Adaptations for Urogynecologic Surgery in Limited-Resource Settings: How to Do More with Less

Pelvic floor disorders affect up to 50% of women in limited-resource settings (LRS) but are severely under-treated. Historically, attention has focused on urogenital fistulae, but pelvic organ prolapse (POP) is emerging as a growing issue, especially for women engaged in manual labor. Women in these regions often endure their conditions in silence owing to social stigma and mental health impacts, compounded by health care access barriers. Delivery of urogynecological services in LRS requires adaptable surgical models and skills because of limited tools and equipment. Diagnostic treatment approaches must be tailored to the unique challenges of these settings.

This article presents a practical guide to managing vesicovaginal fistulae, chronic fourth-degree tears, and POP based on limited evidence and expert experience in LRS. Key diagnostic tools, surgical techniques, and case management strategies are outlined, addressing challenges such as resource scarcity and patient follow-up in LRS.

The article emphasizes the importance of precise diagnosis with limited access to diagnostic testing, adaptable surgical interventions, and postoperative care, offering sustainable solutions that maximize patient outcomes despite restrictions in equipment availability. Cases are presented to illustrate practical diagnostic and surgical approaches to urinary leakage, fecal incontinence, and POP.

The article underscores the need for an adaptable care model that prioritizes cost-effective, reproducible methods while considering patients' long-term health and social well-being.