The State of Urogynecology in Malaysia

About 30% of Malaysian women suffer from urinary incontinence and pelvic organ prolapse. As the condition is seen as a natural aging process and is more prevalent in the elderly, it is still underreported; thus, the numbers may not reflect the true incidence. In the early years, cases related to pelvic floor dysfunction were managed by a general gynecologist.

In 2005 there was only one certified urogynecologist- Dr. Aruku Naidu Apana, who underwent his formal training in urogynecology and received certification in urogynecology and pelvic reconstructive surgery in 2004 from James Cook University. He then spearheaded the services and established urogynecology subspecialty services and training under the Ministry of Health, Malaysia. Subsequently, many more joined the fraternity, and the number has now increased to 24. This subspeciality service is provided through government, university, and private medical centers.

Pelvic organ prolapses, obstetrics anal sphincter injury, and genitourinary syndrome of menopause are all seen in the outpatient clinic. Cases are managed conservatively before surgical intervention. For stress urinary incontinence, amongst the various types of therapy, Kegel pelvic floor exercise is the most popular, where it is offered in > 75% of cases, similar to all Asian countries, followed by surgery- mid-urethral sling - if conservative measures fail.

Female urinary incontinence/ voiding dysfunction is managed, and tests such as urodynamics study and cystoscopy are performed by urogynecologists. In patients with pelvic organ prolapse, voiding dysfunction is simultaneously managed with the initiation of bladder retraining, medication, and pessary insertion. Primary surgery for prolapse is vaginal hysterectomy with modified Mc Call culdoplastry, or sacrospinous fixation and native tissue pelvic floor repair (colporrhaphy). Sacrospinous fixation, if not done previously, is performed in case of recurrent prolapse; other alternatives are laparoscopic sacrocolposuspension or colpocleisis in non-sexually active elderly women. Cosmetic urogynecology, such as labioplasty/ clitoroplasty, is also done by some.

Fellowship training is governed by the Ministry of Health, Malaysia. Training is of 3 years duration consisting of 30 months of urogynecology training and six months compulsory attachment with urology and colorectal division. The trainee will be attached to experienced urogynecology consultants in different centers throughout the training duration and is expected to publish two research papers at the end of the training years. The number of urogynecologists is expected to rise to 39 by 2030 to cover 14 states in Malaysia.

Malaysian Urogynecology Society (MUGS) -The idea was mooted in the year 2012 with the aim to impart knowledge and standardize the quality and national practice. It was officially registered in 2013 and had since been actively contributing, organizing national and international congresses, and conducting workshops. The first IUGA regional was conducted in Penang in 2016. MUGS annual scientific meeting, also endorsed by IUGA, is scheduled for 22-23 September 2023. It consists of 3 hands-on workshops and various symposia to cover issues on prolapse, obstetrics sphincter injury, urinary issues, and cosmetic gynecology.