Tuesday, March 11, 2008

What is Female Urology?

This is a good question. For a long time prior to the entrance of women physicians into the field of Urology, a "Female Urologist" was a urologist who dealt with female urological problems, such as urinary incontinence, bladder prolapse, recurrent urianry tract infections, bladder pain, and voiding dysfunction. In some regard, the subspecialty of Female Urology is akin to Urogynecology. Similarities exist and there are some differences.

Urologists graduate from a usualy a 5 or 6 year surgical traininf program after medical school. Usually it is 1 or 2 years of general surgery training and then 4 years of Urology. In addition, after completion of residency, 1 or 2 years of fellowship training is undertaken in the subspeciaty of Female Urology. These programs focus mainly on incontinence, treating complications, complex urodynamic evaluation, prolapse repair with an emphasis on research and publication.

Gynecologists graduate from a 4 year training program. Those that wish to subspecialize under take a urogynecology fellowship that is typically 3 years. They also focus on incontinence, complications, and prolapse.

Fellowships differ widely depending on the interest and focus of the program director, whether urology or gynecology. Certain programs incorporate some technologies or techniques that others don't. Most of us attend the same academic meetings to keep up on the lastest advances and research.

In my practice I incorporate the use of mesh or grafts in order to bolster pelvic prolapse repair such as cystocele, vault repair or rectocele. Often when not used, cystocele will fail approximately 30% by 3 years. Conversely, despite the success of mesh, it can lead to nonhealing in 6-20% depending on the mesh, the surgery and the surgeon. Some pelvic surgeons will use such grafts but many don't. Surgeon comfort level is also important, that is, can the surgeon use such a product well.

Urologists have the advantage of dealing with the bladder from early in training. Treating bladder injury, dysfunction, removal or replacement are standard things learned in training. Gynecologists operate on the vagina and perform hysterectomies. Our two subspecialties crossover somewhere in the middle. In my fellowship I operated with a urogynecologist at least once a week.

Recurrent urinary tract infections, hematuria (blood in the urine), complex voiding dysfunction (as a result of radiation, surgery, or neurological injury), and non-obstructive urinary retention are best dealt with by a urologist who can repair/reconstruct the bladder, urethra, ureters, and remove such organs if required. All things considered, incontinence and prolapse treatment is often the most fun part of Female Urology, and is very often successful if done well by the well-trained pelvic surgeon.

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