IUGA exchange 2008,, Khartoum, Sudan

Transcription

1 I U G A e X c h a n g e IUGA exchange 2008,, Khartoum, Sudan (where the Blue and White Nile meets) Report of the exchange This document is the report on the IUGA exchange in Khartoum (Sudan), which was held on February 16, and 17, This report is for internal IUGA purpose only. This exchange was organized in collaboration with the Obstetrical and Gynecological Society of Sudan. This report has been prepared by Dr Harry Vervest and Dr Esam Gaffar. IUGA exchange 2008 Khartoum (internal IUGA report, final version).doc page 1 / 12

2 Introduction A request for an IUGA exchange in The Sudan was made to the IUGA Education Committee by Dr Mohamed Siddig (UK) and professor Ashmaig (Sudan). Preparatory meeting A preparatory meeting was organized in Khartoum (The Sudan) on November 21 and This meeting was attended by Dr Harry Vervest (on behalf of IUGA) and the local organizing committee. The proposals for the workshop and the outline of the scientific, financial and social programs were discussed. A separate report of this meeting was filed with the IUGA Executive Board. About The Sudan Sudan is a large country about the size of Europe with 33 million inhabitants. Around 12 million live in or in the neighborhood of the capital city of Khartoum. Gynecologists are mostly trained in The Sudan itself, in the UK or in Arabic countries. There are 300 to 400 gynecologists and most of them are member of the Obstetrical and Gynecological Society of Sudan. Major urogynecological issues are urinary incontinence, vaginal prolapse and fistulae. Report on the exchange in Khartoum The meeting took place on February 16 and 17, 2008 at the Center for Permanent Medical Education in Khartoum. The atmosphere was informal and there was ample opportunity for discussions during the meeting, but also during breaks and in the workshops. There was a great interest in and strong desire to learn about pelvic floor anatomy, function and disorders. The meeting was in conjunction with the Mid Term Meeting of the Obstetrical and Gynecological Society of Sudan. There were also other scientific meetings on topics like infertility, oncology and colposcopy. These meetings were attended by gynecologists from all over The Sudan. Very special in this meeting was the donation of urodynamic equipment by Laborie Medical Technologies from Canada (see under fistula center). Special guests at this meeting were Professor Abdel-Latif Ashmaig (President of the Obstetrical and Gynecological Society of Sudan), Professor Anduslam Geñes and Professor Abbo who is a longstanding member of IUGA and was present when IUGA was founded in 1976 in Mexico City. Unexpectedly present was also Professor John Kelly (UK) who already comes to Sudan for fistula surgery for 39 years. Local organizing committee Dr A. Rahman Ali Eltayeb Elfaki (chairman), Dr Mohamed Siddig (UK), Professor Abdel-Latif Ashmaig, Dr Esam Gaffar Abdu Alrahman, Dr Maisoun A. Mohd.A. Takrouri, Dr Sami Mahmoud Abdu AlKair, Dr Ali Gaffer, Dr Mohamed Merghani, Dr Mazar Osman Abuelgasim, Dr Abdu Alrahman Khalid, Prof. Taha Umbelli. The local organizing committee did a great and respectful job. The meeting was very well organized and attention was paid to every detail. Scientific program The scientific program consisted of plenary lectures, workshops and case presentations. Topics were selected in order to reflect our need in urodynamics and urogynecology, and to highlight the problem of fistula in Sudan. The program is listed in appendix 1. Initially three more workshops were IUGA exchange 2008 Khartoum (internal IUGA report, final version).doc page 2 / 12

