Patient Question: What is the difference between a urologist and a urogynecologist?
That is a very good question, and I get asked that frequently. The truth is that the basic fields are quite different, but as the fields get more specialized, the two fields become more similar and have a great deal of overlap.
A urogynecologist is an OB/Gyn by training who has gone on to more training after residency. Usually this doctor has completed a four-year OB/Gyn residency followed by two or three more years of training, called a fellowship, devoted only to reconstruction of the pelvic floor and other disorders including incontinence of the bladder.
A urologist has gone through five or six years of residency with the focus on the genitourinary system–kidneys, ureters, bladder, prostate, and urethra. A urologist can then go on to a fellowship in many different fields including "female" urology and urethral reconstruction. It is those fields that have a lot of overlap with the urogynecologist.
I don’t believe either field is better than the other; in fact, I think the two fields are rather complimentary, and I routinely share patients with the urogynecologists, as well as straightforward gynecologists in order to provide the best care for the patients.
Very often, a patient is referred to me by a gynecologist for an evaluation of her incontinence. I often perform urodynamics, which is a test to assess bladder function. Many gynecologists can perform this as well; it just depends on the community, and who has the equipment. I also have the ability to perform cystoscopy, which is using a small camera to look inside ones bladder to assess it anatomically or if there has been blood in your urine, or other abnormalities.
After I have done my work-up, I contact the gynecologist and we often plan a combined procedure, if it is appropriate. I usually fix the urethra, by placing a sling, and the gynecologist will do the cystocele, often referred to as a bladder lift or tuck. This may also include a hysterectomy done by the gynecologists if appropriate. Many urogynecologists will do the entire procedure themselves, but it depends on your hospital, and the general medical community.
As I said before, there is a lot of overlap between the fields, and I wouldn’t hesitate to see either health professional. It usually depends on who you see first. In general, if you have a dropped uterus or a very weak pelvic floor, I think a urogynecologist is the most appropriate person for you to see first. If you have either a complex urinary issue, or even straightforward urinary problems, a urologist is probably your best bet. Again, it often depends on the area where you live and what professional you have available to you, and in general either health professional will helpful for you if you are having urinary issues.