Surgical management practice of pelvic organ prolapse among Ethiopian Gynecologists, 2021: a descriptive study

Abstract

Abstract Introduction: Pelvic Organ Prolapse is the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus (cervix), or the apex of the vagina (vaginal vault or cuff scar after hysterectomy). Surgery improves both anatomic problems and the symptoms related to them. Prolapse surgery has been changing constantly over years. There are growing evidences supporting or against the existing options of surgical treatment as well as new emerging trends. Surgical management of pelvic organ prolapse in Ethiopia had evolved from abdominal hysterectomy to vaginal hysterectomy 30 years ago and was later supplemented with McCall’s culdoplasty. Related to the opening of Urogynecology centers in some institutions in the country, the surgical management of pelvic organ prolapse and the training level of gynecologists are not uniform nationally. This study is expected to identify the current practice of Ethiopian gynecologists in the surgical management of pelvic organ prolapse. Objectives: This study was done to assess the surgical management practice of Ethiopian gynecologists on pelvic organ prolapse. Methods: A cross-sectional study was conducted among all Gynecologists in Ethiopia from January to June 2021. Data was collected using online Google forms using structured questionnaires prepared in English. Data were checked, coded, and entered into Epi info 7 and exported to SPSS version 22 software for analysis. Descriptive statistics was done. Results: 280 Ethiopian gynecologists have responded to the study. Anterior colporrhaphy(98.6%), vaginal hysterectomy with McCall’s culdoplasty (51.8%), and Posterior colporrhaphy(97.5%) were the commonest surgical procedures performed for anterior vaginal wall prolapse, apical prolapse (uterine/cervical), and posterior vaginal wall prolapse respectively. Abdominal and vaginal paravaginal repair for anterior vaginal wall prolapse were performed only by 3.2% and 0.7% of the gynecologists respectively. Sacrospinous ligament fixation and sacrocolpopexy for apical prolapse were performed only by 32.9% and 9.3% of the gynecologists respectively. Site-specific posterior repair for posterior vaginal wall prolapse was performed only by 23.9% of the gynecologists. The reasons mentioned not to perform paravaginal repair, sacrocolpopexy, sacrospinous ligament fixation, and site-specific posterior repair were lack of skill and lack of appropriate materials. Conclusion and Recommendation: Most Ethiopian gynecologists are still sticking to vaginal hysterectomy and colporrhaphy procedures for treatment of pelvic organ prolapse due to lack of skill and appropriate materials to perform the other procedures. Short term training on contemporary surgical treatment options and provision of appropriate materials could improve the standard of care of women with pelvic organ prolapse.