3 planned for the second day. However, with the donation of the urodynamic equipment, it was felt that a course in urodynamics ware more appropriate and the program was amended in this way. Khartoum faculty Prof. Abbo, Dr. Adam Salh, Dr. Abuelgasim, Dr. Hassan Omer, Dr. Sahal, Dr. Isam, Dr. Khater, Dr. Siddig, Prof. Taha Umbelli, Dr. Kanan, Prof. Yahya, Dr. Ali Gaffer, Dr. A. Rahman. IUGA faculty Professor Edward Stanford (gynecologist, University of Tennessee, Memphis, USA), Dr Sohier Elneil (Consultant Urogynecologist, London and originally from The Sudan) and Dr. Harry Vervest (gynecologist, St. Elisabeth Hospital Tilburg, The Netherlands). Participants All participants have been invited by the Obstetrical and Gynecological Society of Sudan. There were 34 gynecologists and 6 registrars participating besides 16 national and international faculty members. Language The language for the meeting was English and all participants understood and spoke English well. Venue The venue was the Center for Permanent Medical Education in Khartoum. This venue offered two conference rooms (60 and 200 places) and meeting rooms for the workshops. There were internet facilities, video projection screens, and extensive computer facilities with the possibility of PowerPoint presentations. There were also ample facilities for lunch and coffee/thee breaks. Registration and IUGA certi tifi ficate A registration desk was available and all participants were provided with name batches. All participants received an IUGA certificate of attendance (appendix 2). Summary of the meeting At the end of each day the lectures were summarized by the chairman of that day. At the end of the meeting a CD-ROM was presented to all participants. This CD contained all plenary lectures and workshops. Evaluation and comments There was a pre- and post meeting evaluation filled in by each participant. Furthermore, each participant valued each lecture, workshop or case presentation. This was done in the format of the IUGA Education Committee. The only presentation that was not on the evaluation form, is the presentation by Dr. Adam Salh as this presentation was put in the program during the meeting. The results of the evaluation are presented in appendix 3. Except for the case presentations most lectures, workshops and urodynamic course were well received. Financial contributions and industrial support A registration fee of US$ 100 was charged to participants, which is a low fee for Sudanese standards. The meeting was financially supported by Al Hekma Pharmaceutical Company and Glaxo Smith Kline Company. The Center for Permanent Medical Education provided breakfast, coffee and IUGA exchange 2008 Khartoum (internal IUGA report, final version).doc page 3 / 12

4 refreshments for the two days. There were no commercial boots. However, the supporting company was granted a 5 minutes presentation of its main product, being medication for anemia. IUGA membership Participants were informed about the existence of IUGA and encouraged to become member. Also an initiative to form a Sudanese Urogynaecological Society was realized at the end of the exchange and encouraged to become an affiliate member of IUGA. Websites Obstetrical and Gynecological Society of Sudan: International Urogynecological Association: Laborie Medical Technology: The Fistula Center A major fistula center was established by professor Abbo in the late seventies. This center is located at the Khartoum Teaching Hospital. Gynecologists contribute to this center without any charge to women. More than 500 women are annually operated for all kinds of mostly obstetrical fistulae. It is the second largest fistula center in Africa and gynecologists from this center perform often surgery in other African countries. Professor Stanford and Dr. Vervest were welcomed at this center and were able to attend and discuss several fistula operations. IUGA has established a committee on fistulae which is chaired by Professor Stanford. It is IUGA s goal to establish a fistula program in cooperation with the United Nations and other parties involved in the care of fistula patients. This visit to the fistula center in Khartoum has contributed to IUGA s knowledge on fistula in a significant way and did enhance our understanding of this important health problem not only in Sudan but also in other African countries. At the preparatory meeting it became clear that quite a number of women still suffer from urinary incontinence despite adequate fistula repair. This constitutes often a difficult problem for which proper diagnostic work-up with urodynamic investigation is mandatory. However, at the preparatory meeting it appeared that no urodynamic equipment is available in Sudan. The IUGA Executive decided to approach a major urodynamic equipment company with a request to supply urodynamic equipment to this fistula center. Mr. Ray Laborie (Laborie Medical Technology, Canada), a longtime partner in the Friends of IUGA Program, was so kind to donate this equipment and it is now in place in the fistula center. Also one of the gynecologists received a nine day training by Laborie Medical Technology in Morocco. Both the Obstetrical and Gynecological Society of Sudan and the International Urogynecological Association like to express its sincere gratitude to Mr. Laborie for making this major contribution to improve health care of fistula patients in Sudan. Overall impression of this exchange and conclusions By the IUGA faculty Very well organized Good functioning local organizing committee Excellent and modern venue with state-of-the-art audiovisual support, rooms and food, coffee etc. The IUGA faculty was very much impressed by the high level of knowledge of participants and the often decisive questions and discussions. As this meeting was in conjunction with the Mid Term Meeting of the Obstetrical and Gynecological Society of Sudan several impressive social events like dinners and a cruise on the Nile River were organized and the faculty was invited to all of them. IUGA exchange 2008 Khartoum (internal IUGA report, final version).doc page 4 / 12

