NATIONAL UROGYNECOLOGY SURVEY OFPELVIC FLOOR UNITS IN CHILE: FIRST STEP TO IMPROVE ACCESS INEQUALITY
J. PIZARRO 1, J.ALVAREZ2, R. GUZMAN 3, M. ARELLANO 4,K. FRANCISCO 5, V. I. MANRIQUEZ 6, S. MEDEL 7,A. PATTILLO 8, F. CASTRO 9;
1Urogyneccologydepartment, Hosp. Sotero del Rio, Santiago, Chile, 2Urogyneccologydepartment, Hosp. Padre Hurtado, Santiago, Chile, 3Urogyneccologydepartment, Clinica Alemana Santiago, Santiago, Chile, 4Hosp.Dr. Sotero del Rio, santiago, Chile, 5Urogyneccologydepartment, Hosp. de Quilpue, Quilpue, Chile, 6Hosp.CLINICO UNIVERSIDAD DE CHILE, SANTIAGO, Chile, 7Urogyneccologydepartment, Clinica Las Condes, Santiago, Chile, 8Obstetrics& Gynecology, Pontifical Catholic Univ. Of Chile, Santiago,Chile, 9Urogyneccology department, Hosp. Tisne HSO,Santiago, Chile.
Introduction: Background: Pelvicfloor dysfunction is a growing health burden around the world andespecially in developing countries. As the healthcare system evolvesand the elderly population increases, health situations such as fecalincontinence, urinary incontinence and pelvic organ prolapse becomemore relevant. This is the situation in Chile, were an estimated 18%of the elderly population suffers from urinary incontinence. However,it is unknown how prepared the public health care system is to dealwith such a growing problem. The geography of the country couldinfluence the lack of high quality treatment and overall assessmentin smaller cities. To answer this question, a comprehensivequestionnaire was sent to public hospital throughout the Country. Thequestionnaire is meant to survey the number of pelvic floor unitsavailable and their characteristics. We hypothesized that there is alack of access to specialized management for pelvic floordysfunctions among different region in Chile, with better coveragewithin the capital area.
Objective: To survey the number ofpelvic floor units currently working along the 15 geographic regionsof Chile and to better understand the type of serviceprovided.
Methods: A comprehensive survey was sent topublic hospital throughout the country. 45 hospitals, representing apopulation of about 8 million females, were contacted from November2016 to December 2016 via mail, email or phone and asked to answerand return the questionnaire.
Results: Twenty-five out of45 hospitals responded our questionnaire, representing 5.796.306patients (65%) of the total population assessed. On average an Ob/Gyndepartment would have 20 members. Nineteen (76%) of the 25 hospitalshave a formal pelvic floor unit, and these units are usually composedof 3 physicians. However, only 36% of the pelvic floor units have amember who is formally trained as a fellow whether it be nationallyor abroad. Forty-four percent of urognecology units have access to atrained physiotherapist and more than 58% of the units perform over100 pelvic floor surgeries a year. Among other types of surgery,twenty centers regularly perform abdominal sacralcolpopexy, 12 highuterosacral vault suspension and 16 sacrospinous. However only 4centers are performing laparoscopic sacralcolpopexy regularly.Currently only one hospital offers regularly third-line OAB therapysuch as (BoTox or InterStim) and this hospital is located in thecapital city.
Conclusions: This data gives us a clearerstarting point to better understand the quality of pelvic floorhealth care being provided in Chile. This data may help changepolicies in the future. Much work is needed to improve the inequalityseen throughout the different regions.