Urogynecology: Difference between revisions

Urogynecologist
Occupation
Names	Doctor, Medical Specialist, Surgeon
Occupation type	Gynecology, Urology, Specialty, Surgery
Activity sectors	Medicine, Surgery
Description
Competencies	Patient Care, Education, Research
Education required	Doctor of Medicine (MD); Doctor of Osteopathic Medicine (DO); Bachelor of Medicine, Bachelor of Surgery (MBBS/MBChB);
Fields of; employment	Hospitals, Clinics
Related jobs	Gynecologist, Urologist

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Urogynecology or urogynaecology is a surgical sub-specialty of urology and gynecology.

History

In 1893, Howard Kelly, a gynecologist and pioneering urogynecologist, invented an air cystoscope which was simply a handheld, hollow tube with a glass partition.^[1] When the American Surgical Society, later the American College of Surgeons, met in Baltimore in 1900, a contest was held between Howard Kelly and Hugh Hampton Young, who is often considered the father of modern urology.^[2] Using his air cystoscope, Kelly inserted ureteral catheters in a female patient in just 3 minutes. Young equaled this time in a male patient.^[3] So began the friendly competitive rivalry between gynecologists and urologists in the area of female urology and urogynecology. This friendly competition continued for decades. In modern times, the mutual interest of obstetricians, gynecologists, and urologists in pelvic floor problems in women has led to a more collaborative effort.

Education and training

Urogynecologists are medical professionals who have been to medical school and achieved their basic medical degree, followed by postgraduate training in Obstetrics and Gynaecology (OB-GYN). They then undertake further training in Urogynecology to achieve accreditation/board certification in this subspecialty. Training programme requirements and duration varies from country to country but usually tend to be around 2–3 years in most places. Urogynaecology fellowship programmes are available in some countries, but not all and the levels of formal accreditation and certification vary from country to country.

The International Urogynecological Association (IUGA) is a global body for professionals practising in the field of urogynaecology and female pelvic medicine and reconstructive surgery. IUGA facilitates training for physicians from countries which do not have formal training programmes by maintaining and publishing a directory of fellowship programmes. IUGA also provides educational opportunities for urogynecologists both online and in-person, develops terminology and standardization for the field. The International Continence Society (ICS) is another global organization which strives to improve the quality of life for people affected by urinary, bowel and pelvic floor disorders through education, and research.

Scope of practice

Urogynecology is a sub-specialty of Gynecology, and in some countries is also known as Female Pelvic Medicine and Reconstructive Surgery. A urogynecologist manages clinical problems associated with dysfunction of the pelvic floor and bladder. Pelvic floor disorders affect the bladder, reproductive organs, and bowels. Common pelvic floor disorders include urinary incontinence, pelvic organ prolapse and fecal incontinence. Increasingly, Urogynecologists are also responsible for the care of women who have experienced trauma to the perineum during childbirth.

There is some crossover with the subspecialty of Female Urology - these doctors are urologists who undergo additional training to be able to manage female urinary incontinence, pelvic organ prolapse and interstitial cystitis/PBS. In addition, there are colorectal surgeons who have a special interest in anal incontinence and pelvic floor dysfunction related to rectal function. Contemporary urogynecological practice encourages multidisciplinary teams working in the care of patients, with collaborative input from urogynecologists, urologists, colorectal surgeons, elderly care physicians, and physiotherapists. This is especially important in the care of patients with complex problems, e.g. those who have undergone previous surgery or who have combined incontinence and prolapse, or combined urinary and bowel problems. Multidisciplinary team meetings are an important part of the management pathway of these women.

Urogynaecologists manage women with urinary incontinence and pelvic floor dysfunction. The clinical conditions that a urogynecologist may see include stress incontinence, overactive bladder, voiding difficulty, bladder pain, urethral pain, vaginal or uterine prolapse, obstructed defecation, anal incontinence, and perineal injury. They may also care for women with vesicovaginal or rectovaginal fistulae with specialist training, and in conjunction with other specialties.

Patients will usually be assessed using a combination of history taking, examination (including pelvic examination and assessment of prolapse using validated systems such as the Pelvic Organ Prolapse Quantification System and assessment of quality of life impact using validated questionnaires, including the assessment of sexual function, using Pelvic Organ Prolapse/Incontinence Sexual Questionnaire IUGA- Revised [PISQ-IR]. A bladder diary is often used to quantify an individual's fluid intake, and the number of voids per day and night, as well as the volume the bladder can hold on a day-to-day basis. Further investigations might include urodynamics or a cystoscopy. Treatment usually starts with conservative measures such as pelvic floor muscle training, fluid and food modification or bladder training. Drug therapies can be used for overactive bladder, which may include antimuscarinic drugs or beta 3 receptor agonists - both of these help to control the urgency that is the key component of overactive bladder. If medications fail, more invasive options such as injections of botulinum toxin into the bladder muscle, or neuromodulation are other options for symptom relief. Surgical treatments can be offered for stress incontinence and/or uterovaginal prolapse if pelvic floor muscle training is unsuccessful.

Urogynecological problems are seldom life-threatening, but they do have a major impact on the quality of life of affected individuals. Urogynecologists will usually use quality of life improvement as a treatment goal, and there is a major focus on optimising symptoms using conservative measures before embarking on more invasive treatments.

Some conditions treated in urogynecology practice include:^[4]

Diagnostic tests and procedures performed include:^[4]

Specialty treatments available include:^[4]

References

^ Kelly HA. Medical Gynecology. New York: Appleton, 1908.
^ Hugh H. Young
^ Young HH. A Surgeon's Autobiography. New York: Harcourt, 1940.
^ ^a ^b ^c Mayo Clinic, Gynecology at Mayo Clinic in Arizona, retrieved 14 August 2010

External links

International Urogynecological Association

[1] Kelly HA. Medical Gynecology. New York: Appleton, 1908.

[2] Hugh H. Young

[3] Young HH. A Surgeon's Autobiography. New York: Harcourt, 1940.

[urlGynecology_at_Mayo_Clinic_in_Arizona-4] Mayo Clinic, Gynecology at Mayo Clinic in Arizona, retrieved 14 August 2010

[1]

[2]

[3]

[4]

@@ Line 1: / Line 1: @@
+{{Short description|Sub-specialty of urology and gynecology}}
-{{db-copyvio|url=http://www.urogynecology.in/UIIntro.asp}}
+{{Infobox Occupation
-{{hangon}}
+| name= Urogynecologist
+| image=
+| caption=
+| official_names= Doctor, Medical Specialist, Surgeon
+<!------------Details------------------->
+| type= [[Gynecology]], [[Urology]], [[Specialty (medicine)|Specialty]], [[Surgery]]
+| activity_sector= [[Medicine]], [[Surgery]]
+| competencies= Patient Care, Education, Research
+| formation=
+*[[Doctor of Medicine]] (MD)
+*[[Doctor of Osteopathic Medicine]] (DO)
+*[[Bachelor of Medicine, Bachelor of Surgery]] (MBBS/MBChB)
+| employment_field= [[Hospital]]s, [[Clinic]]s
+| related_occupation=  [[Gynecologist]], [[Urologist]]}}
+'''Urogynecology''' or '''urogynaecology''' is a surgical sub-specialty of [[urology]] and [[gynecology]].
+==History==
-'''Urogynecology''' is a surgical sub-specialty of urology and gynecology.
+In 1893, [[Howard Atwood Kelly|Howard Kelly]], a gynecologist and pioneering urogynecologist, invented an air [[cystoscope]] which was simply a handheld, hollow tube with a glass partition.<ref>[[Howard Atwood Kelly|Kelly HA.]] Medical Gynecology. New York: Appleton, 1908.</ref> When the American Surgical Society, later the [[American College of Surgeons]], met in Baltimore in 1900, a contest was held between [[Howard Atwood Kelly|Howard Kelly]] and [[Hugh H. Young|Hugh Hampton Young]], who is often considered the father of modern urology.<ref>[[Hugh H. Young]]</ref> Using his air cystoscope, Kelly inserted ureteral catheters in a female patient in just 3 minutes. Young equaled this time in a male patient.<ref>[[Hugh H. Young|Young HH.]] A Surgeon's Autobiography. New York: Harcourt, 1940.</ref> So began the friendly competitive rivalry between gynecologists and urologists in the area of female urology and urogynecology. This friendly competition continued for decades. In modern times, the mutual interest of obstetricians, gynecologists, and urologists in pelvic floor problems in women has led to a more collaborative effort.
-==Education==
+==Education and training==
+Urogynecologists are medical professionals who have been to medical school and achieved their basic medical degree, followed by postgraduate training in Obstetrics and Gynaecology (OB-GYN).  They then undertake further training in Urogynecology to achieve accreditation/board certification in this subspecialty. Training programme requirements and duration varies from country to country but usually tend to be around 2–3 years in most places. Urogynaecology fellowship programmes are available in some countries, but not all and the levels of formal accreditation and certification vary from country to country.
-Physicians who practice this sub-specialty usually do a fellowship in urogynecology after completing a residency in urology or obstetrics and gynecology.
+The International Urogynecological Association (IUGA) is a global body for professionals practising in the field of urogynaecology and female pelvic medicine and reconstructive surgery.  IUGA facilitates training for physicians from countries which do not have formal training programmes by maintaining and publishing a directory of fellowship programmes. IUGA also  provides educational opportunities for urogynecologists both online and in-person, develops terminology and standardization for the field. The International Continence Society (ICS) is another global organization which strives to improve the quality of life for people affected by urinary, bowel and pelvic floor disorders through education, and research.
 ==Scope of practice==