5 The IUGA faculty likes to express its sincere appreciation for the generous hospitality of all members of the organizing committee and the participants. We strongly recommend another follow-up exchange in Sudan with special focus on hands-on training on modern incontinence and prolapse surgical techniques. By the Local Organizing Committee Laborie urodynamic machine as a donation to fistula center. Increased awareness in urodynamic and urogynecological problem in Sudan. Establishing the Sudanese Urogynecology Association (SUGA) and 12 members registered as member of IUGA. An important outcome of this meeting is that The Sudanese Urogynecology Association likes to assist and cooperate with IUGA on solving the fistula problems in the world. Future plan for more collaboration with IUGA and hand on training courses on urogynecology. IUGA exchange 2008 Khartoum (internal IUGA report, final version).doc page 5 / 12

6 Impressions of the exchange IUGA exchange 2008 Khartoum (internal IUGA report, final version).doc page 6 / 12

7 Impressions of the professor Abbo s Fistula Center IUGA exchange 2008 Khartoum (internal IUGA report, final version).doc page 7 / 12

8 Appendix 1: 1 Scientific Program Saturday February 16 (2008) Chair: Prof. Abbo, Prof.Taha Umbelli 08:30 09:00 Registration 09:00 09:15 Opening and Welcome Dr Harry Vervest (IUGA) Prof. Abbo H. Abbo Prof. Abdal-latif Ashmaig (President of Obstetrical and Gynecological Society of Sudan) Plenary session 09:15 09:35 Fistula in The Sudan (Prof. Abbo) 09:35 09:45 Fistula experience in Darfour (Dr. Adam Salh) 09:45 10:05 Female health related issues in The Sudan (with emphasis on pelvic floor Dysfunction) (Dr. Abuelgasim) 10:05 10:15 Social impact of fistula (Dr. Abuelgasim) 10:15 10:25 Questions and Answers 10:30 11:00 Breakfast 11:00 11:45 Workshops Group A: pelvic floor, anatomy & physiology (Dr. Hassan Omer, Dr. Sahal) Group B: management of incontinence following fistula repair (Dr. Stanford, Dr. Isam) Group C: techniques of pelvic floor prolapse surgery (Dr. Vervest, Dr. Khater) Plenary session 11:45 12:05 None surgical management of stress urinary incontinence (Dr. Stanford) 12:05 12:25 Surgical management of stress urinary incontinence (Dr. Siddig) 12:25 12:40 Questions and Answers 12:40 13:10 Coffee / thee break 13:10 13:55 Workshops Group A: management of incontinence following fistula repair (Dr. Stanford, Dr. Isam) Group B: techniques of pelvic floor prolapse surgery (Dr. Vervest, Dr. Khater) Group C: pelvic floor, anatomy & physiology (Dr. Hassan Omer, Dr. Sahal) 13:55 14:25 Case presentations and debate 14:25 15:10 Workshops Group A: techniques of pelvic floor prolapse surgery (Dr. Vervest, Dr. Khater) Group B: pelvic floor, anatomy & physiology (Dr. Hassan Omer, Dr. Sahal) Group C: management of incontinence following fistula repair (Dr. Stanford, Dr. Isam) 15:10 15:30 Case presentations and debate (Fistula staff) 15:30 15:40 Summary of the day (Prof.Taha Umbelli) 15:40 Lunch Optional for interested persons: Visit to the Dr. Abbo National Center for Fistula & Urogynaecology IUGA exchange 2008 Khartoum (internal IUGA report, final version).doc page 8 / 12

