks:
- External scar assessment and treatment if tissue healing allows
- Instruction to patient of scar mobilizations
- Intravaginal pelvic floor assessment and treatment if indicated
- Review of pelvic floor lengthening and coordination
- Review and progression of dilator program if appropriate
- Assessment of current bowel/bladder symptoms; home program and instructions to address these symptoms
Study Questionnaires \& Exams:
All patients were administered questionnaires preoperatively and 12 weeks postoperatively. The following questionnaires were administered:
Preoperatively:
- CRAD-8 and UDI-6
- PFIQ-7
Postoperatively 1 week (at the time of routine dilation teaching):
- Vaginal length (routine exam)
Postoperatively 12 weeks:
- CRAD-8 and UDI-6
- PFIQ-7
- PGI-I
- Ease of Passing Dilator (VAS 0-10)
- Pain with Dilation (VAS 0-10)
- Largest dilator size used
- Vaginal length (routine exam)
Cross-Over Treatment:
Any patients in the No PFPT arm who were determined to have pelvic floor dysfunction or symptoms that may have benefitted from PFPT referral, were referred after the 12-week mark. Any patient in one of the PFPT arms who was determined to still need PFPT for persistent pelvic floor dysfunction or symptoms were referred for continued care.
Study design
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, investigator)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Preoperative and Postoperative Pelvic Floor Physical Therapy (PFPT) | Experimental | Other: Preoperative and Postoperative Pelvic Floor Physical Therapy (PFPT)If patients were randomized into the PFPT arm, they were further randomized into the following sub-arms: Preoperative and Postoperative PFPT |
| Postoperative Pelvic Floor Physical Therapy (PFPT) | Active comparator | Other: Postoperative PFPTPatients will present to see the physical therapist 3 weeks postoperatively. The following interventions will be performed: Subjective assessment of bowel and bladder function. Visual and external palpation and assessment of external pelvic floor region. Intravaginal pelvic floor assessment. Pelvic floor muscle dynamics and coordination assessment. Review of pelvic floor anatomy and function. |
| No Pelvic Floor Physical Therapy (PFPT) | Active comparator | Other: No Pelvic Floor Physical Therapy (PFPT)Patients were not assigned to physical therapy. |
Who may qualify
- Ages
- 18 years and older
- Sex
- Male only
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (2 listed)
- Age greater than or equal to 18 years of age
- Patients scheduled for full-depth vaginoplasty surgery
Key exclusion criteria (4 listed)
- Inability to speak or comprehend the English language
- Patients scheduled for no-depth vaginoplasty surgery
- Patients who have undergone previous PFPT
- Patients who are s/p prostatectomy or treatment for prostate cancer
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Preoperative and Postoperative Pelvic Floor Physical Therapy (PFPT)Patients will present to see the physical therapist 3 weeks and 6 weeks postoperatively. The following interventions will be performed: 3 weeks: * Subjective assessment of bowel and bladder function * Visual and external palpation and assessment of external pelvic floor region * Intravaginal pelvic floor assessment * Pelvic floor muscle dynamics and coordination assessment * Instruction of pelvic floor coordination and lengthening * Discussion of dilator program and progression * Home program with instructions 6 weeks: * External scar assessment and treatment if tissue healing allows * Instruction to patient of scar mobilizations * Intravaginal pelvic floor assessment and treatment if indicated * Review of pelvic floor lengthening and coordination * Review and progression of dilator program if appropriate * Assessment of current bowel/bladder symptoms; home program and instructions to address these symptoms | Other | Preoperative and Postoperative Pelvic Floor Physical Therapy (PFPT) |
| No Pelvic Floor Physical Therapy (PFPT)Patients will present to see the physical therapist 3 weeks postoperatively. The following interventions will be performed: Subjective assessment of bowel and bladder function. Visual and external palpation and assessment of external pelvic floor region. Intravaginal pelvic floor assessment. Pelvic floor muscle dynamics and coordination assessment. Review of pelvic floor anatomy and function. | Other | No Pelvic Floor Physical Therapy (PFPT) |
| Postoperative PFPTPreoperative Diaphragmatic breathing Discuss dilator positioning/introduce dilator program External pelvic floor assessment Teach pelvic floor coordination Current bowel/bladder symptoms; home program and instructions 3 weeks Assessment of bowel and bladder function Visual and external palpation and assessment of external pelvic floor region Intravaginal pelvic floor assessment Pelvic floor muscle dynamics and coordination assessment Instruction of pelvic floor coordination and lengthening Discussion of dilator program and progression Home program with instructions 6 weeks External scar assessment and treatment if tissue healing allows Instruction to patient of scar mobilizations Intravaginal pelvic floor assessment and treatment if indicated Review of pelvic floor lengthening and coordination Review and progression of dilator program if appropriate Current symptoms; home program and instructions | Other | Postoperative Pelvic Floor Physical Therapy (PFPT) |
Primary outcome
Patient Reported Ease of Dilation
Time frame: 12 weeks
VAS 0-10 is a validated 10 item questionnaire. Responses to each question are scored on a 10-point Likert scale, ranging from 0 (no pain) to 10 (worst pain). A response of 10 is considered to be a worse outcome.
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 15 Jul 2025.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Cecile Ferrando, M.D. principal investigator
The Cleveland Clinic
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Preoperative and Postoperative Pelvic Floor Physical Therapy (PFPT), No Pelvic Floor Physical Therapy (PFPT) and Postoperative PFPT in people with Pelvic Floor Disorders, run by The Cleveland Clinic at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 15 Jul 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Yes. Results are posted in the registry (first posted 15 Jul 2025). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Patient Reported Ease of Dilation (time frame: 12 weeks). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Jul 2025.