Urology and female patients

[mrs_lady]

Hi, urologists. I'm going to start med school this fall, and I'm not sure yet about what specialty I want to go into. I was talking with a friend of a friend the other day who had urological issues. She said she wanted to see a female urologist, but she had a hard time finding one and ultimately couldn't. She also said it was hard for her, since the procedure was so intimate and painful, and she would have been much more comfortable with a woman.

I had not thought too much about urology before, because I want to work with women when I practice. (Not necessarily exclusively, but definitely a large chunk of patients I see.) But after hearing her story, I started to think that it could be a great way to contribute to women's health care.

My question is -- once you're out of residency, is it possible to work mainly with female patients, or at least have a significant population of female patients?

Thanks in advance for helping me out!

---

Members don't see this ad.

 

[arthrodisiac]

Do Urogynecology....Ob/gyn -> urogynecology fellowship...only women.

 

[mrs_lady]

Do Urogynecology....Ob/gyn -> urogynecology fellowship...only women.

Great, thanks for the info. What about after a straight urology fellowship? Any idea?

 

[drwasabi]

I feel that if you want to be able to treat females with urologic complaints as a surgeon, you may get better training as a urologist.
Do urology residency, then do a fellowship in female urology. Pretty high demand for female urologists right now by the way.

 

[sponch]

if you want to be a surgeon, instead of doing urogyn through the ob/gyn tract, i would do urology and a fellowship in female urology. why? you'll be able to do cases a general urologist does as well was the cases that urogynocologists do. plus urologists are more fun to be around and u don't have to spend all that time delivering babies in the middle of the night. in general urologists are better surgeons because they spend more time operating during residency compared to gyns who do a lot of clinic.

 

[cytoskelement]

if you want to be a surgeon, instead of doing urogyn through the ob/gyn tract, i would do urology and a fellowship in female urology. why? you'll be able to do cases a general urologist does as well was the cases that urogynocologists do. plus urologists are more fun to be around and u don't have to spend all that time delivering babies in the middle of the night. in general urologists are better surgeons because they spend more time operating during residency compared to gyns who do a lot of clinic.

Actually, most urogynecology fellowships are 3 years. Then figure about a third of your time in an OB/GYN residency is spent in the OR and that equals 4 years of OR time - with a significant amount of that time spent as a fellow - not a junior resident. As someone who is considering urodynamics and female urology, my opionion on the advantage of pursuing it through the urology route is more management of surgical patients on the floor and the ICU. However, I do agree with the broader exposure to general urology as a big plus too! And, yes, we are more fun to be around.

 

[sponch]

Actually, most urogynecology fellowships are 3 years. Then figure about a third of your time in an OB/GYN residency is spent in the OR and that equals 4 years of OR time - with a significant amount of that time spent as a fellow - not a junior resident. As someone who is considering urodynamics and female urology, my opionion on the advantage of pursuing it through the urology route is more management of surgical patients on the floor and the ICU. However, I do agree with the broader exposure to general urology as a big plus too! And, yes, we are more fun to be around.

well, yeah, but not exactly. urogyn fellowships are typically 2 years clinical + 1 year research, so you'd really be getting 3 yrs of OR time by your calculation. compare this to 5 years of OR time for a urology residency + 2-3 years of female urology...plus if you compare the cases that urologists do during general surgery and urology years, there is a greater variety of cases and skills you are required to learn. maybe it depends on the institution you are at, but i've just noticed that gyn residents just aren't as good technically as the other surgical specialties.

 

[mrs_lady]

You guys,

thanks so much for your input -- this is really helpful and encouraging! You guys are great. It sounds like the way to go is urology -> female uro fellowship. I have to admit, I was hoping you'd say that, because doing an OB/GYN residency just sounds godawful, bless the hearts of those who do it. I'm also not really interested in doing a lot of research post-med school -- I want to treat patients!

Now I'm going to go try to find a urologist to shadow. I don't suppose any of you have contacts in the Bay Area?

 

[cytoskelement]

well, yeah, but not exactly. urogyn fellowships are typically 2 years clinical + 1 year research, so you'd really be getting 3 yrs of OR time by your calculation. compare this to 5 years of OR time for a urology residency + 2-3 years of female urology...plus if you compare the cases that urologists do during general surgery and urology years, there is a greater variety of cases and skills you are required to learn. maybe it depends on the institution you are at, but i've just noticed that gyn residents just aren't as good technically as the other surgical specialties.