9 Sunday February 17 (2008) Chair: Mr. M Siddig & Dr Isam Gafer Plenary session 09:00 09:20 Overactive bladder (Dr S. Elneil) 09:20 09:50 Pregnancy, childbirth and the pelvic floor (Dr. Vervest) 09:50 10:10 Communication with incontinent patient (Dr. Elneil) 10:10 10:25 Questions and Answers 10:25 10:55 Breakfast Plenary session 10:55 11:15 Current management of prolapse in The Sudan (Dr. Kanan) 11:15 11:35 Recent developments in the practice of prolapse (Dr. Hassan Omer) 11:35 11:55 Management of faecal incontinence (Prof. Yahya) 11:55 12:10 Questions and Answers 12:10 12:30 Management of stage 4 genital prolapse (Dr. Stanford) 12:30 12:50 Case presentation: Vault prolapse following vaginal hysterectomy (Dr. Ali Gaffer) 12:50 13:20 Coffee / thee break Urodynamic Course 13:20 13:40 What is a urodynamic investigation, basics (Dr. Vervest) 13:40 14:10 Explanation of the Laborie urodynamic equipment (Dr. A. Rahman) 14:10 14:30 Cystometry, pressure-flow and uroflowmetry (Dr. Siddig) 14:30 14:45 Urethral Pressure Profilometry (Dr. Elneil) 14:45 15:30 Clinical applications (Dr. Stanford) 15:30 15:45 Summary of the day (Dr. Isam) 15:45 16:00 Closing (Vervest, on behalf of IUGA) and presentation of IUGA certificates to participants 16:00 Lunch IUGA exchange 2008 Khartoum (internal IUGA report, final version).doc page 9 / 12

10 Appendix 2: Example of an IUGA certificate of attendance IUGA exchange 2008 Khartoum (internal IUGA report, final version).doc page 10 / 12

11 Appendix 3: Course evaluation Evaluation of presentations and workshops Saturday February 16, 2008 excellent good fair poor Lectures Female Health related issues in the Sudan 8 30% 12 44% 7 26% 0 0% Fistula in the Sudan 16 59% 9 33% 0 0% 0 0% Social impact of fistula 11 41% 11 41% 5 19% 0 0% Non-surgical management of SUI 11 42% 13 50% 2 8% 0 0% Surgical management of SUI 15 58% 7 27% 3 12% 1 4% Case presentations case % 6 29% 9 43% 1 5% case % 4 44% 4 44% 0 0% Workshops Pelvic floor anatomy and physiology 11 44% 8 32% 6 24% 0 0% Management of incontinence following fistula repair 9 38% 10 42% 5 21% 0 0% Techniques of pelvic floor prolapse 15 60% 5 20% 4 16% 1 4% Sunday February 17, 2008 Lectures Overactive bladder 18 69% 7 27% 1 4% 0 0% Pregnancy, childbirth and the pelvic floor 15 56% 11 41% 1 4% 0 0% Communication with incontinent patients 19 73% 7 27% 0 0% 0 0% Current management of prolapse in the Sudan 4 16% 12 48% 8 32% 1 4% Recent developments in the practice of prolapse 12 48% 10 40% 3 12% 0 0% Management of fecal incontinence 11 41% 10 37% 4 15% 2 7% Case presentations Vault prolapse following vaginal hysterectomy 3 12% 10 40% 10 40% 2 8% Video presentation of the use of mesh in recurrent prolapse 3 21% 5 36% 4 29% 2 14% Urodynamic course What is a urodynamic investigation: basics 15 58% 8 31% 3 12% 0 0% Explanation of the Laborie urodynamic equipment 7 26% 8 30% 7 26% 5 19% Cystometry, pressure-flow and uroflowmetry 14 52% 9 33% 4 15% 0 0% Urethral pressure profilometry 16 62% 6 23% 4 15% 0 0% Clinical applications 13 57% 7 30% 2 9% 1 4% IUGA exchange 2008 Khartoum (internal IUGA report, final version).doc page 11 / 12

12 Lectures Female Health related issues in the Sudan Fistula in the Sudan Social impact of fistula Non-surgical management of SUI Surgical management of SUI Overactive bladder Pregnancy, childbirth and the pelvic floor Communication with incontinent patients Current management of prolapse in the Sudan Recent developments in the practice of prolapse Management of fecal incontinence Workshops Pelvic floor anatomy and physiology Management of incontinence following fistula repair Techniques of pelvic floor prolapse Case presentations case 1 case 2 Vault prolapse following vaginal hysterectomy Video presentation of the use of mesh in recurrent Urodynamic course What is a urodynamic investigation: basics Explanation of the Laborie urodynamic equipment Cystometry, pressure-flow and uroflowmetry Urethral pressure profilometry Clinical applications 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% good or excellent fair or poor IUGA exchange 2008 Khartoum (internal IUGA report, final version).doc page 12 / 12