Urogynecology
Encyclopedia
Urogynecology or urogynaecology is a surgical sub-specialty of urology
and gynecology.
, 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. Using his air cystoscope, Kelly inserted ureteral catheters in a female patient in just 3 minutes. Young equaled this time in a male patient. 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.
A few practitioners have completed a board-accredited fellowship
in female pelvic medicine and reconstructive surgery after completing a residency in urology
or obstetrics
and gynecology. The first fellowship received accreditation in 1996. As of January 2010, there were 30 fellowship programs approved by both the American Board of Obstetrics and Gynecology http://www.abog.org and the American Board of Urology
http://www.abu.org. 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.
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" 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; one in twenty adult women have depression; one in ten adult women have diabetes; and, more than one in two adult women suffer from pelvic floor dysfunction.
Some conditions treated in urogynecology practice include:
Diagnostic tests and procedures performed include:
Specialty treatments available include:
Urology
Urology is the medical and surgical specialty that focuses on the urinary tracts of males and females, and on the reproductive system of males. Medical professionals specializing in the field of urology are called urologists and are trained to diagnose, treat, and manage patients with urological...
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. When the American Surgical Society, later the American College of SurgeonsAmerican College of Surgeons
The American College of Surgeons is an educational association of surgeons created in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice.-Membership:...
, 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. Using his air cystoscope, Kelly inserted ureteral catheters in a female patient in just 3 minutes. Young equaled this time in a male patient. 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
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 a four-year residency in obstetrics and gynecology and female urologists have completed medical school and a five-year residency in urology. These doctors 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.A few practitioners have completed a board-accredited fellowship
Fellowship (medicine)
A fellowship is the period of medical training in the United States and Canada that a physician may undertake after completing a specialty training program . During this time , the physician is known as a fellow...
in female pelvic medicine and reconstructive surgery after completing a residency in urology
Urology
Urology is the medical and surgical specialty that focuses on the urinary tracts of males and females, and on the reproductive system of males. Medical professionals specializing in the field of urology are called urologists and are trained to diagnose, treat, and manage patients with urological...
or obstetrics
Obstetrics
Obstetrics is the medical specialty dealing with the care of all women's reproductive tracts and their children during pregnancy , childbirth and the postnatal period...
and gynecology. The first fellowship received accreditation in 1996. As of January 2010, there were 30 fellowship programs approved by both the American Board of Obstetrics and Gynecology http://www.abog.org and the American Board of Urology
Urology
Urology is the medical and surgical specialty that focuses on the urinary tracts of males and females, and on the reproductive system of males. Medical professionals specializing in the field of urology are called urologists and are trained to diagnose, treat, and manage patients with urological...
http://www.abu.org. 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.
Scope of practice
Urogynecology involves the diagnosis and treatment of urinary incontinenceUrinary incontinence
Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...
and female pelvic floor
Pelvic floor
The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the levatores ani and coccygei, with which may be included the...
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" 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; one in twenty adult women have depression; one in ten adult women have diabetes; and, more than one in two adult women suffer from pelvic floor dysfunction.
Some conditions treated in urogynecology practice include:
- CystoceleCystoceleA cystocele is a medical condition that occurs when the tough fibrous wall between a woman's bladder and her vagina is torn by childbirth, allowing the bladder to herniate into the vagina. Urethroceles often occur with cystoceles....
- EnteroceleEnteroceleAn enterocele is a protrusion of the small intestines and peritoneum into the vaginal canal.It may be treated transvaginally or by laparoscopy....
- Female genital prolapse
- Fecal incontinenceFecal incontinenceFecal incontinence is the loss of regular control of the bowels. Involuntary excretion and leaking are common occurrences for those affected. Subjects relating to defecation are often socially unacceptable, thus those affected may be beset by feelings of shame and humiliation...
- IncontinenceIncontinenceIncontinence or Incontinent may refer to:*Fecal incontinence, the inability to control one's bowels*Incontinence *Incontinent , a 1981 album by Fad Gadget*Urinary incontinence, the involuntary excretion of urine...
(fecalFecal incontinenceFecal incontinence is the loss of regular control of the bowels. Involuntary excretion and leaking are common occurrences for those affected. Subjects relating to defecation are often socially unacceptable, thus those affected may be beset by feelings of shame and humiliation...
and urinaryUrinary incontinenceUrinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...
) - Interstitial cystitisInterstitial cystitisInterstitial cystitis or bladder pain syndrome is a chronic, oftentimes severely debilitating disease of the urinary bladder...
- Lichen planusLichen planusLichen planus is a chronic mucocutaneous disease that affects the skin, tongue, and oral mucosa. The disease presents itself in the form of papules, lesions, or rashes. Lichen planus does not involve lichens, the fungus/algae symbionts that often grow on tree trunks; the name refers to the dry and...
- Lichen sclerosusLichen sclerosusLichen sclerosus is an uncommon disease of unknown cause that results in white patches on the skin, which may cause scarring on and around genital skin....
