The State of Urogynecology and Pelvic Reconstructive Surgery Training and Services in Pakistan

The awareness about urogynecology and pelvic reconstructive surgery among general gynecologists and urologists has attained a remarkable level. Even the educated public now knows a little about urogynecology. But in remote areas, a urogynecologist is taken as an expert in genito-urinary fistula surgery. The Pakistan Urogynecological Association (PAUGA) is affiliated with the International Urogynecology Association (IUGA). Many organizations conduct short-duration workshops, seminars, or conferences on common urogynecology topics. The formal structured training in urogynecology and pelvic reconstructive surgery was started by the Postgraduate Medical Education PGME, Aga Khan University in 2012. This two-year program was approved by higher educational stakeholders i.e., College of Physicians & Surgeons, Pakistan (CPSP), in 2015, but unfortunately, since there was no other approved center, an exit level examination could not be conducted, and PGME, AKU remained the sole center for approval and certification of this two-year fellowship. As far as services are concerned, the OMI hospital has offered a broad spectrum of urogynecology services for two years, including many diagnostic and operative modalities. The most performed procedures are urodynamic assessments, EMG, endo-anal ultrasound, mid urethral slings, burch colposuspension, non-descent vaginal hysterectomy, hysteropexy, and vaginoplasty. There is a dire need to introduce a short-term training program (minimum one year) which could be offered for both general urologists (with a special interest in female urology) and specialists in OBGYN keen to acquire further training in urogynecology. This would not only increase the number of training providers but also expand the spectrum of training centers as well.