Indian Journal of Medical Sciences Medknow Publications on behalf of Indian Journal of Medical Sciences Trust ISSN: 0019-5359 EISSN: 1998-3654 Vol. 59, Num. 1, 2005, pp. 28-30

Indian Journal of Medical Sciences, Vol. 59, No. 1, January, 2005, pp. 28-30

Letter To Editor

Survey of knowledge, attitudes and practices of urogynecological problems amongst gynecologists of Delhi

Sharma Jai Bhagwan, Wadhwa Leena, Mittal Suneeta

Departments of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi
Correspondence Address:Departments of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, jbsharma@eth.net

Code Number: ms05006

Sir,

Urogynecological problems are common problems encountered in gynecological clinics especially in elderly women, but are often neglected as most women consider them as part of normal ageing and suffer in silence. Although there is good awareness amongst gynecologists and women in western countries about these problems, as most big hospitals have developed the clinics run by gynecologists with special interest in urogynecology, such clinics are still lacking in India.

We conducted this open-ended questionnaire survey which was pre-validated, to know the views of gynecologists (postgraduate degree or diploma in obstetrics and gynecology) of Delhi about various aspects of urogynecological problems in their day-to-day clinical practice and the feasibility of starting urogynecology clinics in Delhi and their views about referring their patients with urogynecology problems to such clinics.

The mean age of the practitioners was 41.8 years. There were 86% women and 14% male gynecologists with 57% doctors from private practice and 43% were from Government hospitals. Out of average 83 patients seen by them per month, 23.6% had urogynecologic problems which were urinary tract infections (UTI) (13.2%), stress incontinence (SI) (3.8%), urge incontinence (UI) (4.1%), genital prolapse (5.1%), vesico-vaginal fistula (0.4%) and miscellaneous (2%) cases [Table - 1]. A total of 83% doctors thought that urogynecological problems were equally common in India and west. Eighty four percent doctors thought that women consider it part of normal ageing and suffer in silence, while 83% thought that women ignore their urogynecologic problems due to financial and other health problems. Regarding their views about various aspects of stress incontinence (SI), only 38% doctors routinely performed urodynamic studies before operating for SI. Most doctors (70%) used pelvic floor exercises as the first line of treatment for SI, while only 5% used vaginal devices. A total of 25% doctors used operation as first line of treatment for SI. About their views about choice of type of surgery for SI, 44% doctors performed kelly′s repair, 20% open Burch′s colposuspension, 17% laparoscopic Burch′s colposuspension, 2% Obtape, 4% sling operation while 11% used miscellaneous or combination methods. All doctors considered Burch′s operation to be the best operation with high long time success of about 90%.

In their views about first line treatment for urge incontinence (UI), 68% doctors used antibiotics for suspected UTI, 7% used Flavoxate, 4% oxybutynin, 8% combination of antibiotics and Flavoxate, 9% combination of antibiotics and oxybutynin, 2% each used miscellaneous treatment and surgery.

A total of 94% gynecologists stressed the need for development of urogynecology clinics in India, while 93% opined that SI should be surgically treated by a gynecologist with special interest and skill in urogynecology. A total of 94% doctors stressed the need for referring patients of urogynecological problems to such clinics.

It is estimated that 5-10% of elderly ladies and upto 50% institutionalized women in USA suffer from urinary incontinence with SI accounting for 25% cases while the rest were urge incontinence, increase frequency, enuresis and incomplete emptying and are due to estrogen deficiency.[1] The questionnaires have been used to know the views about services in vaginal deliveries, cesarean section and hysterectomy.[2] They have also been used to asses quality of life in women with urinary incontinence.[3],[4] The present study gives in sight into the views of Delhi gynecologists about various urogynecology problems encountered by them and how they manage them. As highlighted most gynecologists want specialty urogynecology clinics to be established in Delhi run by gynecologists with special interest, skills in the specialty and most gynecologists would like to refer their patients to such clinics To conclude, there is need to develop urogynecology clinics in India by dedicated gynecologists to improve women′s health care.

REFERENCES

1.	Centers for Disease Control. Perspectives in disease prevention and health promotion: Urinary incontinence among hospitalized persons aged 65 years and older. United States, 1984, 1987. Morb Mort Wkly Rep 1991;40:433-6.  Back to cited text no. 1
2.	Sharma JB, Malhotra M, Gupta S, Kumar A, Singh BP, Vindal A. A preliminary survey of patient's views on awareness, information choices and expectations in women undergoing hysterectomy. J Ind Med Assoc (JIMA) 2004;102:304-8.  Back to cited text no. 2
3.	Jackson S, Donovan J, Brookes S, Eckford S, Swithinbank L, Abrams P. The Bristol Female Lower Urinary Tract Symptoms questionnaire: Development and psychometric testing. Br J Urol 1996;77:805-12.  Back to cited text no. 3  [PUBMED]
4.	Kelleher CJ, Cardozo LD, Khullar V, Salvatore S. A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol 1997;104:1374-9.  Back to cited text no. 4  [PUBMED]

Copyright 2005 - Indian Journal of Medical Sciences

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