Urogynecology or urogynaecology is a surgical sub-specialty of
urology
Urology (from Greek οὖρον ''ouron'' "urine" and '' -logia'' "study of"), also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary-tract system and the reproductive org ...
and
gynecology
Gynaecology or gynecology (see spelling differences) is the area of medicine that involves the treatment of women's diseases, especially those of the reproductive organs. It is often paired with the field of obstetrics, forming the combined are ...
.
History
In 1893,
Howard Kelly Howard Kelly may refer to:
* Howard Kelly (Royal Navy officer) - (1873-1952) Royal Navy admiral
* Howard Atwood Kelly
Howard Atwood Kelly (February 20, 1858 – January 12, 1943) was an American gynecologist. He obtained his B.A. degree and M.D ...
, a gynecologist and pioneering urogynecologist, invented an air
cystoscope
Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.
The urethra is the tube that carries urine from the bladder to the outside of the body.
The cystoscope has lenses like a telescope or microscope ...
which was simply a handheld, hollow tube with a glass partition. When the American Surgical Society, later the
American College of Surgeons
The American College of Surgeons is an educational association of surgeons created in 1913.American College of Surgeons Online "What is the American College of Surgeons?"/ref>
See also
*American College of Physicians
The American College o ...
, met in Baltimore in 1900, a contest was held between
Howard Kelly Howard Kelly may refer to:
* Howard Kelly (Royal Navy officer) - (1873-1952) Royal Navy admiral
* Howard Atwood Kelly
Howard Atwood Kelly (February 20, 1858 – January 12, 1943) was an American gynecologist. He obtained his B.A. degree and M.D ...
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.
[ Young HH. A Surgeon's Autobiography. New York: Harcourt, 1940.] 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
Elderly care, or simply eldercare (also known in parts of the English-speaking world as aged care), serves the needs and requirements of senior citizens. It encompasses assisted living, adult daycare, long-term care, nursing homes (often called re ...
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
The Pelvic Organ Prolapse Quantifications System (POP-Q) is a system for assessing the degree of prolapse of pelvic organs to help standardize diagnosing, comparing, documenting, and sharing of clinical findings. This assessment is the most frequ ...
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
ISQ-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:
*
Cystocele
A cystocele, also known as a prolapsed bladder, is a medical condition in which a woman's bladder bulges into her vagina. Some may have no symptoms. Others may have trouble starting urination, urinary incontinence, or frequent urination. Complicat ...
*
Enterocele
An enterocele is a protrusion of the small intestines and peritoneum into the vaginal canal.
It may be treated transvaginally or by laparoscopy.
An enterocele may also obstruct the rectum, leading to symptoms of obstructed defecation. Enteroceles ...
*
Female genital prolapse
Pelvic organ prolapse (POP) is characterized by descent of pelvic organs from their normal positions. In women, the condition usually occurs when the pelvic floor collapses after gynecological cancer treatment, childbirth or heavy lifting.
In me ...
*
Fecal incontinence
Fecal incontinence (FI), or in some forms encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents, both liquid stool elements and mucus, or solid feces. When this loss includes flatus (gas), it is referred ...
*
Urinary incontinence
Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It has been identified as an important issue in geria ...
*
Interstitial cystitis
Interstitial cystitis (IC), a type of bladder pain syndrome (BPS), is chronic pain in the bladder and pelvic floor of unknown cause. It is the urologic chronic pelvic pain syndrome of women. Symptoms include feeling the need to urinate right awa ...
*
Lichen planus
Lichen planus (LP) is a chronic inflammatory and immune-mediated disease that affects the skin, nails, hair, and mucous membranes. It is not an actual lichen, and is only named that because it looks like one. It is characterized by polygonal, fla ...
*
Lichen sclerosus
Lichen sclerosus (LS) is a chronic, inflammatory skin disease of unknown cause which can affect any body part of any person but has a strong preference for the genitals (penis, vulva) and is also known as balanitis xerotica obliterans (BXO) when ...
*
Müllerian agenesis
Müllerian agenesis, also known as Müllerian aplasia, vaginal agenesis, or Mayer-Rokitansky-Küster-Hauser syndrome (MRKH syndrome), is a congenital malformation characterized by a failure of the Müllerian ducts to develop, resulting in a missi ...
*
Overactive bladder
Overactive bladder (OAB) is a condition where there is a frequent feeling of needing to urinate to a degree that it negatively affects a person's life. The frequent need to urinate may occur during the day, at night, or both. If there is loss ...
*
Painful intercourse
Dyspareunia ( ) is painful sexual intercourse due to medical or psychological causes. The term ''dyspareunia'' covers both female dyspareunia and male dyspareunia, but many discussions that use the term without further specification concern the f ...
*
Pelvic organ prolapse
Pelvic organ prolapse (POP) is characterized by descent of pelvic organs from their normal positions. In women, the condition usually occurs when the pelvic floor collapses after gynecological cancer treatment, childbirth or heavy lifting.
In me ...
*
Rectocele
In gynecology, a rectocele ( ) or posterior vaginal wall prolapse results when the rectum bulges ( herniates) into the vagina. Two common causes of this defect are childbirth and hysterectomy. Rectocele also tends to occur with other forms of pel ...
*
Rectovaginal fistula
A rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina.