Agreed for the most part. However, I'd leave internship out of the equation for both. Although I'm hoping for a considerable amount of time in the OR next year, I've resolved to know that I probably won't get much. Also, many uro programs can be top heavy with little OR experience as junior residents. So who knows... 6 one way or a half dozen the other. And I think we all know that it really is case dependent. I worked with a non-fellowship trained urogyn who was one of the best laparoscopists and skilled surgeons I've met.

Sponch... are you currently a resident? Thanks for the insight on the female uro felloships. I'm planning on a one-year fellowship if possible. Three years would be crazy! That amount of time is one of the reasons I'll likely not complete a fellowship in onc - even though it's so damn interesting. I'm 30 now and time is becoming a factor in finishing my training.

http://www.sufuorg.com/pdf/Fellowships.pdf

This link is found on urologymatch.com and lists all of the female urology fellowships.

 

[sponch]

mrs lady, both stanford and ucsf have big urology departments. at ucsf there is donna deng who is starting up a pretty busy female/reconstructive urology practice. at stanford is chris payne who has an established female urology practice. i don't know how busy their schedules are our what the rules for shadowing are, but i'm sure they wouldn't mind if you asked nicely and if it's allowed by their respective institutions...

 

[-Goose-]

What are the key differences b/t urogyn & female urology in pp? How distinguishable are they from one another?

 

[drivesmecraazee]

What are the key differences b/t urogyn & female urology in pp? How distinguishable are they from one another?

Good question dude, I would like to know this too

 

[smq123]

What are the key differences b/t urogyn & female urology in pp? How distinguishable are they from one another?

Urology (in general) deals with the urinary tract. So if you had recurring kidney stones that required some type of surgery, you'd see a urologist. For example, urologists can put in nephrostomy tubes (which urogyns cannot).

If you have urinary incontinence, you could probably see either.

If you have problems with the pelvic floor - i.e. uterine prolapse, vaginal prolapse, etc. - you'd see a uro-gynecologist. Urogynecologists can put in pessaries, do hysterectomies, and do a culpocleisis procedure (in which the vagina is sewn shut).

I don't know if this answers your question....

 

[viagradoc]

There certainly is alot of overlap btwn urogynecologists and urologists who operate on women (nearly all). The core training is arguably better for urologists, since we do have general surgical training first, whereas ob-gyn attendings and residents teach you how to operate instead of various general surgical and surgical subspecialty attendings/residents training you. By the time you actually are trained by urology attendings, you already know how to sew, plicate, use mesh, take care of critically ill ICU patients, manage trauma situations, etc. There is a difference in the core training btwn the two specialties, for sure.
I would suggest you spend time with a female urogynecologist in private practice, then find a female urologist to spend time with. Another consideration may be your liability exposure for the future. Your clout with a jury one day might just be greater if you were trained from the start to be a bladder surgeon, doing bladder surgery. I see ob-gyns running to urogynecology as a way to avoid doing deliveries which have become prohibitively risky...

 

[bobbyseal]

Ob/Gyn: relatively easy residency to get
Urogyn fellowship: probably fairly hard to get

Urology residency: fairly hard to get
Female urology fellowship: probably fairly easy to get, depending on where you look to go.

Finally, when a urogynie gets in trouble, she probably calls a urologist. A) she cut the ureter and doesn't know how to reimplant it or B) Her sling eroded through the bladder, oops! sorry, I can't fix that.

 

[smq123]

I see ob-gyns running to urogynecology as a way to avoid doing deliveries which have become prohibitively risky...

If that's true, then why not just do straight gyn? Much easier than pursuing and doing a fellowship.

Ob/Gyn: relatively easy residency to get
Urogyn fellowship: probably fairly hard to get

Finally, when a urogynie gets in trouble, she probably calls a urologist. A) she cut the ureter and doesn't know how to reimplant it or B) Her sling eroded through the bladder, oops! sorry, I can't fix that.

Urogyn fellowships are actually not THAT hard to get. It's not like gyn onc or REI. Sure, all fellowships are getting more competitive, but urogyn isn't becoming prohibitively difficult to get into.

Urogyn training should teach you how to reimplant bladders and how to fix slings that have eroded through the bladder. Even then, it shouldn't be a huge deal. I imagine it depends somewhat on where you train, but they should teach you something about how to fix your mistakes. At some hospitals there may be politics or legal reasons why a urogyn would call a urologist in, though.