Urogynecology and Urology: What’s the difference?

Urogynecologists are restoring the health and quality of life of thousands of women today suffering from pelvic floor disorders.

Yet these specialists remain largely unheard of.

Greater awareness is critical to helping more women get the care they need for conditions ranging from urinary and fecal incontinence to pelvic organ prolapse to childbirth injuries, says Dr. Francisco Orejuela, professor of obstetrics and gynecology at Baylor College of Medicine and director of the division of Urogynecology and Reconstructive Pelvic Surgery.

What do women need to know about urogynecologists, and how do these “pelvic floor specialists” differ from general urologists?

Unique training

A urogynecologist could be a gynecologist or a urologist with special training in the field of urogynecology.
Urogynecologists are trained in both gynecologic and urologic pathologies, a combination that gives them a unique understanding of women’s pelvic floor disorders.

“After completing residency training in gynecology, urogynecologists must also complete an ACGME-accredited 36-month fellowship in urogynecology and reconstructive pelvic surgery (URPS),” Orejuela said. Urology residents are required to complete a minimum 24-month fellowship in URPS as a pre-requisite for a subspecialty in urogynecology.

Board certification matters

“The most important thing is the board certification in urogynecology and reconstructive pelvic surgery by the American Board of Obstetrics and Gynecology or the American Board of Urology,” he emphasized. “It’s the stamp of someone who has special training and special interest in urogynecology.”

A focus on females and female issues only

“Urogynecologists exclusively treat females and their issues related to the muscles, ligaments and connective tissues that support the female pelvic organs, the lower urinary tract and a woman’s reproductive system. We treat many conditions – from urinary incontinence to pelvic organ prolapse of the uterus, vagina, bladder or rectum to birth injuries,” said Orejuela.

“Urology practices see the full spectrum of patients, both male and female.”

When should women see a urologist versus a urogynecologist?

While there is overlap, urologists also specialize in issues affecting the upper urinary tract, including the kidneys and ureters, he said. “Kidney stones, ureteral reflux, malignancies of the urinary tract – those are urology territory.”

Urogynecologists focus more on issues of a woman’s pelvic floor, including the lower urinary tract, meaning the bladder (for conditions like overactive bladder and interstitial cystitis) and the female reproductive system, including the vagina, uterus and fallopian tubes (for conditions like pelvic organ prolapse and birth injuries), Orejuela said.

A different perspective

“With training in both gynecology and urology, along with practicing within a larger OB/GYN practice, comes a greater understanding of the physiology of the female pelvic floor, the changes women undergo during pregnancy and childbirth, and the problems intimately related to that, such as prolapse and incontinence,” said Orejuela. “Our patients appreciate that.”

Integrated pelvic floor physical therapy

Women with urogynecologic disorders often have a difficult time finding a pelvic floor physical therapist, he noted. “Pelvic floor physical therapists are an integral part of our practice. Our urogynecology practice is fortunate to work with a large complement of these specialized physical therapists who offer the full spectrum of treatments for women. We have conferences with these physical therapists on a regular basis to discuss cases, and we stay in close communication with them.”

Treatment of childbirth-related injuries

Urogynecologists are well-equipped to assist in treating injuries to the pelvic floor, bladder or sphincter that result from childbirth, added Orejuela. “At our Pregnancy Pelvic Floor Wellness Clinic, we see patients after delivery with issues that include severe perineal lacerations, injured sphincters, incontinence, new prolapse and pain with intercourse when new mothers return to sexual activity after childbirth.”

Surgical expertise and OB/GYN collaboration

Urogynecologists offer advanced surgical techniques, including reconstructive surgery, to restore normal female anatomy and function. “We are specialized surgeons, and we work closely with other specialists across the department of OB/GYN to care for complex pelvic floor disorders, including our colleagues in minimally invasive gynecologic surgery, robotic surgery and fistula surgery, as well as our Baylor colleagues in colorectal surgery, urology and other specialties – everything our urogynecology patients need.”

To make an appointment with a Baylor College of Medicine urogynecologist, call (832) 826-7500. Patient care is provided at Texas Children’s Pavilion for Women and Ben Taub Hospital.

By Sharon Dearman, a writer in the Department of Obstetrics and Gynecology