The State of Urogynecology in India

Scope and Current Status of Urogynecology Setups in India

India is one of the most populous countries in the world, harbouring around 18% of the world population. The female population amounts to around 49 % of the total population. The life expectancy for Indian women is 68 years, and around one-third of all women suffer from urogynecological problems at least once in their lifetime.

The concept of urogynecology is not new for Western countries, but the situation is disappointing in developing countries. Urogynecological conditions have been inadequately treated by medical professionals not doing dedicated practice in this field, despite available treatments substantially improving the health, self-esteem, and quality of life of patients.

There can be a multitude of possibilities in India to conduct new and innovative research focussing on statistics, epidemiology, and other aspects to improve the quality of life for women with pelvic organ prolapse and urinary or fecal incontinence. Dedicated urogynecology centers can provide complete one-stop care to such patients, helping them avoid too many visits to other specialists like gynecologists, urologists, and colorectal surgeons for treatments. Currently, there are only two tertiary institutes offering a full-time dedicated fellowship program in urogynecology. Another dedicated urogynecology setup with modern amenities providing fellowship is expected to be commissioned soon in a dedicated urogynecology department in West India.

Intricacies in Establishing this Subspecialty in India

Contrary to the common notion, lack of money, education, or resources is not a constraint, especially for the private sector of healthcare in India. The roadblock is the common myth among care seekers and care providers that these problems are just a natural part of aging. Either nothing can be done about it, or only surgery is the solution, which is not justified for these minor ailments.

The next challenge is the lack of reporting due to the associated social stigma that prevents the sufferers from mentioning their problems. In the Indian scenario, as for the other functional disorders not involving the immediate threat to life, the patients are usually resigned to the fate of bearing the dysfunction– probably due to lack of education and the low priority of these disorders impacting their quality of life. This results in paucity of data due to underreporting at outpatient clinics.

Another issue is the territorial conflict between urologist and gynecologist which has delayed the implementation of initiatives and impeded the growth of this specialty. There are very few dedicated structured training programmes in India which has resulted in a shortage of manpower in this field. Also, there is a lack of highly sophisticated investigation facilities like urodynamics or dynamic MRI in remote areas in India.

Shaping the Future of Urogynecology in India

• A roadmap needs to be developed for regional training programs in female pelvic medicine and reconstructive surgery with a focus on the unique challenges and particular needs of that region.
• Establishment of dedicated urogynecology training centres with multidisciplinary support of radiologists, colorectal surgeons, urologists, physiotherapists, and pain specialists.
• At the international forum of IUGA, the countries that are running successful units and involved in research can collaborate with India, where a reasonable patient load is available, but guidance and mentorship are required.