Abstract
Introduction and hypothesisThe DAK Foundation (Sydney) has facilitated pelvic organ prolapse (POP) repairs performed by local gynecologists for underprivileged women in Bangladesh and Nepal since 2014. Initially, there was no long-term patient follow-up. When 156 patients were examined at least 6 months after their surgery, an unacceptably high rate of prolapse recurrence and shortened vaginas was identified. This demonstrated the need for surgical up-skilling in both countries. Our hypothesis is that the introduction of a surgical training program in low-resource countries can significantly improve patient outcomes after pelvic floor surgery.MethodsOne-on-one surgical re-training was undertaken to up-skill the gynecologists in fascial vaginal repair and vaginal apical reconstruction utilizing sacrospinous fixation (SSF). Following the surgical up-skilling, a further 289 women (between 6 and 18 months post-operatively) were examined to determine patient outcomes. Outcome measures were:Prolapse recurrence: POPQ (pelvic organ prolapse quantification [1]) ≥ stage 2Vaginal length < 4 cmResultsPrior to implementation of the surgical training program, 76% of patients had recurrent prolapse ≥ stage 2, and 56% had a vagina < 4 cm in length. Following the training program, prolapse recurrence was reduced to 45% with significant reductions in the apical, anterior and posterior compartments. The incidence of unacceptable vaginal shortening was 4%. We could not rely on patient symptoms to determine whether they had recurrences.ConclusionClinical patient follow-up to determine surgical outcome is essential in low-resource settings. We have demonstrated that surgical up-skilling in vaginal hysterectomy, vaginal repair and introduction of SSF were necessary to achieve acceptable prolapse recurrence rates in our programs in Bangladesh and Nepal.
Highlights
Introduction and hypothesis The DAKFoundation (Sydney) has facilitated pelvic organ prolapse (POP) repairs performed by local gynecologists for underprivileged women in Bangladesh and Nepal since 2014
Clinical patient follow-up to determine surgical outcome is essential in low-resource settings
We have demonstrated that surgical up-skilling in vaginal hysterectomy, vaginal repair and introduction of sacrospinous fixation (SSF) were necessary to achieve acceptable prolapse recurrence rates in our programs in Bangladesh and Nepal
Summary
Introduction and hypothesis The DAKFoundation (Sydney) has facilitated pelvic organ prolapse (POP) repairs performed by local gynecologists for underprivileged women in Bangladesh and Nepal since 2014. Int Urogynecol J (2021) 32:1031–1036 documented a self-reported prevalence of any stage of POP of 23.5% but the Maternal Morbidity Validation Survey [3] demonstrated considerable over-reporting of symptoms, predicting an adjusted prevalence of pelvic organ prolapse quantification (POPQ) [4] stage 3 or 4 prolapse in 11.4 per 1000 Bangladeshi women who have ever given birth. This suggests that there are more than 535,000 women in Bangladesh living with major POP. Half of these women are aged between 15 and 49 years
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