During the study period from January 2008 to December 2012, 177 women had transvaginal sacrospinous ligament fixation (SSF) for vault suspension at General Hospital Kuala Lumpur. Of the 177 women, 133 (75.1%) had severe uterovaginal prolapse while 44 (24.9%) had post-hysterectomy vault prolapse. All patients with severe uterovaginal prolapse and rectocele undergone vaginal hysterectomy and posterior colporrhaphy respectively. A hundred and seventy-four patients (98.3%) had anterior repair whilst 48 (27.1%) received midurethral sling as concomitant procedure to vault suspension (SSF). The mean duration of surgery was 92.1±30.2 minutes and the mean estimated blood loss was 319±199.3mls. There was no surgical mortality. Two patients (1.1%) had rectal injuries. No patient had bladder injury or de novo urinary symptoms. The commonest immediate postoperative complications was fever (98; 55.4%) followed by buttock pain in 18 (10.2%) patients. Both complications were resolved with conservative measures. Seven patients (3.9%) had sutures erosion as late complications. Of the 177 women, 158 (89.3%) and 141 (79.7%) came for the 6 and 12 months follow-up, respectively. The success rate for all three compartments ranged from 92.4% to 98.1% at 6 months and reduced to range from 85.7% to 94.4% at 12 months. The highest success rate was observed in the posterior compartment followed by apical and anterior compartment. Equally, the recurrence rate was lowest in the posterior compartment (1.9%), followed by the central (3.8%) and anterior compartment (7.5%) at 6 months’ review. This increased to 5.7% for rectocele, 7.8% for vault prolapse and 14.2% for cystocele at 12 months’ follow-up. None had repeated surgery for prolapse recurrence during the study period. In conclusion, SSF remains a high priority in our therapeutic regime for the treatment of severe uterovaginal and vault prolapse as it has a reasonably good success rate with lower serious complications in the skillful hands.
Hysterectomy, Vaginal

De novo stress urinary incontinence (SUI) may occur in up to 80% of clinically continent women following genitourinary prolapse surgery. This had resulted in an increase in the rate of concurrent continence surgery during prolapse repair from 38% in 2001 to 47% in 2009 in the United States. To date, there is no local data available to estimate the prevalence of occult SUI (OSUI) among Malaysian women awaiting surgery. Therefore, this study was conducted to elicit the prevalence of occult SUI and its associated risks factors in patients awaiting prolapse surgery. We retrospectively studied the records of 296 consecutive women with significant pelvic organ prolapse awaiting reconstructive repair. All patients attended the Urogynaecology Unit in Hospital Kuala Lumpur Malaysia between October 2007 and September 2011. They had undergone standardized interviews, clinical examinations and urodynamic studies. During the urodynamic testings, all prolapses were reduced using ring pessaries to elicit OSUI. Primary outcome was the prevalence of OSUI with prolapse reduction to predict possibility of developing de novo SUI following prolapse surgery. Secondary outcome was the assessment of potential risk factors for OSUI. Among the 296 women studied, 121 (40.9%) were found to have OSUI. The risk factors associated with OSUI included age, BMI, numbers of SVD, recurrent UTI, reduction of urinary flow symptoms and grade 2 to 4 central compartment prolapses. We concluded that preoperative urodynamic testing with reduction of prolapse is useful to identify women with OSUI. This is important for preoperative counselling as well as planning for one step approach of prophylactic concomitant anti-incontinence procedures during prolapse surgery in order to avoid postoperative de novo SUI.
Pelvic Organ Prolapse

Introduction: Continuous professional development (CPD) is an important aspect of a medical practitioner’s career. Aiming to be at par with other developed countries for high quality of professional practice, Malaysia is planning to implement compulsory CPD for the doctors. Aim: The aim of the study was to explore the private general practitioners’ (GPs) views, experiences and needs regarding CPD programme in the primary care service. Methods: This study used a qualitative methodology. Seven semi-structured interviews and three focus group discussions were conducted with private general practitioners from an urban area of Malaysia between January and December 2012. An interview topic guide was developed based on literature review and researchers’ discussions and it was used to guide the interviews. All the interviews were audio-recorded, transcribed verbatim and the transcripts formed the data for analysis using the thematic approach. Results: GPs undertook a wide range of CPD programmes to keep up with medical advances, meet patients’ expectations and improve financial rewards. Conferences, lectures and online recourses were the most mentioned methods of keeping updated. Some of the GPs felt that peer motivation and networking seem to motivate and facilitate participation in CPD programmes. However, they were wary of the validity and relevance of some CPD programmes, particularly those related to pharmaceutical industry. Although the participants agreed to the new mandatory CPD regulation, they voiced concerns on how it would be implemented and wished for a more effective method of monitoring. Conclusions: Organised peer support and relevant CPD content may improve GP participation in CPD but adequate regulatory measure should be in place to monitor the CPD activities.
Education, Medical ; Primary Health Care ; Education, Professional

Procidentia is uncommon condition altering quality of life ofyoung and nulliparous women. Its management posessignificant dilemma and challenges as its associated bodyimage, fertility and sexuality issues. Uterine preservationsurgery described by Archibald Donald in 1888 known asManchester –Fothergill procedure seems best option asalternative to vaginal hysterectomy. Despite its increasingpopularity among surgeons and patients, robust clinicalevidence is needed. We report a case of recurrentprocidentia in a young nulliparous woman who hadManchester repair following vaginal sacrospinoushysteropexy. We concluded that Manchester repair is auseful and safe alternative for uterine-preserving technique.

Introduction and Objectives There are limited studies conducted on the needs of cancer survivorsin developing countries like Malaysia. This qualitative study aimed at exploring the post-treatmentimpact and needs of prostate cancer survivors.Method: A qualitative study design was used. One in-depth interview and four focus groupdiscussions were conducted with 24 prostate cancer survivors (age range: 58–79 years) fromgovernment and private hospitals in Malaysia in 2013. Trained researchers used a topic guide toguide the interviews, which were audio-recorded, transcribed verbatim, checked and managed withNvivo 10 software. A thematic approach was used to analyse the data.Result: Three main themes emerged from the analysis: (a) impact of prostate cancer on thesurvivors, (b) support needed for coping and (c) information needs. Prostate cancer has animportant impact on the survivors’ lifestyle after treatment. Some of them have to live with thepost-treatment side effects. They were anxious about the possibility of relapse. In addition tofamily and peer support, there were participants who felt that spiritual support was important inhelping them cope with the possibility of relapse. The survivors felt that they did not receive enoughinformation about post-treatment care, dietary measures and supplements for relapse prevention,treatment and prognosis.Conclusion: Prostate cancer has a significant impact on the survivor’s lifestyle, emotional andphysical health. They need information and emotional support from the healthcare professionals,family and peers. Therefore, it is important for healthcare providers to explore the needs of prostatecancer survivors and provide the necessary support.