Faculty at Indiana University School of Medicine Department of Obstetrics and Gynecology are training doctors to provide care for women dealing with difficult pelvic disorders. These women often experience symptoms that can be painful and embarrassing, greatly impacting their quality of life. Since 1988, the department has trained dozens of doctors to provide life-changing care for these women through its female pelvic medicine and reconstructive surgery fellowship program. Michael Heit, MD, PhD, the program’s director, answers some questions about this subspecialty of obstetrics and gynecology and what makes this program unique.
What is female pelvic medicine and reconstructive surgery and what are the different conditions you treat?
Female pelvic medicine and reconstructive surgery, previously recognized as urogynecology, is an Accreditation Council for Graduate Medical Education (ACGME) accredited subspeciality of obstetrics and gynecology focused on the care and management of women with pelvic floor disorders. These disorders include pelvic organ prolapse, stress urinary incontinence, overactive bladder, fecal incontinence, constipation, hematuria, recurrent urinary tract infection and other lower urinary tract symptoms such as bladder pain syndromes.
What are some of the treatments you use in this field?
Many of our surgeries are minimally invasive, requiring minimal to no hospital stay and allowing for quick recovery for women with pelvic floor disorders. Most of our surgical procedures for pelvic organ prolapse involve laparoscopic techniques utilizing native tissue or mesh augmented repairs to provide durable results. Midurethral slings are used to surgically treat stress incontinence while newly innovative approaches, such as Botox® bladder injections and sacral neuromodulation (pacemakers) treat overactive bladder. We have state-of-the-art diagnostic testing equipment to help physicians better define disease processes for providing unmatched quality care to our patients. Non-surgical treatment regimens including pelvic floor physical therapy, medications, pessary and behavior modification are also available.
What made you interested in this subspecialty?
This subspecialty offers providers the opportunity to care for women with unique disorders that affect their quality of life. We can significantly improve the quality of life of these individuals with the nonsurgical and surgical therapies that are available. We can advance our field of female pelvic medicine and reconstructive surgery through clinical and basic science research.
What makes IU School of Medicine’s female pelvic medicine and reconstructive surgery fellowship program unique?
The fellowship training program in female pelvic medicine and reconstructive surgery is one of the oldest programs in the nation, beginning in 1988. It was the first American Board of Obstetrics and Gynecology accredited training program in the United States. We have successfully graduated 28 trainees who now practice their subspecialty throughout the United States. Our graduates have a 100 percent pass rate on the written and oral subspecialty boards to date.
What are some of the highlights of this fellowship program that fellows experience?
We offer graduated experiences with less direct supervision of trainees as they progress through their fellowship program on their way to becoming subspecialty consultants in female pelvic medicine and reconstructive surgery. Fellows spend two months on female urology, learning an alternative approach to the care and management of women with pelvic floor disorders from a fellowship-trained female urologist. Upon graduation, fellows are adequately trained as advanced laparoscopic surgeons capable of providing minimally invasive surgical care without assistance from robots. Fellows have the opportunity to conduct both clinical and basic science research, resulting in publication of their findings in peer-reviewed medical journals.
What are some fellowship graduates of this program doing now?
Most of our fellowship trainees enter private practice, hospital/health system-based practice, or accept full-time academic medicine positions throughout the entire United States upon graduation.