Rectovaginal fistulae may be extremely debilitating. If the opening between the rectum and vagina is wide it will allo ...
*Recurrent
urinary tract infection
A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidney ...
s
*
Urinary incontinence
Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It has been identified as an important issue in geria ...
*
Urinary retention
Urinary retention is an inability to completely empty the bladder. Onset can be sudden or gradual. When of sudden onset, symptoms include an inability to urinate and lower abdominal pain. When of gradual onset, symptoms may include loss of bladd ...
*
Vaginal agenesis
Vaginal atresia is a condition in which the vagina is abnormally closed or absent. The main causes can either be complete vaginal hypoplasia, or a vaginal obstruction, often caused by an imperforate hymen or, less commonly, a transverse vaginal sep ...
*
Vaginal septum
A vaginal septum is a vaginal anomaly that is partition within the vagina; such a septum could be either longitudinal or transverse. In some affected women, the septum is partial or does not extend the length or width of the vagina. Pain during ...
*
Vesicocutaneous fistula
*
Vesicouterine fistula
Vesicouterine fistula refers to an abnormal communication between the bladder and uterus. The first case of vesicouterine fistula was reported in 1908. It was however first described in 1957 by Abdel Fattah Youssef, an obstetrician and gynaecolo ...
*
Vesicovaginal fistula
Vesicovaginal fistula (VVF) is a subtype of female urogenital fistula (UGF).
Presentation
Vesicovaginal fistula, or VVF, is an abnormal fistulous tract extending between the bladder ('' vesica'') and the vagina that allows the continuous involu ...
*
Voiding difficulties
Diagnostic tests and procedures performed include:
*
Cystourethroscopy
Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.
The urethra is the tube that carries urine from the bladder to the outside of the body.
The cystoscope has lenses like a telescope or microscope ...
*
Urodynamic testing
Urodynamic testing or urodynamics is a study that assesses how the bladder and urethra are performing their job of storing and releasing urine. Urodynamic tests can help explain symptoms such as:
* incontinence
* frequent urination
* sudden, stro ...
*
Ultrasound
Ultrasound is sound waves with frequency, frequencies higher than the upper audible limit of human hearing range, hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hea ...
Specialty treatments available include:
*
Abdominal reconstruction
*
Behavioral modification
Behavior modification is an early approach that used respondent and operant conditioning to change behavior. Based on methodological behaviorism, overt behavior was modified with consequences, including positive and negative reinforcement contin ...
*
Biofeedback
Biofeedback is the process of gaining greater awareness of many physiology, physiological functions of one's own body by using Electronics, electronic or other instruments, and with a goal of being able to Manipulation (psychology), manipulate t ...
*
Botulinum toxin injection
*
Dietary modification
In nutrition, diet is the sum of food consumed by a person or other organism.
The word diet often implies the use of specific intake of nutrition for health or weight-management reasons (with the two often being related). Although humans are o ...
*
Fascial grafts
*
Laparoscopic reconstruction
*
Medications
A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and rel ...
*
Pelvic floor re-education
*
Pessary
A pessary is a prosthetic device inserted into the vagina for structural and pharmaceutical purposes. It is most commonly used to treat Stress incontinence, stress urinary incontinence to stop urinary leakage and to treat pelvic organ prolapse to ...
(for prolapse and incontinence)
*
Pubovaginal slings
*
Relaxation techniques
A relaxation technique (also known as relaxation training) is any method, process, procedure, or activity that helps a person to relax; to attain a state of increased calmness; or otherwise reduce levels of pain, anxiety, stress or anger. Relax ...
*
Robotic reconstruction
*
Sacral nerve stimulation
Sacral nerve stimulation, also termed sacral neuromodulation, is a type of medical electrical stimulation therapy.
It typically involves the implantation of a programmable stimulator subcutaneously, which delivers low amplitude electrical sti ...
*
Urethral injections
*
Urethral reconstruction
*
Urge suppression drills
*
Vaginal reconstruction
Vaginoplasty is any surgical procedure that results in the construction or reconstruction of the vagina. It is a type of genitoplasty. Pelvic organ prolapse is often treated with one or more surgeries to repair the vagina. Sometimes a vaginoplas ...
See also
*
J. Marion Sims
James Marion Sims (January 25, 1813November 13, 1883) was an American physician in the field of surgery. His most famous work was the development of a surgical technique for the repair of vesicovaginal fistula, a severe complication of obstruc ...
father of American
gynecology
Gynaecology or gynecology (see spelling differences) is the area of medicine that involves the treatment of women's diseases, especially those of the reproductive organs. It is often paired with the field of obstetrics, forming the combined are ...
. Best known for repairing
vesicovaginal fistula
Vesicovaginal fistula (VVF) is a subtype of female urogenital fistula (UGF).
Presentation
Vesicovaginal fistula, or VVF, is an abnormal fistulous tract extending between the bladder ('' vesica'') and the vagina that allows the continuous involu ...
s.
*
Howard Atwood Kelly
Howard Atwood Kelly (February 20, 1858 – January 12, 1943) was an American gynecologist. He obtained his B.A. degree and M.D. degree from the University of Pennsylvania. He, William Osler, William Halsted, and William Welch together are known ...
famous American gynecologist.
References
External links
International Urogynecological Association
{{Authority control
Urology
Gynaecology
Surgical specialties