Urogynecology Subspecialty Approval
Physicians who complete a residency in either Obstetrics & Gynecology or in Urology are eligible to apply for a focused fellowship training program called “Female Pelvic Medicine & Reconstructive Surgery” (FPMRS) and are frequently called Urogynecologists or Female Urologists, respectively.
March 2011 – The American Board of Medical Specialties (ABMS) recently voted to approve the FPMRS specialty nationally. This means that FPMRS fellowships are now formally recognized nationally, in the same way that Maternal Fetal Medicine, Gynecologic Oncology, and Reproductive Endocrinology specialties are recognized and approved. This means that women with prolapse, incontinence, bladder control problems and pelvic pain, can now receive care from FPMRS physicians who are specially trained and certified in this highly sub-specialized field of medicine. The new FMPRS Board is supported jointly by the American Board of Urology (ABU) and the American Board of Obstetrics and Gynecology (ABOG). The FPMRS subspecialty was designed to train gynecologists and urologists to care for women with complex pelvic floor disorders. With the new designation from the ABMS, FPMRS fellows may graduate from a certified program and be recognized as board eligible. Once they pass a board exam (the first being offered in 2013), they will become certified as FPMRS sub-specialists.
Mesh use in Urogynecologic Surgery
Traditionally, reconstructive surgery for incontinence and pelvic organ prolapse involved the use of suture and sometimes biologic grafts (human or animal), but long-term durability of these repairs was not optimal. Vaginal mesh kits were first marketed to urologists and gynecologists as a way to improve success rates for POP repairs with native tissue, but without well-designed trials to establish the safety and efficacy of these devices.
In 2001, the FDA reviewed the first surgical mesh indicated for repair of POP and found it substantially equivalent to surgical mesh indicated for hernia repair. This finding was done without clinical data, and, since then, many subsequent mesh products have been cleared for the same indication without clinical data. Currently, an estimated 100 synthetic mesh devices or kits have been cleared by the FDA for use in surgery for POP. Modification of mesh devices continues and the FDA is currently re-evaluating the process it uses to evaluate mesh intended for vaginal repair of POP.
July 13, 2011 – The FDA issued a safety communication and update, intending to inform patients and health care providers that “serious complications associated with surgical mesh for transvaginal repair of pelvic organ prolapse are not rare.”
Find out more about what this means for patients, talking points, and links on where to find more information: