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}}
 {{Infobox Occupation
 | name= Urogynecologist
@@ Line 8: / Line 9: @@
 | activity_sector= [[Medicine]], [[Surgery]]
 | competencies= Patient Care, Education, Research
-| formation= [[Doctor of Medicine]], [[Doctor of Osteopathic Medicine]]
+| 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]]}}
@@ Line 14: / Line 18: @@
 ==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.<ref>[[Howard Kelly|Kelly HA.]] Medical Gynecology. New York: Appleton, 1908.</ref> When the American Surgical Society, later the [[American college of surgeons|American College of Surgeons]], met in Baltimore in 1900, a contest was held between [[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.<ref>Delancey JO. Current status of the subspecialty of female pelvic medicine and reconstructive surgery. American journal of obstetrics and gynecology (2010) vol. 202 (6) pp. 658.e1-4</ref>
+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 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.
-Gynecologists who practice this sub-specialty are called urogynecologists and urologists who practice this sub-specialty are called female urologists. In the United States, urogynecologists have completed medical school and at least a four-year residency in obstetrics and gynecology and female urologists have completed medical school and at least a five-year residency in urology. However, many specialists also complete fellowship training after residency that can range from 1-3 years in length.  These physicians become specialists with additional training and experience in the evaluation and treatment of conditions that affect the female pelvic organs, and the muscles and connective tissue that support the organs. The additional training focuses on the surgical and non-surgical treatment of non-cancerous gynecologic problems.<ref name="urlWhat is a Urogynecologist?">{{Citation |url=http://www.mypelvichealth.org/ToolsforPatients/WhatisaUrogynecologist/tabid/140/Default.aspx |title=What is a Urogynecologist? |author=American Urogynecologic Society |accessdate=12 August 2010}}</ref>
+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.
-The subspecialty of Female Pelvic Medicine and Reconstructive Surgery obtained approval for board certification from the American Board of Medical Specialties in 2012, and in June 2013 practitioners will be taking the board certification exam in the subspecialty for the first time, meaning that there are very few board certified urogynecologists, such as [http://www.miklosandmoore.com/miklos.php Dr. John R. Miklos] and [http://www.miklosandmoore.com/moore.php Dr. Robert D. Moore]. Board certified urogynecologists' titles are followed by 'FPMRS' (Female Pelvic Medicine and Reconstructive Surgery) to reflect their status.   Some practitioners have completed a board-accredited [[fellowship (medicine)|fellowship]] in Urogynecology and Reconstructive Pelvic Surgery after completing a residency in [[Obstetrics]] and [[Gynecology]] or Urology. The first fellowship received accreditation in 1996.<ref name="urlUrogynecology Associates Fellowship Program">{{Citation |url=http://myurogyn.com/fellowship.htm |author=Urogynecology Associates |title=Urogynecology Associates Fellowship Program |accessdate=13 August 2010}}</ref>  As of January 2010, there were 30 fellowship programs approved by both the [[ABOG|American Board of Obstetrics and Gynecology]]<ref>http://www.abog.org</ref> and the [[urology|American Board of Urology]].<ref>http://www.abu.org</ref><ref name="Accredited Female Pelvic Medicine and Reconstructive Surgery Fellowships">{{Citation |url=http://abog.org/publications/FPMPROGS-1-10.pdf |title=Accredited Female Pelvic Medicine and Reconstructive Surgery Fellowships |date=January, 2010 |author=American Board of Obstetrics and Gynecology |accessdate=12 August 2010}}</ref> Additionally, qualified candidates may seek board certification for Female Pelvic Medicine and Reconstructive Surgery through the [[American Osteopathic Board of Obstetrics and Gynecology]] (AOBOG).<ref>{{cite web|title=Specialties & Subspecialties|url=http://www.osteopathic.org/inside-aoa/development/aoa-board-certification/Pages/specialty-subspecialty-certification.aspx|publisher=American Osteopathic Association|accessdate=25 September 2012}}</ref> These fellowships are three-years for obstetrician-gynecologists and two-years for urologists. Thus, the combined duration of training for female pelvic medicine and reconstructive surgery is seven years after medical school for both urologists and gynecologists. The International Urogynecology Journal publishes a listing of world-wide training programs.<ref name="urlUrogynecology Fellowship Training Program Directory">{{Citation |url=http://www.springerlink.com/content/0241526v6x675762/ |title=Urogynecology Fellowship Training Program Directory |date=June, 2009 |author=The International Urogynecological Association |accessdate=13 August 2010 Requires Paid Subscription}}</ref>
 ==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. Incontinence and pelvic floor problems are remarkably common but many women are reluctant to receive help because of the stigma associated with these conditions. "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"<ref>[[Howard Atwood Kelly]], M.D, 1928</ref> Although countless women are bothered by a loss of bladder control, bowel symptoms, and pelvic discomfort they are often not aware that these problems have a name much less how common they really are. Pelvic floor conditions are more common than hypertension, depression, or diabetes. One in three adult women have hypertension;<ref name="urlAmerican Heart Association High Blood Pressure Statistics">{{Citation |url=http://www.americanheart.org/presenter.jhtml?identifier=4621 |title=High Blood Pressure Statistics |year=2006 |author=American Heart Association |accessdate= 14 August 2010}}</ref> one in twenty adult women have depression;<ref name="urlDepression in the United States Household Population, 2005-2006">{{Citation |url=http://www.cdc.gov/nchs/data/databriefs/db07.htm |title=Depression in the United States Household Population, 2005-2006 |author=Center for Disease Control and Prevention (CDC) |date=September 2008 |accessdate=14 August 2010}}</ref> one in ten adult women have diabetes;<ref name="urlDiabetes Statistics">{{Citation |url=http://www.diabetes.org/diabetes-basics/diabetes-statistics/ |title=Diabetes Statistics |year=2007 |author=American Diabetes Association |accessdate=14 August 2010}}</ref> and, more than one in two adult women suffer from pelvic floor dysfunction.<ref>Goldberg et al. Delivery mode is a major environmental determinant of stress urinary incontinence: results of the Evanston-Northwestern Twin Sisters Study. Am J Obstet Gynecol (2005) vol. 193 (6) pp. 2149-53</ref>
+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.
-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 |accessdate=14 August 2010}}</ref>
+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]]
@@ Line 69: / Line 81: @@
 *[[robotic surgery|Robotic reconstruction]]
 *[[Sacral nerve stimulation]]
-*[[stress incontinence#Peri/Trans Urethral Injections|Urethral injections]]
+*[[stress incontinence#Peri/trans urethral injections|Urethral injections]]
 *[[Urethral reconstruction]]
 *[[Urge suppression drills]]
@@ Line 79: / Line 91: @@
 ==References==
+{{Reflist}}
-<references/>
 ==External links==
-* [http://www.augs.org American Urogynecologic Society]
+* [http://www.iuga.org International Urogynecological Association]
-* [http://abog.org/publications/FPMRSGUIDE03.pdf Guide to Learning in Female Pelvic Medicine and Reconstructive Surgery] (PDF) Retrieved 2010-08-12.
-*[http://www.iuga.org International Urogynecological Association]
-*[http://www.sufuorg.com Society for Urodynamics and Female Urology]
-* [http://www.miklosandmoore.com International Urogynecology Associates]
 {{Medicine}}
+{{Authority control}}
 [[Category:Urology]]
 [[Category:Gynaecology]]
 [[Category:Surgical specialties]]
-[[Category:Medical specialties]]