The State of Urogynecology in Singapore

Singapore is an island city-state with a land area of 728.6 km2. Its population of 5.64 million (2022), multiethnic, multicultural, and multireligious inhabitants making it the third most densely populated country in the world (2021). In 2010, about 1:10 Singaporeans were elderly (≥ 65); a decade later, it had risen to 1:6, and by 2030, it would be almost 1:4. This has significant implications for urogynecology as the prevalence of both urinary incontinence and pelvic organ prolapse increase proportionally in the aged. Urogynecology in Singapore is relatively young compared to the other three subspecialties. Its recognition and training began in 1990 in its three oldest hospitals: KK (Women’s and currently Children), National University, and Singapore General Hospital.

Using the RACOG’s recommendation of 1 Urogynecologist per 500,000 population (1998), Singapore’s 16 Urogynecologists have met this criterion. 6 are in the above two Government-reconstructed tertiary and University hospitals. The remaining ten are in private hospitals, medical centers, and clinics. Very few of those in private practice return for one or two sessions per week to their former hospitals. At least five more are training to join our ranks.

The urogynecological training in Singapore consists of 3 to 4 months in the 3rd year of the six years of Residency training and six months at the Registrar level in their last two years after passing the RCOG or RACOG/ MMed examination. They are required to log and pass OSATs (objective structured assessment of technical skills) for core surgeries: 15 &10 vaginal hysterectomies (including McCall culdeplasty), 25 & 10 pelvic floor repairs, and 10 &10 cystoscopies respectively.

The other non-core urogynaecological operations include native tissue repair: Manchester, Colpocleisis, Sacropspinous ligament colpopexy/ hysteropexy, and open and laparoscopic Sacrocolpopexy/ hysteropexy and vaginal mesh augmented POP repair. Non-laser functional and aesthetic gynecology surgeries include Fenton perineoplasty, colpoperineoplasty, and labiaplasty. We also work closely with our Urological, Colorectal, Geriatric, physiotherapy, and nursing colleagues. Urodynamic stress urinary incontinence surgeries include mid-urethral retropubic and transobturator tapes; and open and laparoscopic colposuspension.

Urogynecological and Urodynamics clinic training, including endoanal ultrasound for previous OASIS repair, is also provided. We have three Urogynecologists who are IUGA PROTECT certified and a few preparing to do so. We conduct at least one sow bottom hands-on workshop annually. Those who wish to subspecialize in Urogynecology undergo 1-2 years of training locally after their OBGYN Exit / Specialist examination and another year in a recognized Urogynecology Centre abroad. We thank our IUGA family for training our Urogynecologists. 2 of our hospitals have also trained overseas Urogynecological Fellows and Observers.

Our Urogynecologists have been active members of IUGA, contributing as members of the Board, committees, SIGs, publications in the IUJ journal, Workshops, and round table chairs and faculty as well as the eXchange programs and regional symposia. Singapore organized the latter in 2012, the 46th IUGA virtual meeting in 2021, and will be hosting the 49th IUGA meeting in Singapore, 19-22 June 2024. We welcome all of you to our cosmopolitan country.