{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T03:24:23Z","timestamp":1740108263500,"version":"3.37.3"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2020,10,14]],"date-time":"2020-10-14T00:00:00Z","timestamp":1602633600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,10,14]],"date-time":"2020-10-14T00:00:00Z","timestamp":1602633600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int Urogynecol J"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction and hypothesis<\/jats:title>\n                <jats:p>The DAK Foundation (Sydney) has facilitated pelvic organ prolapse (POP) repairs performed by local gynecologists for underprivileged women in Bangladesh and Nepal since 2014. Initially, there was no long-term patient follow-up. When 156 patients were examined at least 6\u00a0months after their surgery, an unacceptably high rate of prolapse recurrence and shortened vaginas was identified. This demonstrated the need for surgical up-skilling in both countries. Our hypothesis is that the introduction of a surgical training program in low-resource countries can significantly improve patient outcomes after pelvic floor surgery.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>One-on-one surgical re-training was undertaken to up-skill the gynecologists in fascial vaginal repair and vaginal apical reconstruction utilizing sacrospinous fixation (SSF). Following the surgical up-skilling, a further 289 women (between 6 and 18\u00a0months post-operatively) were examined to determine patient outcomes. Outcome measures were:<jats:list list-type=\"order\">\n                  \n                    \n                    <jats:list-item>\n                      <jats:p>Prolapse recurrence: POPQ (pelvic organ prolapse quantification [1]) \u2265 stage 2<\/jats:p>\n                    <\/jats:list-item>\n                  \n                  \n                    \n                    <jats:list-item>\n                      <jats:p>Vaginal length\u2009&lt;\u20094\u00a0cm<\/jats:p>\n                    <\/jats:list-item>\n                  \n                <\/jats:list><\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Prior to implementation of the surgical training program, 76% of patients had recurrent prolapse \u2265 stage 2, and 56% had a vagina &lt; 4\u00a0cm in length. Following the training program, prolapse recurrence was reduced to 45% with significant reductions in the apical, anterior and posterior compartments. The incidence of unacceptable vaginal shortening was 4%. We could not rely on patient symptoms to determine whether they had recurrences.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Clinical patient follow-up to determine surgical outcome is essential in low-resource settings. We have demonstrated that surgical up-skilling in vaginal hysterectomy, vaginal repair and introduction of SSF were necessary to achieve acceptable prolapse recurrence rates in our programs in Bangladesh and Nepal.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00192-020-04562-4","type":"journal-article","created":{"date-parts":[[2020,10,14]],"date-time":"2020-10-14T06:02:40Z","timestamp":1602655360000},"page":"1031-1036","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pelvic organ prolapse surgical training program in Bangladesh and Nepal improves objective patient outcomes"],"prefix":"10.1007","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8446-9273","authenticated-orcid":false,"given":"Barbara","family":"Hall","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judith","family":"Goh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maqsudul","family":"Islam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anubha","family":"Rawat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,10,14]]},"reference":[{"key":"4562_CR1","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.1007\/s00192-016-3038-0","volume":"27","author":"F Akter","year":"2016","unstructured":"Akter F, Gartoulla P, Oldroyd J, Islam R. Prevalence of, and risk factors for, symptomatic pelvic organ prolapse in rural Bangladesh: a cross-sectional survey study. Int Urogynecol J. 2016;27:1753\u20139.","journal-title":"Int Urogynecol J"},{"key":"4562_CR2","doi-asserted-by":"crossref","unstructured":"Bangladesh Maternal Mortality and Health Care Survey. 2016. [4] Chowdhury S. Editorial Bangladesh J Obstet Gynaecol 2010;25(1):1-2.","DOI":"10.3329\/bjog.v25i1.13722"},{"key":"4562_CR3","unstructured":"Maternal Morbidity Validation Survey 2016. Prevalence of obstetric fistula and pelvic organ prolapse in Bangladesh: summary of the 2016 National Estimates. MEASURE evaluation\/USAID."},{"issue":"1","key":"4562_CR4","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/S0002-9378(96)70243-0","volume":"175","author":"RC Bump","year":"1996","unstructured":"Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996 Jul;175(1):10\u20137.","journal-title":"Am J Obstet Gynecol"},{"key":"4562_CR5","unstructured":"Unite Nations Population Fund (UNFPA). Status of reproductive morbidities in Nepal. 2006 Accessed on June 2016. Available at: http:\/\/un.org.np\/sites\/default\/files\/report\/tid_67\/2009-03-17-UNFPA-status-morbidity.pdf"},{"key":"4562_CR6","unstructured":"United Nations Population Fund. Government of Nepal. Ministry of Health. Family Health Division. Study on selected reproductive health morbidities among women attending reproductive health camps in Nepal. 2016. Accessed on Aug 2018. Available at: https:\/\/nepal.unfpa.org\/sites\/default\/files\/pub-pdf\/RH%20Morbidity%20study_0.pdf."},{"key":"4562_CR7","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1016\/j.tjog.2012.11.002","volume":"52","author":"L Tseng","year":"2013","unstructured":"Tseng L, Cheng I, Chang S, Lee C. Modern role of sacrospinous ligament fixation for pelvic organ prolapse surgery - a systemic review. Taiwan J Obstet Gynecol. 2013;52:311\u20137.","journal-title":"Taiwan J Obstet Gynecol"},{"key":"4562_CR8","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1007\/s00192-016-2981-0","volume":"27","author":"I Bergman","year":"2016","unstructured":"Bergman I, Westergren Soderberg M, Kjaeldgaard A, Ek M. Does the choice of suture material matter in anterior and posterior colporrhaphy? Int Urogynecol J. 2016;27:1357\u201365.","journal-title":"Int Urogynecol J"},{"key":"4562_CR9","doi-asserted-by":"publisher","first-page":"1815","DOI":"10.1007\/s00192-013-2172-1","volume":"24","author":"MD Barber","year":"2013","unstructured":"Barber MD, Maher C. Apical Prolapse. Int Urogynecol J. 2013;24:1815\u201333.","journal-title":"Int Urogynecol J"},{"key":"4562_CR10","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1067\/mob.2001.119077","volume":"185","author":"M Karram","year":"2001","unstructured":"Karram M, Walsh P. High uterosacral vaginal vault suspension with fascial reconstruction for vaginal repair of enterocoele and vaginal vault prolapse. Am J Obstet Gynaecol. 2001;185:1339\u201343.","journal-title":"Am J Obstet Gynaecol"}],"container-title":["International Urogynecology Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00192-020-04562-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00192-020-04562-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00192-020-04562-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,14]],"date-time":"2021-10-14T00:55:08Z","timestamp":1634172908000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00192-020-04562-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,14]]},"references-count":10,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021,4]]}},"alternative-id":["4562"],"URL":"https:\/\/doi.org\/10.1007\/s00192-020-04562-4","relation":{},"ISSN":["0937-3462","1433-3023"],"issn-type":[{"type":"print","value":"0937-3462"},{"type":"electronic","value":"1433-3023"}],"subject":[],"published":{"date-parts":[[2020,10,14]]},"assertion":[{"value":"10 July 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 October 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 October 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare they have no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}