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Urogynecology
in India
KGH
Former Professor & Head of the
Department
Department of Urogynecology
Institute of Social Obstetrics,
Government Kasturba Gandhi Hospital &
Madras Medical College
Dr. N. Rajamaheswari
As a young woman entering the portals of the Thanjavur medical college
to get a basic degree, I was glad that I was getting an opportunity to
serve humanity.
When I completed my post - graduation in obstetrics and gynecology, my
wish to work in the field of women’s’ health was fulfilled.
While serving as Gynecologist at the rural medical institutions, I
understood the call for further specialization in the management of
women with complex urogenital problems and I decided to make that my
Mission and Vision.
Towards this end, I obtained a qualification in Urology, becoming the first
gynecologist to qualify in that discipline and the only professor of
Qualifications
Professor of Urogynaecology
First Gynecologist to qualify in Urology
(MCh)
&
MD, DGO, MCh ., (Urology)
Title of Degree Year University Medical College
M.B.B.S 1978 Thanjavur Thanjavur Medical
College
D.G.O 1980 Thanjavur Thanjavur Medical
College
M.D (Ob & Gy) 1982 Madras Madras Medical
College
M.Ch (Urology) 1985 Madras Kilpauk Medical
College
Fellowship 1992 U. K South Mead Gen.
Hospital , UK
Medical Education
International Training
• Urogynaecology - Bristol , UK 1991, Texas USA 2006
• Laparoscopic Urological Surgery - Dublin & London 1992
• Laparoscopic Gynecological Surgery - Germany 1991
• Ultrasound - Bristol, UK 1992
• Urinary Incontinence procedures - Korea 2002, Belgium 2004,
Houston USA 2010 Australia 2012
Certified specialist in PROTECT
Prevention & Repair of Perineal Trauma /
Episiotomy through Coordinated Training
30 .06 .2013
30 Years of service in Govt of
Tamil Nadu Medical Service
1982 - 1985 (3 yrs)
Assistant Surgeon
Specialist M.D., DGO.,
1985 - 2006 (21 yrs)
Assistant Surgeon as
M.D., DGO., M.Ch (Urol)
Superspecialist
2006 - 2012 (6 yrs) Chief Urogynaecologist
MBBS 1971 - 1978
DGO
1979 - 1980
MD Ob Gy
1980 - 1982 IOG
Thanjavur Medical Colleg
Madras Medical College
TNGS as MD., DGO., 9. 6. 1982
Asst Surgeon Ob & Gy
TMC 1982 - 1983
Journey as
Gynecologist
Primarily served the rural community & complications of
pregnancy & delivery were common causes of mortality / morb
My medical career began in 1971, in Thanjavur a small
town in Tamil Nadu. Later I moved to Chennai to pursue
postgraduate degree in OB & GY
Our institute was primarily serving the rural community &
complications of pregnancy & delivery were common
causes of mortality & morbidity
In 1982, I returned to the department of OB & GY in the
same government medical college in Thanjavur, from where
I had graduated
Urology
MCh (urology)
KMC 1983 - 1985
In the beginning of my career,
I accidentally injured a ureter
during a vaginal hysterectomy
Repair was done by my
colleague
Which spurred me
further to specialize in
Urology
MCh (urology)
1983 - 1985
Guilt is a powerful motivation & that
is what drove me to specialize in
Bemused expression of faculty of Urology
on my first day of residency as my
candidature was completely unexpected
Prof. A. Rajasekaran MCh Urology
1983 - 1985
I still remember the bemused expression & disappointment of
faculty of urology on my first day of my residency as my
candidature was completely unexpected
No one had the experience of training a gynaecologist in urology
till then and yet the responsibility was forced on them, but
eventually I became part of the team
I had to face the scepticism of urologists who were more
concerned about problems of prostate, transplant procedures &
stone disease and did not consider that urogynaecology required
expertise & experience
MCh (urology)
1983 - 1985
Prof. A. Rajasekaran was very supportive &
helpful through out my career
They didn’t consider that
Urogynecology required
expertise & experience
Urologists were more concerned about
problems of prostate, transplant procedures &
stone disease
…. eventually I became part of the team
Mentors
Prof. R. Vijaya Prof. A. Rajasekaran
Genesis of
Teacher
Academicia
n
Great
Surgeon
Crucial
Role
Pragmatically, female urology & urogynaecology failed to
lure general urologists & gynaecologists despite its
potential; I decided to pursue female urology &
urogynaecolgy
After successfully completing my residency in Urology, I
worked for a year in Govt Stanley Hospital
In 1986, Govt entrusted the responsibility of managing
urological problems of women at Govt Kasturba Gandhi
Hospital, Madras Medical College, Chennai, Tamil Nadu
ourney as Urologist
8 . 8 . 1986
1985 - 86
Gen Surgery
Government Kasturbha Gandhi Hospital in Chennai, a
695 bed hospital for women providing tertiary care.
Our department was recognized as the ultimate
stopover for women with urinary leakage following child
birth & surgery
Most were complex fistula demanding elaborate
reconstruction of the urinary tract, sometimes repeated
repairs & occasionally urinary diversions
Govt KGH
Journey as Uro /
Gynecologist
1986 - 2012
Pragmatically,
Female Urology &
Urogynaecology
failed to lure General
Urologists & Gynaecologists
despite its potential
Most were complex fistula demanded
elaborate reconstruction of urinary tract,
sometimes repeated repairs &
occasionally urinary diversions
Fistula An intricate complication
delivered - moribund or dead born
operated - caesarean or hysterectomy
I realized my responsibility to these unfortunate
women and at the same time I was aware of my
inadequacy in treating some of the complex cases
Considering the complex nature of the cases managed,
I desired further training & underwent a one - year
fellowship in reconstructive surgery & urodynamics in
Bristol, UK
Fellowship
Awarded Commonwealth Medical Fellowship
trained in Urogynecology and Urodynamics
at South Mead General Hospital, Bristol,
United Kingdom (1991 - 92)
Department of Urology
1992
I joined the same Institute after my fellowship
Optimistically, I took my first step on a long march,
with the vision to develop the
Best possible Urogynaecology unit.
Nrm cv ppt   10.12.20
Evolving as Urogynecology depart
1992 - 2012
Govt KGH
Improving the Qol of women
Comprehensive & quality UG
health care for poor & needy
Mission
Vision
To serve
Deprived & Needy
Dept of Urogynaecology
Comprehensiv
e
Updated treatment
Scientifi
Specialised
Government Institutions
Lack amenities
Inadequate staff
Infrastructure
Not clean
Unhygenic
No scope for advanced & special
 Myth
Care & treatment
Bridging the gap
Govt Hospital
Corporate Hospital
Urogynaecology
It deals with the function and disorders of the
lower urinary & genital tracts
Urogynaecological problems
Pelvic floor dysfunction
Urinary incontinence
Urinary tract infection, etc
50% of women > 35 years
Urinary incontinence top priority,
Pelvic floor dysfunction highly prevalent
More & more complicated
Gynec problems requiring elaborate ,
intricate, repair & reconstructive
procedures sought help
More than 50 % of our surgeries were
addressed to manage these problems
Absolutely essential to provide comprehensive
quality health care for women BPL
Establishing the medical
speciality “Urogynacology”
in Govt Institution
Urinary incontinence &
pelvic floor dysfunction
Establishing
Urogynecology
- The roads crossed
Nrm cv ppt   10.12.20
Developing the sub specialty
Urogynaecology in India
intimidating
sometimes discouraging
always challenging
Exhilarating
I’m just moving clouds today
Tomorrow I’ll try mountains
How did we
proceed
Chennai
Chennai
Urogynaecolog
y
What did we do
Nrm cv ppt   10.12.20
Limitations
Sterilizer
Storage
Unexpected visito
Uninvited residents
Changing
room
Scrub
Improving
basic amenities
# 1
Past
Improved OT
Present
Enhanced OT infrastructure
Improved toilet
Urodynamics
diagnosis
Urinary Incontinence
Obstruction - urinary tract
Bladder dysfunction
State of the art
equipment
Fistula ward
# 2
Fistula
Fistula
ward
Only one of its
kind in India
Urovaginal fistulae
poor
divorced
deserted
demoralized
Author Yr Total Obstet
Devi 1965 500 95.0 % 5.0 %
Rao 1975 297 97.0 % 3.0 %
Rajamaheswari 1997 110 76.0 % 24.0 %
Rajamaheswari 2007 55 61.8 % 38.2 %
Aetiology of VVF – A National
Comparison
Non-obst
Rajamaheswari 2012 26 23.1% 76.9 %
Surgical outcome
Success repeat repairs
Obstetric Fistula
Success - I repair - 79.6%
Overall success rate 93. 3 %
# 3
Recognized by Royal College
of Australia & Newzealand
for training their Fellow’s in
Fistula surgery at Govt KGH
2004- Dr. Yik Lim
Urogynaecology Fellow 6 weeks training
Urogynaecology fellow - Australia
# 4
Raised foreign fund &
aid to Govt KGH
- Sir Winston Churchill
“You make a living with
what you get
You make a life with
what you give”
2007 - Fistula Ward
adopted by
Dr. Paula Rane
Rane’s
Philanthropic family
Nrm cv ppt   10.12.20
“ Kalpana Chawla Award 2009 ”