- Müllerian agenesisMullerian agenesisMüllerian agenesis is a congenital malformation in women characterised by a failure of the müllerian ducts to develop, resulting in a missing uterus and fallopian tubes and variable malformations of the upper portion of the vagina. It is the second most common cause of primary amenorrhea after...
- Overactive bladderOveractive bladderOveractive bladder is a urological condition defined by a set of symptoms: urgency, with or without urge incontinence, usually with frequency and nocturia. Frequency is usually defined as urinating more than 8 times a day. The International Continence Society is responsible for this definition...
- Painful intercourse
- Pelvic organ prolapse
- RectoceleRectoceleA rectocele results from a tear in the rectovaginal septum . Rectal tissue bulges through this tear and into the vagina as a hernia...
- Rectovaginal fistulaRectovaginal fistulaA rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina. Rectovaginal fistula may be extremely debilitating. If the opening between the rectum and vagina is wide it will allow both flatulence and feces to escape through the...
- Recurrent urinary tract infectionUrinary tract infectionA urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...
s - Urinary incontinenceUrinary incontinenceUrinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...
- Urinary retentionUrinary retentionUrinary retention, also known as ischuria, is a lack of ability to urinate. It is a common complication of benign prostatic hyperplasia , although it can also be caused by nerve dysfunction, constipation, infection, or medications...
- Vaginal agenesis
- Vaginal septumVaginal septumA vaginal septum is a congenital partition within the vagina; such a septum could be either longitudinal or transverse.-Longitudinal septum – double vagina:...
- Vesicocutaneous fistula
- Vesicouterine fistula
- Vesicovaginal fistulaVesicovaginal fistulaVesicovaginal fistula is a subtype of female urogenital fistula .-Presentation:VVF is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault....
- Voiding difficulties
Diagnostic tests and procedures performed include:
- Cystourethroscopy
- Urodynamic testingUrodynamic testingUrodynamic testing refers to the process of performing urodynamics. Urodynamics is a study that assesses how the bladder and urethra are performing their job of storing and releasing urine...
- UltrasoundUltrasoundUltrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...
Specialty treatments available include:
- Abdominal reconstructionAbdominal surgeryThe term abdominal surgery broadly covers surgical procedures that involve opening the abdomen. Surgery of each abdominal organ is dealt with separately in connection with the description of that organ Diseases affecting the abdominal cavity are dealt with generally under their own names The term...
- Behavioral modification
- BiofeedbackBiofeedbackBiofeedback is the process of becoming aware of various physiological functions using instruments that provide information on the activity of those same systems, with a goal of being able to manipulate them at will...
- Botulinum toxin injection
- Dietary modification
- Fascial grafts
- Laparoscopic reconstructionLaparoscopic surgeryLaparoscopic surgery, also called minimally invasive surgery , bandaid surgery, or keyhole surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions as opposed to the larger incisions needed in laparotomy.Keyhole surgery makes use of images...
- Medications
- Pelvic floor re-educationKegel exerciseA pelvic floor exercise, more commonly called a Kegel exercise , consists of contracting and relaxing the muscles that form part of the pelvic floor, which are now sometimes colloquially referred to as the "Kegel muscles". Several tools exist to help with these exercises, though many are ineffective...
- PessaryPessaryA pessary is a small plastic or silicone medical device which is inserted into the vagina or rectum and held in place by the pelvic floor musculature. - Therapeutic pessaries :...
(for prolapse and incontinence) - Pubovaginal slings
- Relaxation techniques
- Robotic reconstructionRobotic surgeryRobotic surgery, computer-assisted surgery, and robotically-assisted surgery are terms for technological developments that use robotic systems to aid in surgical procedures....
- Sacral nerve stimulationSacral nerve stimulationSacral nerve stimulation, also termed sacral neuromodulation, involves the implantation of a programmable stimulator subcutaneously which delivers low amplitude electrical stimulation via a lead to the sacral nerve, usually accessed via the S3 foramen....
- Urethral injections
- Urethral reconstruction
- Urge suppression drills
- Vaginal reconstruction
See Also
- J. Marion SimsJ. Marion SimsJ. Marion Sims, born James Marion Sims was a surgical pioneer, considered the father of American gynecology. Modern historians argue about his legacy as Sims used slaves as experimental subjects.-Early career:...
father of American gynecology. Best known for repairing vesicovaginal fistulaVesicovaginal fistulaVesicovaginal fistula is a subtype of female urogenital fistula .-Presentation:VVF is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault....
s. - Howard Atwood KellyHoward Atwood KellyHoward Atwood Kelly was an American gynecologist. He was one of the "Big Four" founding professors at Johns Hopkins Hospital. Howard Atwood Kelly (February 20, 1858 – January 12, 1943) was an American gynecologist. He was one of the "Big Four" founding professors at Johns Hopkins Hospital....
famous American gynecologist.