Indonesian Society of Obstetrics and Gynecology Guideline on Urogynecology

Abstract

Pelvic floor disorders—including urinary incontinence, overactive bladder, pelvic organ prolapse, voiding dysfunction, recurrent urinary tract infection, and genitourinary syndrome of menopause—are chronic conditions that significantly affect quality of life. The Indonesian Society of Obstetrics and Gynecology guideline provides a person‑centered framework emphasizing symptom burden and patient goals rather than anatomical findings alone. It recommends standardized assessment, early access to pelvic floor rehabilitation, bladder training, lifestyle optimization, and pessary care as first‑line management, with stepwise progression to pharmacological and surgical options when necessary. Diagnostic testing should be proportionate, reserving advanced investigations for complex cases, while surgical interventions require shared decision‑making, explicit consent, and governance safeguards, particularly regarding synthetic mesh use.

Implementation in Indonesia is proposed through a tiered referral model linking primary care, general obstetrics and gynecology, subspecialty services, and urogynecology centers, supported by national datasets, validated questionnaires, registries, and audit systems. The guideline integrates pregnancy, postpartum, and fertility considerations, stresses antibiotic‑sparing strategies for recurrent UTI, and highlights competency‑based credentialing for procedures. Evidence ratings follow the GRADE approach, with provisional recommendations pending multidisciplinary consensus. The overarching goal is equitable, safe, and effective care for women with pelvic floor disorders, tailored to the Indonesian health system context