5 Lakhs was donated by Dr.
N.Rajamaheswari
to Fistula Ward of Govt KGH
which she received as cash award of Kalpana
Chawla Award 2009
Prof. Paul Riss Travel grant
Two young Faculty - participated
IUGA conference 2009 at Italy
URPSSI
Austria # 5
Small group training
Fellowship program
# 6
(Ms) No. 131 (17.04.2007)
Commencement of Certificate course &
Training Courses in Urogynaecology
Unique outcome
Has the only training centre
Urogynaecology
for a country of 1 billion
Certificate &
Training Courses
Urogynecology
Urogynaecological
problems
Pelvic floor dysfunction
Urinary incontinence
urinary tract infection
etc
…. a hidden epidemic
50 % of women > 35 years
Morbidity
65.9 crores
136 crores
Birth rate 21.0 / 1000
7.9 crores
3.5 crores
(2014)
Challenge ahead…
Uroaecological
problems
Urogynecologist
s
Challenge
Urogynaecological
problems
Health & Social
Burden
65.9 crore
Bridging the gap
between care seekers
(patients) & providers
( specialist)
Urogynaecology
International
exchange
Reconstructive Urology
operative workshop
‘Urogynaecology Speciality’
 CME
 Conferences
 Lectures  Operative workshop
 Training program
 Exchange program
Instituted
Evolved
Nurtured
Guest Lectures & Discourses
Training & education
Surgical demo
• Operating Faculty
• Invited speaker
• Visited all the states
UG problems
> 100 Institutions
KGH
# 7
Assam (1)
Haryana (1)
Kerala (9)
Telengana (1)
Tamil Nadu (54)
Pondicherry (2)
Uttarkand (2)
Odhisa (10)
Maharashtra (15)
Karnataka (12)
Gujarat (8)
Delhi (9)
Rajasthan (6)
Madhya Pradesh(5) West Bengal (4)
Andhra (6)
Punjab (2)
Jharkand (2)
Uttar Pradesh (10) Assam (1)
National Scientific
Guest Lectures
(138), Orations (17),
Key note address
Assam (1)
Assam (1)
179
UG problems
Trained care - givers
Health & Social Burden
Demand vs
659 million
Big group Educational
program (Short term)
URPS
Conference
# 8
2000 - “Urogynaecology ”
CME
2001 - URPS 2001
Operative workshop
Urogynaecology &
Reconstructive Pelvic
Surgery
URPS 2003
Book
“ Urogynecology ”
URPS 2005
URPS 2006
URPS
2007
URPS 2008
URPS
2010
URPS 2009
URPS 2011
URPS 2012
URPS 2015
URPS 2014
URPS
2016
URPS 2017
IUGA eXchange Programme 2007
IUGA eXchange Programme 2007
IUGA Regional
Symposium
URPS 2018
URPS 2014
URPS 2012
URPS 2010
URPS 2008
URPS 2002 URPS 2003
22
Chennai,
Tamil Nadu
International
Urogynaecology
experts
URPS Conferences
&
Live Operative
Workshop
22
“What seems impossible
is not really always so”
National
outreach program
# 9
August 2008
Delhi
Bangalore Society of Ob &
Reconstructive
Surgery Workshop
2009
Gauwathi, Assam
2010
Indore, MP
10 . 4 .
