Manual on Urogynecology Suchitra N Pandit, Rajendra Nagarkatti, Mukesh Gupta, Vineet Mishra
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What is Urogynecology?Chapter 1

Suchitra N. Pandit,
Rajendra Nagarkatti
 
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.4
 
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.5
 
Scope of Practice
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-2
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”9 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;10 one in twenty adult women have depression;11 one in ten adult women have diabetes;12 and, more than one in two adult women suffer from pelvic floor dysfunction.13
Some conditions treated in urogynecology practice include14:
  • Cystocele, Enterocele & Rectocele
  • Female genital prolapse
  • Pelvic organ prolapse
  • Fecal incontinence & Urinary incontinence
  • Interstitial cystitis
  • Lichen planus & Lichen sclerosus
  • Overactive bladder
  • Painful intercourse
  • Recurrent urinary tract infections
  • Urinary incontinence
  • Urinary retention
  • Müllerian agenesis
  • Rectovaginal fistula
  • Vaginal agenesis
  • Vaginal septum
  • Vesicocutaneous fistula, Vesicouterine fistula & Vesicovaginal fistula
  • Voiding difficulties
Diagnostic tests and procedures performed include14:
  • Cystourethroscopy
  • Urodynamic testing
  • Ultrasound
Specialty treatments available include14:
  • Abdominal & Laparoscopic reconstruction
  • Behavioral modification & Biofeedback
  • Urge suppression drills
  • Dietary modification
  • Fascial grafts
  • Medications
  • Pelvic floor re-education & Relaxation techniques
  • Pessary (for prolapse and incontinence)
  • Pubovaginal slings
  • Robotic reconstruction
    3
  • Sacral nerve stimulation
  • Botulinum toxin injection
  • Urethral injections
  • Urethral reconstruction
  • Vaginal reconstruction
 
Suggested Reading
  • J. Marion Sims – father of American gynecology. Best known for repairing vesicovaginal fistulas.
  • Howard Atwood Kelly – famous American gynecologist.
REFERENCES
  1. Kelly HA. Medical Gynecology. Appleton,  New York:  1908.
  1. Hugh H. Young
  1. Young HH. A Surgeon's Autobiography. Harcourt,  New York:  1940.
  1. 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
  1. American Urogynecologic Society, What is a Urogynecologist?, retrieved 2010-08-12
  1. Urogynecology Associates, Urogynecology Associates Fellowship Program, retrieved 2010-08-13
  1. American Board of Obstetrics and Gynecology (January, 2010), Accredited Female Pelvic Medicine and Reconstructive Surgery Fellowships, retrieved 2010-08-12
  1. The International Urogynecological Association (June, 2009), Urogynecology Fellowship Training Program Directory, retrieved 2010-08-13 Requires Paid Subscription
  1. Howard Atwood Kelly, M.D, 1928
  1. American Heart Association (2006), High Blood Pressure Statistics, retrieved 2010-08-14
  1. Center for Disease Control and Prevention (CDC) (September 2008), Depression in the United States Household Population, 2005-2006, retrieved 2010-08-14
  1. American Diabetes Association (2007), Diabetes Statistics, retrieved 2010-08-14
  1. 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
  1. a b c Mayo Clinic, Gynecology at Mayo Clinic in Arizona, retrieved 2010-08-14