Prevalence of, Clinical Presentation of, and Factors Associated With Advanced Pelvic Organ Prolapse Among Young Women (18-49 Years) Undergoing Surgery in Urogynecologic Camps in Uganda

Abstract

Background: In low-resource settings where pelvic organ prolapse (POP) surgery is often accessed through outreach surgical camps, it is crucial to have evidence of the magnitude, clinical presentation, and profile of young women with advanced POP for community health education, screening, resource mobilization, and surgical planning. The objective of the study was to describe the clinical presentation and determine the prevalence of and factors associated with advanced stage POP among young women undergoing POP surgery in urogynecologic camps in Uganda. Methods: A retrospective records review for women aged 18 to 49 years that had undergone POP surgery in 30 urogynecologic care camps at eight centers in Uganda from January 2022 to December 2025 was conducted. The primary outcome was advanced POP defined as stage III or IV genital prolapse at maximum Valsalva strain during a speculum pelvic examination as per the POP quantification (POP-Q) system. Non advanced POP referred to stage II POP in this study population of young women operated for POP during the study period. Predictor variables were socio-demographic, obstetric/gynecologic, and medical factors. Baseline characteristics were summarized in frequency tables. Prevalence of advanced POP was computed as a percentage with 95% confidence interval (CI). Bivariable and multivariable modified Poisson regression analysis with robust standard errors was done to determine factors associated with advanced POP. Prevalence ratios (PRs) were reported and p values less than 0.05 were considered significant. Results: Out of 547 women operated for POP, nearly half 49% (n = 268) were young women aged 18 to 49 years and they were all enrolled into the study. They had a mean age of 38.9 years (SD: 6.9), mean parity of 5.6 (SD 2.6), presented late with a median duration of symptoms of 36 months (interquartile range (IQR) 24- 84). Majority of the young women presented with the classic symptom of sensation of a mass or bulge in the vagina (84%, n = 225), concurrent pelvic floor disorders were: obstetric anal sphincter injuries (7.8%, n = 21) and stress urinary incontinence (3.0%, n = 8). The prevalence of advanced POP was 84% (224/268) (CI: 78.63 - 87.57). History of prior POP surgery increased the likelihood for advanced POP (adjusted PR (aPR) 1.19, CI: 1.08-1.31, p < 0.001), while having completed primary education (aPR 0.90 CI: 0.82 - 0.98, p = 0.015) and being married (aPR 0.91 CI: 0.85-0.98, p = 0.009) were protective against advanced POP. Conclusions: The prevalence of advanced POP among young women undergoing POP surgery in Uganda is high. Prior POP surgery increases the likelihood for advanced POP while education and being married are protective. We recommend intensifying preventive strategies against POP in young women such as scaling up family planning uptake, skilled obstetric care, and postpartum pelvic floor muscle rehabilitation. Efforts should be undertaken to increase access and use of vaginal pessaries as first line therapy for management of POP in young women in Uganda to lower the risk of recurrence of advanced POP.