2011
Nrm cv ppt   10.12.20
URPS with FOGSI & OG Societies
Madurai (2017)
Jaipur (2009, 2012, 2017)
Gorakpur (2016)
Nagpur
(2008, 2010, 2011, 2016)
Bhubaneswar
(2007, 2011 ,
2012, 2016, 2016)
Ranchi (2016)
Kolkatta (2001, 2016)
Kanpur (2015)
Chennai (2001, 2012, 2015)
Trivandrum (2014)
Burla
(2007, 2010, 2013)
Aurangabad (2012)
Varanasi
(2009, 2012)
Lucknow (2011)
Hyderabad
(2005, 2008, 2011, 2017)
Bareilly (2010)
Coimbatore
(2005, 2005, 2007, 2010)
Coimbatore (2007)
Indore (2007, 2009, 2011)
Trichy (2007, 2012)
Bangalore (2006, 2007)
Cochin (2006)
Thanjavur (2006)
Mysore (2005)
New Delhi (2005, 2008,
2008, 2009, 2009, 2010)
Mumbai
(2002, 2002, 2003, 2013)
Thrissur (2002)
Kolapur (2001)
Gawhathi (2010)
Ahamadabad
(2008, 2009)
Surat (2009)
Nellore (2008)
Pune (2002, 2008)
71
Delhi (2018)
Jodhpur (2014)
Mumbai (2014)
Delhi (2014)
Tirupathi (2012)
Madurai (2011)
Agra (2010)
Ahmadabad (2009)
Indore (2009)
Bangalore (2008)
Mehsana (2006)
New Delhi (2006)
Ahmadabad (2001)
Calicut (2001)
Madurai (2000)
URPS with Urological Societies
13
Karnataka (4)
Gujarat (8)
Assam (1)
Delhi (9)
Rajasthan (4)
Madhya Pradesh (1)
Kerala (5)
West Bengal (4)
Maharashtra (9)
Andhra (5)
Telengana (1)
Telengana
Odhisa (6)
Tamil Nadu (13)
Punjab
Jharkand (1)
Uttar Pradesh (6)
Assam (1)
FOGSI, State,
sister OBGY (71) &
Urological Societies
of India (13)
Live operative
Urogynaecology
workshops
84
Perineal injuries
PIE 8 out of 10 vaginal
# 10
Perineal Injuries
Trained care - givers
Health & Social Burden
495 million
83%
> 20 million in India
perineal trauma / yr
Punjab
Rajasthan
Jharkand
Uttar Pradesh
Madhya Pradesh
Karnataka
Maharashtra
Kerala
Tamil
Nadu
Odhisa
PIE
Perineal
injuries
Workshop
39
PIE
Bagalkot 2018 (46)
Jaipur 2017 (120)
Indore 2017 (550)
Madurai 2017 (350)
Ranchi 2016 (132)
Bhuvaneshwar 2016 (252)
Gorakpur 2016 (196)
Nagpur 2016 (56)
Kanpur 2015 (96)
Cuttack 2014 (312)
Trivandrum 2014 (312)
Madurai 2013 (256)
Mumbai 2013 (950)
Amristar 2013 (560)
Burla 2013 (254)
Bangalore 2009 (302)
KGH, Chennai - Annual workshop 2007 – 2012,
2014,
Chennai - 2014 - 2018
IOG 2012 (136)
VHS 2013 (70)
39
PIE - Live Operative
Workshop,
KGH, Chennai
21 . 9 . 2007
Nrm cv ppt   10.12.20
Nrm cv ppt   10.12.20
PIE
Dr Mehta’s 2017
OB & Gy PGs
Urogynaecology Teaching Program -
Annual
MBBS students
2000 - till now
2007 - 2012
Contribution to
Urogynecology
#
11
Published 20
Educational
Operative Video DVDs
“ Pearl Video Series ”
a
9
b
Publication 2003
Authored & Published the book
“ Urogynaecology - An Indian Focus”
c
Contributed 16 Chapters
to Text Books
Editor “Menopausal Syndrome”
Published by Central Council for
Research in Homoeopathy,
New Delhi 2011
d
e
Vaginal repair of supratrigonal
VVF
- a 10 year review
Int Urogynecol J (2012) 23 : 1675 - 1678
Land mark publication
Success rate of vaginal repair of Supratrigonal VVF
is comparable to abdominal approach
f
Mid urethral Bulbo cavernous
muscle sling for SUI in
women
First prize for innovations in
urology
USICON, Gauhati - 2003
Innovative contribution to Urogynaecology
g
Nrm cv ppt   10.12.20
Technical
Innovation
Developed Simple, Effective &
economical MUS surgery for
SUI
Modified minimally invasive synthetic
mid - urethral sling
h
Needle Vault Suspension as
treatment of Vault Prolapse
Paper presented in annual conference of the
International Urogynaecological Association
Kaulalampur, Malaysia, 1994.
