The division of Urogynecology and Reconstructive Pelvic Surgery, since

its creation in 1997, has enjoyed tremendous successes and growth.  Now one of the largest

divisions nationally in this subspecialty, it has become an integral part of the department

through it's educational, research, and clinical care contributions.   Our division's mission

is to deliver excellent, compassionate, state-of-the-art care for patients suffering from

urogynecologic disorders; to provide excellent training for medical students, residents,

and fellows in urogynecology; to serve as a prominent referral site for women with

urogynecologic problems in the North Texas area; and to advance knowledge in

urogynecology through creative and innovative research projects. 

The division of Urogynecology is committed to medical professional training through its participation in didactic, laboratory, and clinical instruction.
 
Subspecialty training is a primary emphasis of the division.   In 1999 our fellowship program received accreditation from the American Board of Obstetrics and Gynecology and was re-accreditation in 2001.  The 3-year fellowship in Female Pelvic Medicine and Reconstructive Surgery offers fellows an extensive clinical training and a solid foundation in basic science and clinical research. 

Fellows care for patients in a university-based setting at Parkland Memorial Hospital and University Hospitals-St. Paul and Zale Lipshy.  The Scott & White Clinic in Temple, Texas affords yet another venue for surgical training with 2 expert urogynecologic surgeons.  Because of the close relationship of urogynecology with colorectal surgery and urology, fellows also train in one month blocks in both of these specialties.

Currently the first and third years of the fellowship program are spent in clinical activities while the second is spent in basic science research.  Ou goal is to mentor future researchers. Every effort is made to provide research training and to develop the skills necessary for a productive research career. Supported by the department and division, fellows are expected to become involved in research from the start of the fellowship and to continue this involvement throughout the 3-year program.

Residents in obstetrics and gynecology from Parkland Memorial Hospital work on the urogynecology service during their second and third year of training.  Currently, 3 residents per month participate in patient care on our service.  Residents become proficient in evaluating patients with urinary incontinence, pelvic organ prolapse, and related disorders of the lower genital urinary tract.  They learn basic and complex urodynamic testing as well as surgical and non-surgical treatments for urogynecologic problems.

The division's pelvic anatomy laboratory contributes substantially to medical education within the department.

Medical students, residents, and fellows have an opportunity to improve their understanding of gynecologic disorders and anatomy by dissecting fresh, frozen, and fixed cadaveric specimens. Enduring educational material in the form of pictorial and instructional CD-ROM programs of pelvic anatomy have also been created.

Our division invites fourth-year students from medical schools nationwide to work in one-month blocks on the urogynecology service.  Students on this elective evaluate patients in UT Southwestern and Parkland Health and Hospital System clinical settings, assist in operative procedures, and learn the basics of urodynamic testing.

Consistent with our mission statement the division continues to offer its annual continuing medical education series.  The course offers topics which include: non-surgical and behavioral management of female pelvic floor disorders, female incontinence and pelvic organ prolapse, and urogynecologic anatomy with cadaver dissection.  The 3-day course welcomes medical physicians, nurse practitioners, and physical therapists.   

The physicians in our division are committed to improving quality of life for all our patients.  Our service provides thorough assessment, careful diagnosis, and individualized treatment for pelvic floor and urinary tract disorders.  Faculty members focus on the total patient during evaluation and treatment.  Detailed information regarding activity limitations, diet, and medical history help provide diagnostic information and treatment goals for each patient.
The division has a fully equipped urodynamic laboratory capable of performing diagnostic studies to determine the cause of urinary and fecal incontinence and other pelvic floor disorders.  Available testing such as cystoscopy, urodynamic testing, dynamic cystoproctography, electrodiagnostic testing, video urodynamics, defecography, ultrasonography, and pelvic MRI allow our staff to fully assess patients for pelvic floor pathology and dysfunction.
Physicians within the division develop an individualized treatment plan for each patient.  Our priority is to educate patients and encourage them to actively participate in the plan for their condition. Treatment services available include: physical therapist instruction on pelvic floor exercises and biofeedback techniques, behavioral and dietary modification, pessary fitting, pelvic muscle strengthening by electrostimulation, and vaginal, abdominal, and laparoscopic pelvic surgery. Patients are invited to learn more about their condition via specialized web-based patient education materials (CLICK HERE).
Our comprehensive, non-surgical program for the management of pelvic floor disorders is staffed by nurse practitioners and physical therapists.  These health care professionals, specialty trained in urogynecology, are integral patient-care team members.  They, along with our division's fellows and faculty members, staff the various urogynecology clinics which include:
	Pelvic Floor Research Clinic  Urogynecology Pre-operative Clinic  Pessary Clinic  Urogynecology Clinic  Urogynecology/Physical Therapy Clinic  Pelvic Floor Biofeedback Clinic
Coordination of care and attention to individual patient needs are emphasize within the division.  Our monthly Physical Therapy Conference provides an arena for physicians, nurse practitioners, and physical therapists to discuss patient care.  Treatment planning and assessment of patient progress are the focus of this meeting.  Similarly, patient care for all surgical cases for the upcoming week are discussed in weekly meetings with the urogynecology fellow and residents. Many patients self-refer to our clinics, but most are referred by gynecologists, urologists, or primary care physicians in the North Texas area.  Urogynecologic clinical care is provided at Parkland Memorial and University Hospital-St. Paul.  We invite patients to learn more about our program at www.utsouthwestern.org/obgyn.

Research within the division continues to grow, funded in part by several NIH grants.  One grant is devoted to the study of childbirth related pelvic floor injury.  Another evaluates the treatment of urinary incontinence.  Other areas of clinical investigation within the division include: 
               

• Pessary use for relief of symptoms of pelvic floor dysfunction
• Development of a structured dissector for anatomical dissection
• Prevalence of anal incontinence
• Randomized trial of 2 bowel regimens for the treatment of constipation
• Randomized trial of 3 techniques for posterior repair
• Cognitive effect of tolterodine in elderly women
• Pharmaceutical trials for urinary incontinence
• Excellence in gynecologic surgical training
  
  
  

Our basic science research program in urogynecology is at the forefront of investigations into the pathophysiology of pelvic floor dysfunction.  Current studies focus on the role of muscle, nerve, and connective tissue in this process.