+Urogynecology is a sub-specialty of Gynecology, and in some countries is also known as Female Pelvic Medicine and Reconstructive Surgery.  A urogynecologist manages clinical problems associated with dysfunction of the pelvic floor and bladder.  Pelvic floor disorders affect the bladder, reproductive organs, and bowels.  Common pelvic floor disorders include urinary incontinence, pelvic organ prolapse and fecal incontinence.  Increasingly, Urogynecologists are also responsible for the care of women who have experienced trauma to the perineum during childbirth.
-Urogynecology involves the diagnosis and treatment of urinary incontinence and female pelvic floor disorders.
+There is some crossover with the subspecialty of Female Urology - these doctors are urologists who undergo additional training to be able to manage female urinary incontinence, pelvic organ prolapse and interstitial cystitis/PBS.  In addition, there are colorectal surgeons who have a special interest in anal incontinence and pelvic floor dysfunction related to rectal function.  Contemporary urogynecological practice encourages multidisciplinary teams working in the care of patients, with collaborative input from urogynecologists, urologists, colorectal surgeons, [[elderly care]] physicians, and physiotherapists.  This is especially important in the care of patients with complex problems, e.g. those who have undergone previous surgery or who have combined incontinence and prolapse, or combined urinary and bowel problems.  Multidisciplinary team meetings are an important part of the management pathway of these women.
+Urogynaecologists manage women with urinary incontinence and pelvic floor dysfunction.  The clinical conditions that a urogynecologist may see include stress incontinence, overactive bladder, voiding difficulty, bladder pain, urethral pain, vaginal or uterine prolapse, obstructed defecation, anal incontinence, and perineal injury.  They may also care for women with [[vesicovaginal fistula|vesicovaginal]] or rectovaginal fistulae with specialist training, and in conjunction with other specialties.
+Patients will usually be assessed using a combination of history taking, examination (including pelvic examination and assessment of prolapse using validated systems such as the [[Pelvic Organ Prolapse Quantification System]] and assessment of quality of life impact using validated questionnaires, including the assessment of sexual function, using Pelvic Organ Prolapse/Incontinence Sexual Questionnaire IUGA- Revised [PISQ-IR].  A bladder diary is often used to quantify an individual's fluid intake, and the number of voids per day and night, as well as the volume the bladder can hold on a day-to-day basis.  Further investigations might include urodynamics or a cystoscopy.  Treatment usually starts with conservative measures such as pelvic floor muscle training, fluid and food modification or bladder training.  Drug therapies can be used for overactive bladder, which may include antimuscarinic drugs or beta 3 receptor agonists - both of these help to control the urgency that is the key component of overactive bladder. If medications fail, more invasive options such as injections of botulinum toxin into the bladder muscle, or neuromodulation are other options for symptom relief.  Surgical treatments can be offered for stress incontinence and/or uterovaginal prolapse if pelvic floor muscle training is unsuccessful.
+Urogynecological problems are seldom life-threatening, but they do have a major impact on the quality of life of affected individuals.  Urogynecologists will usually use quality of life improvement as a treatment goal, and there is a major focus on optimising symptoms using conservative measures before embarking on more invasive treatments.
+Some conditions treated in urogynecology practice include:<ref name="urlGynecology at Mayo Clinic in Arizona">{{Citation |url=http://www.mayoclinic.org/gynecology-sct/ |title=Gynecology at Mayo Clinic in Arizona |author=Mayo Clinic |access-date=14 August 2010}}</ref>
+*[[Cystocele]]
+*[[Enterocele]]
+*[[Female genital prolapse]]
+*[[Fecal incontinence]]
+*[[Urinary incontinence]]
+*[[Interstitial cystitis]]
+*[[Lichen planus]]
+*[[Lichen sclerosus]]
+*[[Müllerian agenesis]]
+*[[Overactive bladder]]
+*[[Painful intercourse]]
+*[[Pelvic organ prolapse]]
+*[[Rectocele]]
+*[[Rectovaginal fistula]]
+*Recurrent [[urinary tract infection]]s
+*[[Urinary incontinence]]
+*[[Urinary retention]]
+*[[Vaginal agenesis]]
+*[[Vaginal septum]]
+*[[Vesicocutaneous fistula]]
+*[[Vesicouterine fistula]]
+*[[Vesicovaginal fistula]]
+*[[Voiding difficulties]]
+Diagnostic tests and procedures performed include:<ref name="urlGynecology at Mayo Clinic in Arizona"/>
+*[[Cystourethroscopy]]
+*[[Urodynamic testing]]
+*[[Ultrasound]]
+Specialty treatments available include:<ref name="urlGynecology at Mayo Clinic in Arizona"/>
-'''UROGYNECOLOGY INDIA'''
+*[[abdominal surgery|Abdominal reconstruction]]
+*[[Behavioral modification]]
+*[[Biofeedback]]
+*[[botox|Botulinum toxin injection]]
+*[[Dietary modification]]
+*[[Fascial grafts]]
