What is a Urogynecologist?

A Urogynecologist is a Urologist or Obstetrician-Gynecologist physician who specializes in treating women's urinary and reproductive system problems including:

How do I know if I need a Urogynecologist?

If you have already been diagnosed and treated for one of the conditions listed above and you are not satisfied with the outcome, you'd probably be better off seeing a Urogynecologist. If you think you might have one of these problems, but are not sure, you might check with your primary care doctor first and he or she can begin the process and make a referral if necessary.

The first thing to do is to check out whether the doctor is a Urologist or Gynecologist because that might influence your ultimate choice. Urologists treat both men and women. Gynecologists treat only women. To complicate things, some Urogynecologists are also Urologists, so they treat both men and women.

Should I choose a Urologist or Gynecologist?

As a general rule, a Urologist is more familiar with overactive bladder, urinary incontinence, voiding dysfunction, and interstitial cystitis and a gynecologist is more familiar with pelvic organ prolapse. However, there are so many exceptions to this rule, especially amongst younger doctors that it is hard to generalize. The expertise of the individual doctor far outweighs which specialty he comes from.

So, how do I choose?

You've got do your homework, and there are a lot of resources for this, but you need to be careful because many of these resources assess doctors using measures that may not be as clinically important, but are politically correct. More about that later.

First you need to compile a list of doctors and take the following information about each doctor into account:

How do I find out about all these things?

First, recognize that all doctors are not the same. Like everything else in life there are good ones and bad ones. And when it comes to your health, you need a good one. Start with friends, doctors, nurses or anyone else you might know in the health care industry. Ask them about their recommendations and their own personal experiences and begin to compile a list of doctors. Then get on the Internet and check out the doctors? credentials on their website if they have one. If not, you can check with the American Board Medical Specialties (www.abms.org) or at an ever increasing number of web sites that list or rate doctors. I purposely have not recommended any specific web site, because on my review, the quality is very uneven when comparing different doctors that I know, even on the same website. It is likely that some of these websites are accurate; I just don't know which ones. Neither will you, but it's a start.

The doctor's websites can tell you a lot. If they list urogynecology or female urology problems along with a list of all the other conditions that urologists and gynecologists treat, they are probably not subspecialists and may not be expert at the condition that you have. If they list only urogynecology or female urology on their website, they are likely to be true subspecialists, but that doesn't mean that they are good doctors. You've got to do more digging to find that out (see below).

Before you narrow your search and actually pick a doctor to make an appointment with, here are some words of advice:

Ok, I've compiled my list and I've chosen a doctor. How do I know if he's the right one for me?

The short answer is that the best way to find out is a consultation with the doctor, but there are number of things you can do first. Call his office. Does a live person answer the phone or do you get a recorded voice giving you a menu of choices? I prefer the former. If a live person answers and says 'Doctors office, please hold,' that's not good either. Ask if the doctor is experienced with whatever your problem is. If you get an immediate 'yes,' that's good. If you get put on hold, he may not have many patients like you. Tell the receptionist what your problem is and that you want to make an appointment and ask if there is anything you need to prepare or bring with you before the first visit. The more specific the response, the more likely it is that the doctor treats a lot of patients like you. Much or all of these things may be available on the doctor's web site -- it may be possible to get all this information and even make your appointment on line.

Come to the first visit prepared. It's best if you have a written description of you symptoms, your medical history, medications, allergies, prior surgeries. If you know in advance that you have questions, prepare a list of those, but it's generally best to wait until the doctor has formulated an opinion and recommendations before asking a lot of specific questions.

So I met with the doctor and I liked him; what next?

This is where it really gets hard because there are no hard and fast rules. You will need to make as best an informed decision as your 'gut reaction' will allow. There are usually two kinds of outcomes from the initial consultation -- a treatment recommendation or a recommendation for further diagnostic evaluation and, for your part, a lot of questions to the doctor are in order. To begin with, for any of the doctor's recommendations that incur risk or expense, I suggest asking the question 'what if I do and what if I don't.' For example, if you have a dropped bladder and the doctor recommends that you try a pessary, he might respond that if you do try it, it might solve your problem, but there is no harm if you don't try it. On the other hand, if you have blood in your urine and he recommends cystoscopy, he might say that if you do it and diagnose bladder cancer, it could be lifesaving and if you don't do it, there is no other reliable way to diagnose bladder cancer.

If the doctor recommends immediate treatment, whether it's medical or surgical, ask him about the risks and benefits, any alternative treatments and why he chose that particular treatment. Ask him about how many patients he's treated this way and for how long he has been doing this treatment. Ask for his own personal success rate with the treatment and how that compares to the medical literature. And be sure to ask about the possible side effects and complications, whether it is surgery or medical treatment.

When it comes to surgery, in general, the more operations a surgeon has performed, the better he or she gets. However, that's not an infallible rule since I know a lot of golfers who play an awful lot of golf, but never seem to get better at it. That can be the case with surgeons too! It's certainly better that your prospective surgeon has done a lot of operations, but it does not guarantee that he is proficient. Further, a young doctor who has done 150 operations is probably less experienced than an older doctor who has done 15 a year for 10 years because he has the perspective of being able to see how those patients did over the long term.

In conclusion, there is no foolproof way to evaluate the competency of your surgeon (or for that matter, anything else in life), and there's no easy way to be sure that you've chosen the right one, but if you follow the guidelines that I've just outlined and follow your gut, you've done the best you can do.

I wish you all good health!