Innovative contribution to
Urogynaecology
i
National
Honors &
Awards
#
12
Scholastic Honors
Prof. P. Venugopal oration – Karnataka 2006
Dr. Murali Rane oration – Chennai 2007
K.C. Mittal oration - New Delhi 2007
Prof. Dr. Engineer oration - Aligarh 2007
Silver Jubilee Oration - Ahmedabad 2008
Scholastic Honors
Dr. B. Ramamurthy Oration - Trichy 2008
Brig. Khanna Oration - Delhi 2008
Dr. Moorthy endowment Oration - Chennai 2010
Dr. Bamandas Mukherjee Memorial Oration – Kolkatta
2010
Dr. A. D. Engineer Oration - UP 2014
Scholastic Honors
Dr. Shakuntala Sahay Memorial Oration, Ranchi 2016
Bhimsen Sahoo Memorial Oration, Orissa 2016
Dr. Leela Dube Oration, Maharashtra 2016
National Award
Rotary International’s Highest award
“Service before self” 2005 - 2006 for
having rendered yeomen service towards
the poor women patients in India
“For The Sake of Honour”
“ Kalpana Chawla Award 2009 ”
National
Award
• Mother Therasa Award 4. 4. 2014
• Life Time Achievement Award &
"Best Doctor Award 2012 – 2013”
by the Tamilnadu Dr. MGR Medical
University 4 .08. 2012
Coimbatore, March 28 - 31, 2019
“FOGSI SUPER HERO AWARD” by YUVA FOGSI South
Zone
Coimbatore, March 28 - 31, 2019
“FOGSI SUPER HERO AWARD” by YUVA FOGSI South
Zone
Nrm cv ppt   10.12.20
Nrm cv ppt   10.12.20
International
Honors &
Award
#
13
“ Baden Lecturer ”
First Asian honored on 30 .11. 2006
19 th annual Wayne Baden day
The Texas A & M University Health Science centre,
Texas, USA
“Ulf Ulmsten Speaker” - IUGA 2008
33rd Meeting
of International
Urogynaecological
Association, Taipei
As recognition for
research &
contribution to the
field of
16. 9. 2008
ICI Paris, France July 5 - 8, 2008
Member of the International Committee - ICUD, ICI &
ICS
International consultation on Urological Diseases (ICUD)
International consultation on Incontinence (ICI)
Chairing sessions
IUGA Como, Italy
Invited faculty -
Abroad
 XIII Annual Meeting of Australian
Gynecological Endoscopy Society
AGES Melbourne, Australia, 2012
 Lecture “Obstetric trauma in India" 17. 03.
2012
 Keynote Lecture: Pelvic floor surgery
 IUGA Regional Symposium 2012 Singapore
 Prevention & Management of Vesico & Urethro
vaginal fistula
 Ureteral Injuries
 IUGA Regional Symposium 2016 Penang,
Malaysia
 Management of Vesico Vaginal Fistula on
22 .04 .2016.
