Surgery for female pelvic organ prolapse is a well recognized field within gynaecologic surgery. Due to the improved understanding of the pathophysiology of prolapse and the introduction of new highly effective meshes together with kits for specific operations, rapid progress is currently being made in the field of prolapse, known as Urogynaecology.

The trade joined into this movement and arranged numerous short training sessions aimed at the use of the abovementioned kits, which cover only part of the spectrum of the surgical procedures for prolapse. Both Gynaecologists and Urologists were invited to these meetings and apparently, Urologists saw this as an invitation to move into the field of prolapse surgery.

Prolapse is divided into 3 compartments: anterior, middle (apical) and posterior. The anterior compartment (bladder and urethra) is a field of overlap between Gynaecology and Urology. In contrast, the middle compartment belongs to Gynaecology only (uterus and vagina). The posterior compartment (perineal body, anus, rectum, pouch of Douglas and sigmoid colon) again is a field of overlap, this time between Gynaecology and Surgery.

Instant training does not entitle a Urologist to the entire field of prolapse, but should increase their understanding of the anterior compartment. Therefore, the treatment of anterior compartment prolapse is the domain of both Urologists and Gynaecologists. Similarly, the treatment of posterior compartment prolapse is the domain of both Surgeons and Gynaecologists. Only with comprehensive and complete training in the other fields, these disciplines may move into the other two compartments. Such training still has to be adequately described.

Patients with prolapse are subjected to severe morbidity, decreasing their quality of life. A physician approaching this problem without a complete understanding of the pathophysiology of prolapse and without having mastered the complete range of surgical and medical treatment options, can do more harm than good. Patients should be protected and therefore, it is necessary to issue firm guidelines on the evaluation and treatment of female pelvic organ prolapse, particularly concerning the specialty groups involved.

The South African Society of Obstetricians and Gynaecologists categorically states that in female pelvic organ prolapse the following role players are involved:

1. Anterior compartment prolapse : Gynaecology Urology
2. Middle compartment prolapse : Gynaecology
3. Posterior compartment prolapse : Gynaecology Surgery

In addition, urinary incontinence in the female is a traditional field within Gynaecology (and its subdiscipline Urogynaecology). This is also an overlapping field between Gynaecology and Urology.

We recognize the need for guidelines for further training of people in any of these three disciplines (Gynaecology, Urology and Surgery) whishing to expand their expertise into the traditional fields of related disciplines.

I appreciate your assistance.

Kind regards