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Why a Urologist?
You may wonder why a urologist is interested in female pelvic relaxation, since for many years urology was traditionally consideredto be a male field. In the late 1970’s, female urology emerged as a specialty branch of urology much as pediatric urology had donepreviously. The person largely responsible for this emergence was Dr. Shlomo Raz, director of female urology at the U.C.L.A. School of Medicine. Dr. Raz, a world-renowned physician and surgeon, developed the field of female urology into a comprehensive surgical discipline. In addition to writing the textbook Atlas of Transvaginal Surgery and editing the textbook Female Urology, Dr. Raz is responsible for redefining the previously confusing nomenclature of female pelvic anatomy. F or the past four decades, Dr. Raz has hosted a fellowship at U.C.L.A. in which two surgeons per year are trained with him in all aspects of female urology. I was fortunate to be selected for one of these positions and after the completion of my urology residency at the University of Pennsylvania School of Medicine, spent the years 1987–1988 operating with Dr. Raz, focusing on prolapse, incontinence, and voiding dysfunction. Obviously, prolapse is an exclusively female field, but incontinence and voiding dysfunction encompass both females and males. My practice is, in fact, almost equally divided between women and men, and I find that I enjoy this balance.
For years, the urologist’s role in female pelvic relaxation was limited to surgery for urinary incontinence, and other aspects of pelvic relaxation were largely ignored. Similarly, the gynecologist’s role in female pelvic relaxation was focused on prolapse of the bladder, uterus, and rectum, but ignored the urethral prolapse that is often responsible for stress urinary incontinence. Thus there was a division of labor, a “territoriality” within the realm of female pelvic surgery, as illustrated in this cartoon demonstrating the roles of the urologist, gynecologist, as well as the colon/rectal surgeon. (Figure 1). Dr. Raz espoused the concept of a pelvic surgeon, one capable of dealing with any and all aspects of female pelvic relaxation, with a thorough knowledge of pelvic anatomy and plastic surgical reconstructive principles. The ultimate goal of the female urology fellowship that Dr. Raz established became to train accomplished pelvic surgeons who could then obtain academic positions at University medical centers throughout the United States, the appropriate venue for further dissemination of the art and science of female urology and pelvic reconstructive surgery to medical students and residents in training. Thus, at Hackensack University Medical Center, one of my roles is to instruct urology residents and medical students from the University of Medicine and Dentistry of New Jersey in the principles and surgical techniques of Dr. Raz.
Female pelvic reconstructive surgery incorporates principles of both urological, gynecological, and plastic surgery. A pelvic reconstruction for pelvic prolapse is not dissimilar to cosmetic facial surgical procedures performed by plastic surgeons for aging and sagging eyelids and jowels. Both pelvic reconstructive and plastic facial reconstructive surgery require some degree of creativity and artistic talent in addition to the requisite scientific knowledge of anatomy and surgical principles. I personally find female reconstructive surgery to be particularly gratifying because of both the instant ability to assess the results before leaving the operating room as well as the great potential to improve the lifestyle and function of the person suffering with prolapse. Unlike facial cosmetic surgery, pelvic reconstruction, in addition to improving Refer to ( Figure 1). cosmetic appearance, will result in functional improvement in terms of alleviation of incontinence, voiding dysfunction, sexual dysfunction, bowel dysfunction, and other symptoms associated with pelvic prolapsew
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