Urogynecology is a fairly new subspecialty and a fast-growing one, with increasing rates of pelvic floor disorders fueling a high demand for its services. In 1996, there was one board-accredited fellowship program for advanced training in urogynecology. By June 2010, according to the American Journal of Obstetrics and Gynecology, the number of accredited fellowship programs offered by leading academic institutions had grown to 37, and membership in societies associated with the sub-specialty had doubled.
Women affected by pelvic floor disorders such as stress urinary incontinence and pelvic organ prolapse are often referred to these specialists, as are women who are in need of specialized care for complications stemming from vaginal mesh procedures.
Training of a Urogynecologist
A urogynecologist is a physician who has completed medical school and a four-year residency in obstetrics and gynecology, and then gone on to receive additional, highly specialized training in surgical and non-surgical treatment of pelvic floor disorders. During that training, these physicians become specialists in the evaluation and treatment of health conditions that affect women’s pelvic organs, such as the vagina, uterus, rectum and bladder, as well as the pelvic floor, a structure made up of muscles, ligaments, nerves and connective tissues that supports pelvic organs and assists in the control of their functions.
Pelvic Floor Disorders
Pelvic floor disorders occur when the pelvic floor is weakened or stretched due to damage caused by childbirth, obesity, surgery, disease or activities such as high-impact sports or repetitive heavy lifting. Some of the most common problems women face due to pelvic floor disorders are urinary or fecal incontinence, pelvic or vaginal pain, difficulty emptying the bladder or bowels, and pelvic organ prolapse, which is the dropping of pelvic organs from their normal position.
Depending upon the severity of symptoms and the health of the patient, conservative, non-surgical therapies are often the first approach used in the treatment of pelvic floor disorders. These include medications, pelvic muscle exercise, lifestyle and dietary modifications, use of a vaginal support device called a pessary, biofeedback and electric stimulation of pelvic floor muscles. If these methods fail to provide adequate symptom improvement, surgery may be used to repair pelvic floor defects.
While many primary care physicians and gynecologists are knowledgeable about pelvic floor disorders, a urogynecologist holds an additional level of expertise in the treatment of these issues. Problems that may merit a referral to a urogynecologist include incontinence, emptying disorders, pelvic pain and sexual dysfunction. Patients who need surgery for the repair of pelvic floor disorders can benefit from seeing a urogynecologist, since their special expertise in vaginal surgery can minimize the risk of complications.
How Urogynecologists Help with Transvaginal Mesh Complications
Surgical procedures that use transvaginal mesh implants to repair pelvic floor disorders have been widely used — by urogynecologists and others — over the past decade. However, these synthetic mesh implants have proven problematic for a significant number of patients.
The U.S. Food and Drug Administration (FDA) received 2,874 adverse event reports associated with transvaginal mesh procedures in the three years between January 2008 and December 2010 — a fivefold increase from the previous three years. The most frequently reported complications include mesh erosion through the vagina, pain, bleeding, infection, organ perforation and urinary problems.
Mesh contraction was also reported, as well as neuro-muscular problems, vaginal scarring and shrinkage, recurrent prolapse and sexual dysfunction.
For many women suffering these complications, removal of the transvaginal mesh implant is necessary to restore health and quality of life. These difficult revision procedures are best handled by a urogynecologist. Mesh is intended to be a permanent surgical implant and can be very difficult to remove, since the body’s tissues grow into and around the implant. The skill and expertise brought to the table by a urogynecologist can increase the chances of successful revision surgery and decrease the risk of multiple procedures being necessary to repair the damage done by the mesh.
How to Find a Urogynecologist
If you need to find a urogynecologist in your area for pelvic floor problems or transvaginal mesh-related complications, asking for a referral from your OB-GYN or family doctor is the first avenue to explore. If they are not able to help, call university hospitals in your area. University hospitals often have urogynecologists on staff or can offer solid recommendations. The American Urogynecologic Society website offers listings that can help you find credentialed urogynecologists in your area, and if you are involved in a transvaginal mesh lawsuit, you may find that your lawyer is able to recommend urogynecologists who have extensive experience in treating the problems associated with transvaginal mesh.