+*[[laparoscopic surgery|Laparoscopic reconstruction]]
+*[[Medications]]
+*[[kegel exercise|Pelvic floor re-education]]
+*[[Pessary]] (for prolapse and incontinence)
+*[[Pubovaginal slings]]
+*[[Relaxation techniques]]
+*[[robotic surgery|Robotic reconstruction]]
+*[[Sacral nerve stimulation]]
+*[[stress incontinence#Peri/trans urethral injections|Urethral injections]]
+*[[Urethral reconstruction]]
+*[[Urge suppression drills]]
+*[[Vaginal reconstruction]]
+==See also==
-"There is no more distressing lesion than urinary incontinence-A constant dribbling of the repulsive urine soaking the clothes which cling wet and cold to the thighs, making the patient offensive to herself and her family and ostracizing her from society"  –  Howard A.Kelly, M.D,1928
+*[[J. Marion Sims]]{{spaced ndash}}father of American [[gynecology]]. Best known for repairing [[vesicovaginal fistula]]s.
-Disorders of the bladder and bowel as well as sexual dysfunction are common in adult women. While most of these ailments are not life threatening, they severely impair Quality of life (QOL) in the affected. As the aging population grows, thanks to advances in health care, prevalence of pelvic organ dysfunction also increases. Women are increasingly less willing to accept incontinence or prolapse as a normal part of ageing Expectations for a high quality of life, have led to greater public awareness and help seeking behaviour among women in the west.   Sadly, these social albeit health issues are swept under the bed in our country.
+*[[Howard Atwood Kelly]]{{spaced ndash}}famous American gynecologist.
-Why talk about a new specialty now? Well, demographics of our current population trends reveal a staggering 25-70% of adult women suffering from urinary incontinence and a further 20% from genital prolapse. Also 11% have a lifetime risk of undergoing surgery for either prolapse or incontinence and of these 30% will have a second surgery within three years. The population of middle aged women amongst whom these problems are common is also on the rise. A new speciality was definitely on the cards to address these issues.
-Coexistence of dysfunction of urinary and bowel control is a well established fact and hence treating pelvic floor problems was a challenge. Traditionally, clinicians who address these problems are Urologists, Gynecologists or Colorectal surgeons. Fragmentation of health care duties among these specialists led to significant gaps in providing comprehensive treatment for pelvic floor dysfunction. This led to patients being subjected to serial surgeries because of lack of identification of problems in an adjacent organ system of the pelvic floor. To give an example:   A woman who has uterine descent could also have urinary leakage which involved the bladder.   The subspecialty of Urogynecology and Pelvic Reconstructive Surgery was born out of the necessity to address these issues comprehensively.
-Having substantiated the need for Urogynecology it is important to note that a pelvic floor team is required to address all pelvic floor problems. A Colorectal surgeon, A Sexual dysfunction specialist, A Gastroenterologist, A Physiotherapist and A Continence nurse are all part of the pelvic floor team.
-Urinary incontinence and or pelvic organ prolapse greatly impair quality of life and should not be tolerated as a normal process of aging. Women should come out of the closet and seek help, as this wonderful speciality is now available.
+==References==
-GAURI (Guna Associates in Urogynecology & Research for Incontinence) is the first continence and pelvic health centre in India. At GAURI, you can find the help you need for yourself or a loved one. The centre offers state-of-the-art care for women with bladder control and support problems, including all resources necessary for effective diagnosis and treatment. The expert staff at the continence centre specialize in medical, non-invasive and minimally invasive management of urinary and faecal incontinence. Consultations and second opinions are provided, along with testing of bladder dysfunction problems.
+{{Reflist}}
+==External links==
-Following diagnosis, the center offers non-surgical as well as surgical treatment options in its urogynecology / reconstructive pelvic surgery clinic. Treatment options range from effective new medications to pelvic floor physiotherapy including biofeedback, collagen injections, sling procedures and grafts for advanced pelvic organ prolapse.
+* [http://www.iuga.org International Urogynecological Association]
+{{Medicine}}
-The centre's physicians participate in multiple clinical research studies, facilitating access to the latest technology and up-to-the-minute medical information within the urogynecology field. Most surgeries are performed on an outpatient basis at the centre.
+{{Authority control}}
+[[Category:Urology]]
-[http://www.urogynecology.in gauri india link]
+[[Category:Gynaecology]]
+[[Category:Surgical specialties]]