A Timeline of the Development of Urogynecology and Female Pelvic Medicine and Reconstructive Surgery in the US

    The Early Years
    During the mid-1960s Dr. Jack Robertson was an attending at Harbor General Hospital, Torrance, CA  and Dr. Don Ostergard was a second year resident.  A Urogynecology clinic was organized at Harbor General Hospital for basic incontinence evaluation.  The first "fellowship" in urogynecology was started by Dr. Ostergard when he was still at Harbor General. The first fellow was Dr. Tom McCarthy who also had a special interest in vulvar diseases. Dr. Narender Bhatia was the second fellow. Dr. Ostergard moved to Long Beach Memorial, Long Beach CA and University of California at Irvine.

    In the 1970s’ there was activity and special interest amongst a few gynecologists to learn more about incontinence in women. The first paper on detrusor instability Detrusor Dyssynergia was written by Drs. Hodgkinson and Drukker.

    In 1973, while the three other Ob-Gyn subspecialty boards were being formed, the past president of ACOG, Howard Judd, was asked to form a subspecialty board in what is now referred to as Urogynecology. The general sentiment was that the field was not big enough to warrant a separate subspecialty.

    In the 1975, during a sabbatical year, Dr. Don Ostergard does a literature review which reveals the fragmented nature of the field.  This motivates him to begin evaluating the need for an organization focused on female incontinence.  Dr. Ostergard visits to the current leaders at the time: gynecologists Dr. Stuart Stanton in London, Drs. Torkel Rud and Mogens Asmussen in Oslo, and urologist Dr. Emil Tanagho in San Francisco, to learn more about the diagnosis and treatment of this condition.

    The Spread of Urodynamics
    In 1974, Drs.  Jack Robertson and Don Ostergard visit Dr. Paul Hodgkinson at Henry Ford Hospital in Detroit, MI to watch urodynamics. Dr. Glenn Hurt also visits and brings back the diagnostic technique to his institution at the Medical College of Virginia. At Medical College of Virginia, Dr. Glenn Hurt teaches urodynamics to Dr. Andy Fantl who was a resident at the time. Dr. C. Paul Hodgkinson also made by hand catheters for urodynamic testing. The Mikro-tip® transducers were adapted originally from a cardiac catheterization tip by an engineer from Texas named Millar. The requested markings on the Millar catheter were to follow the design of Dr. C Paul Hodgkinson. While on sabbatical, Dr. Henry Thiede visits the Continence Program for Women at the Medical College of Virginia. Here, Dr. Henry Thiede learns urodynamics from Dr. Andy Fantl. In the late 1970’s, Dr. Tanagho of San Francisco uses a double balloon catheter for a "hand-made transducer"

    Development of a Society
    The first steps toward organization and increasing awareness involved providing postgraduate courses in this new field to educate physicians in the evaluation of incontinence with an international faculty of experts. Through the efforts of Drs. Jack Robertson and Don Ostergard, such courses were given throughout the US.
    During each course, participants were asked whether a society devoted to the dissemination of information in the urological aspects of gynecology would be of interest.  The response was universally positive and the groundwork was laid to officially organize a non-profit organization.

    In 1979, the Gynecologic Urology Society (GUS), later to become the American Urogynecologic Society (AUGS), formed. The society was formed in a living room in Orange County, California by Drs. Jack Robertson, Finnis Wiggins, Earl Fuller, Fred Jansen, and Don Ostergard. Dr. Fuller’s wife was an attorney who drafted all the necessary paperwork to legalize the organization as a non-profit California corporation.  At this meeting, Dr.  Jack Robertson became President and Dr. Don Ostergard assumed the role of Secretary-Treasurer. Dr. Ostergard’s secretary, Collette, provided staff support and functioned much like the society’s current association management company Smith Bucklin.  Dr. Earl Fuller wrote a quarterly newsletter reviewing current publications of interest to the membership.

    In 1979, the Gynecologic Urology Society has its first meeting in California, and 16-20 providers attend and join the society. In 1980, an annual scientific meeting of GUS is held in New Orleans, Louisiana. In 1986, the society name Gynecologic Urology Society (GUS) changes to the American Urogynecologic Society (AUGS). In 1992, Smith Bucklin assumes management of AUGS.

    Early Research and Publications
    In 1979, Dr. Fantl received a grant from the NIH/NIA. In 1981, GUS (AUGS) wrote the first edition of Educational Objectives for Postgraduate Education in Gynecologic Urology (the “little red book”). It is written by Drs. Linda Cardozo, Stuart Stanton, Henry Theide, Andy Fantl, and Gloria Sarto. The "little red book" was submitted to CREOG for resident training guidelines.  In 1987, the first NIH consensus conference on Urinary Incontinence was held.  Here, Dr. Fantl presented the state of the science. The NIH document generated from the meeting was published in 1988. In 1992, the first AHCPR clinical practice guidelines for Urinary Incontinence in Adults is published.