Invited faculty
Invited Faculty
 PAN - ASIAN program IUGA 2015 Nice, France
 Lecture on Uro vaginal Fistula
 Panel discussion: on surgical treatment of
recurrent POP / vaginal vault prolapse
 Fellows / Trainees Forum Program
IUGA 2016 Cape Town, South Africa
 Hands on Bladder Repair
 Management of VVF
Faculty Fellows Program
IUGA 2016
Cape Town, South Africa
Hands on Bladder
Repair
Urogynecology
speciality
Established
Nurtured
Advanced
Chennai
Chennai
Urogynaecologic
al services
made available
What did we achieve
Managing Urogynec problems
Creating awareness about
availability & benefits
of urogynecological services
Encouraging women to seek medical help
Primary Task - 1

Availability of technologically
advanced Urogynecological
treatment facilities
in their own neighborhood

Primary Task - 2
Educating fellow
Consultants & Practioners
Reaching the wider section of patients through
fellow medical fraternity
Apt technique
Surgical skills
Learning curve

Primary Task - 3
Training budding specialists
Reaching the wider section of patients
through fellows & trainee
KGH
Trained Fellows &
Consultants
 State of Tamil Nadu
 Other states of India
 Overseas

Primary Task - 3
Trained Specialists with enhanced
skills
KGH
return to their own states
& pass on the benefits to
patients at native place
Fellows & Consultants
Outcom
e
Outcom
Patients (BPL)
 State of Tamil Nadu
 Other states of India
 Overseas
Benefits of UG
Specialized services
reached
KGH

Urogynecological specialised services
spread across the country
The word ‘Urogynecology’
got accepted by the
medical faternity and
benefits cascaded to the patients
URPSSI

Chenna
i
Outcom
Eventually UG sub speciality is
recognized by National OBGY
society
UG - not a mystry anymore
to patients & professionals
Medical fraternity is familiar
with UG & convinced about
its necessity & benefits

Chenna
i
Outcom
UG curriculam included
In OG & Urology PG
First UG department
founded in Tamil Nadu
Later followed in
other states of India

Nrm cv ppt   10.12.20
“ Weave in faith &
God will find the thread ”
Continued undeterred
It is true that despite human &
economic resource constraints
so much could be accomplished
with so little, if there is a will
Bob Shull
U.S.A.
Paul Riss
Austria
alph
Peter Dwyer
Australia
Sylvia Botros
Justin Oliver Daly
Fiona Lindo
Ajay Rane
Malcolm Ian Frazer R Keith Huffaker
George K
Richard
Wasserman
Linda
Brubaker
Ranee T
UK
Abdul Sultan
UK
Neither expected
Nor dreamt !
Sacrifices / Hardship
Accomplishment
vs
Urogynecolog
All truth goes through 3 stages
First it is ridiculed
Secondly, it is violently opposed
Thirdly, it is accepted as being self
evident
To establish Urogynaecology in India
Sacrificed
series of
promotions
Devoted whole
Time, Energy &
Effort
Lucrative private practice
Work after dusk
Worked over and above my
commitment as Urogynaecologist, female
Urologist &
Ob & Gy specialist at Govt KGH
Dr. N. Rajamaheswari
No sequestrated time allocated to do this
30 years of service in the Government
of Tamil Nadu Medical Service
1982 - 1985 (3 yrs)
Assistant Surgeon
Specialist M.D., DGO.,
1985 - 2006 (21 yrs)
Assistant Surgeon with
M.D., DGO., M.Ch (Urol)
Superspecialist
2006 - 2012 (6 yrs) Chief Urogynaecologist
Declaration of Dept of Urogynaecology
Department of Urogynaecology
G.O. (Ms) No. 155 ( 21. 07. 2005 )
The only department in India
Dr. N. Rajamaheswari MD., DGO., MCh.,
24 Years Assistant
Surgeon
Unsurpassed
service
Longest career as a superspeciality
qualified assistant surgeon in govt
service
80%
“ It is under the greatest
adversity that there exists
the greatest potential for doing
good, both for oneself & others ”
Urogynaecology &
Reconstructive Pelvic Surgery
Society of India
URPSSI
Urogynaecology & Reconstructive
Pelvic Surgery Society of India
URPSSI Affiliated to IUGA
2008
International Uro Gynacological
Association
URPSSI
Urogynecology & Reconstructive Pelvic
Surgery Society of India
Promotes collaboration among Specialists &
Keeps them updated about latest
Objective
Annual URPS workshop from 2001
Registered in 2005
Affiliated to IUGA in 2008
URPSSI founded 2005
URPS
SI sharing
Learning
Knowledge skills
Urogynaecology Teaching
& Training courses
nrmurogyn@gmail.com
URPSSI
Nrm cv ppt   10.12.20
Currently
Consultant Urogynecologist,
Medway Women Centre, Chennai
President
URPSSI (Urogynaecology & Reconstructive Pelvic
Surgery Society of India )
Member - Editorial board International
Urogynaecology Journal 2012 - till now
2014 - till now
Member - International Advisory board International
Urogynecological Association Southern Asia from
2019
Member International Advisory board TOG - The journal
of Obstetricians & Gynecologists of Royal College of
UK
Nrm cv ppt   10.12.20
Nrm cv ppt   10.12.20
Urogynecology
India
KGH
Great works
are performed
not only by strength
but also by perseverance

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