How important is urology/gynecology collaboration?

Urology Times reached out to three urologists (selected randomly and asked them each the following question: What steps do you take to avoid surgical complications?

Dr. Goudelocke"Not surprisingly, I think it’s very important. Often, the perception of urologists versus urogynecologists is that it’s competitive. In my opinion, collaborating is incredibly important. 

Overactive bladder is a large part of my practice. It’s very important to work with gynecologists because, for the majority of women, that’s their primary care physician. Just as it’s important for urologists to work collaboratively with primary care physicians, it’s important for urologists to work with gynecologists.

Also see: What steps do you take to avoid surgical complications?

There are way more overactive bladder patients than urologists. So educating gynecologists about how to identify overactive bladder and screen out patients who may need subspecialty referral, teach first-line therapies, like behavioral modification-before even getting to medication-is incredibly important.

It’s important because in many areas there is a lot of overlap, but not always. In my community, what a urogynecologist does and what I do can be very different. Training differs in some communities just as practice patterns differ.

I do not do hysterectomies, so if the patient has significant prolapse and the uterus needs to be addressed, either through a hysterectomy or ureteral suspension, I’m better off working with a urogynecology colleague with that expertise.

If the ultimate goal is the best patient care, it’s important to consider areas where there isn’t an exact overlap in practice, so you can get the patient to the person with the most expertise.”

Colin Goudelocke, MD / Chattanooga, TN

Next: "It’s absolutely important"

"It’s absolutely important. Because we have so much overlap in our patient population, our patients are best served by us working together. I do a lot of combined surgery with gynecologists. They do the hysterectomy, then I do the reconstruction.

Read: What one thing about MOC would you change if you could?

If a patient comes in with issues like pelvic pain, that could be something like interstitial cystitis or endometriosis. We work together to figure out the best plan for the patient, because it’s not always just a urologic issue or gynecologic issue.

Some gynecologists are very good at treating complicated voiding dysfunction issues and others like to refer those to urology. It depends on the experience and preference of the gynecologist.

We probably got ourselves into much of this mess with mesh issues, with urologists and gynecologists doing female reconstructive surgery by going to a Saturday morning course. That’s partially why certification came about.

I’m board-certified in female pelvic medicine and reconstructive surgery. It’s a nice specialty, but urologists or gynecologists with 20 years’ experience under their belt can also do a good job in that area without having board certification-especially when they work together.

Also see: What one thing about MOC would you change if you could?

Another advantage of working with gynecologists is the referral pattern. I do at least eight combined surgeries a month with gynecologists and probably have 20 gynecologists who refer patients to me.”

Maggie Vuturo, MD / Boise, ID

Next: "One reason we have subspecialty training for people from both backgrounds is that we can’t completely exist without each other"

Dr. McAchran"In female pelvic medicine and reconstructive surgery, now an accredited subspecialty, working together is incredibly crucial. If we are going to further this field, we need to pool our resources and talents, which are similar, but slightly different, to provide the best patient care. The pool of patients with these problems is getting bigger as the American population ages.

Overall, urology and gynecology work well together on many levels, particularly at an academic medical center. In our infertility center, urology male infertility specialists work closely with female infertility specialists; clearly, one can’t exist without the other. Another area of overlap is oncology. Gynecologic oncologic problems often affect urologic organs.

Read: What are you doing to work smarter, rather than harder?

One reason we have subspecialty training for people from both backgrounds is that we can’t completely exist without each other. Since the subspecialty fellowship began, training is much more standardized. Historically, it was more of an apprenticeship. You got experience in whatever the person you were working with did. Accreditation led to standardization of training.

The two specialties need to work together. People with complex problems such as urinary incontinence, combined with prolapse of the vaginal walls and rectal prolapse, are sent to see colorectal surgeons, GI specialists, then maybe urogynecologists who can handle one part, but not incontinence, so then it’s the urologist. Patients shouldn’t have to maneuver themselves through the waters of the complex pelvic floor disorders. This multidisciplinary collaborative approach allows us to develop a care plan involving input from all of these people.”

Sarah E. McAchran, MD / Madison, WI

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