    Development of an ABOG Subspecialty
    Dr. Clarence Erlich, Chairman at Indiana University is named the executive director of the American Board of Obstetrics and Gynecology (ABOG) who meets with Drs. Theide and Fantl in Washington DC. There they present the need for a subspecialty of urogynecology. Dr. Erlich unexpectedly passes and Dr. Norman Gant is elected executive director of ABOG

    In late 1991/early 1992, at an ABOG meeting in Dallas, AUGS and SGS leaders: Drs. David Nichols, Ray Lee, Neil Jackson, Andy Fantl, and Linda Brubaker meet to discuss formalized training programs in urogynecology. ABOG had invited members of AUGS ("the urodynamicists") and SGS ("the vaginal surgeons") who were already training individuals in fellowship programs to discuss formalized training programs in this discipline. A key individual at the meeting was Dr. Ray Lee, who helped "broker" some of the compromises between AUGS and SGS members. Once representatives of the two societies were willing to work together, ABOG decided to explore whether the discipline was mature enough to warrant fellowship training.

    In November 1992, members of AUGS and SGS presented a "State of the Art" conference to the ABOG Board of Directors to educate ABOG further about the subspecialty. Dr. Henry Thiede led the conference and many presented mini-lectures.

    In 1994, the Urogynecology and Reconstructive Pelvic Surgery (URPS) subspecialty was formalized.   This name was to include both aspects of the field- both the AUGS Urogynecologists and the SGS pelvic surgeons. A committee was formed, chaired by Dr. Morton Stenchever of ABOG, to write URPS learning objectives; two representatives of the SGS were chosen, Drs. Ray Lee and David Nichols and two representatives of AUGS, Drs. Richard Bump and Nicolette Horbach. Representatives of the Society of Urodynamics and Female Urology (SUFU) were at the meeting as well. The committee also included Dr. Butch Fowler, who had experience in developing the subspecialty of Gynecologic Oncology.

    ABOG and the American Board of Urology (ABU) agreed that the field warranted specialized fellowship training. With the ABOG/ABU approved learning objectives and guidelines, ABOG/ABU leadership approached the American Board of Colon and Rectal Surgery (ABCRS) to see if they wanted to be part of the process. ABCRS declined, so ABOG/ABU went forward alone. In 1995, URPS was changed to Female Pelvic Medicine and Reconstructive Surgery (FPMRS). This committee then was responsible for accreditation of fellowships. In 1996, the first fellowship program to be accredited was Dr. Tom Benson’s program in Indianapolis, ID.

    Developing Years
    The growth of the AUGS society quickens with many key events as noted:

    • 1997 – Kimberly Clark provides endowment for creation of the June Allyson Foundation
    • 1999 – the First NIH RFA for the study of pelvic floor disorders is funded. This is a result of AUGS leadership visiting the NIH and advocating for research funding.
    • 2001 – the First AUGS Resident Scholars is sponsored by Eli Lilly & Co.
    • 2001 – The AUGS Foundation (AUGSF) is formed to support research regarding the causes, prevention, cure and treatment of urogynecologic disorders
    • 2006 – The AUGS Foundation awards its first research grant
    • 2008 – The June Allyson Foundation comes under the AUGS Foundation umbrella
    • 2009 – 30th Annual Scientific Meeting in Hollywood, Florida
    • 2010 Journal of Female Pelvic Medicine and Reconstructive Surgery is published
    • 2011  AUGSF/AUGS merge

    Development of Female Pelvic Medicine and Reconstructive Surgery

    • 1995 subspecialty of Female Pelvic Medicine and Reconstructive Surgery is named
    • 2010 the American Board of Medical Specialties (ABMS) application for the subspecialty of Female Pelvic Medicine and Reconstructive Surgery is written with the collaboration of urology and gynecology
    • 2011  ABMS recognizes the subspecialty of FPMRS
    • 2011 ABOG/ABU board certification process develops
    • 2012 the June 2013 exam date for FPMRS is announced
    • 2012 test questions for the FPMRS exam are written with collaboration of urology and gynecology

    The growth of the Society, the field of urogynecology, and Female Pelvic Medicine and Reconstructive Surgery has been more than any of us could have envisioned.  For this we are grateful as through the efforts of those before us and our future leaders; our female patients with pelvic floor disorders will benefit through better research, education and advocacy.

    Respectfully submitted,

    Deborah L. Myers MD
    AUGS president 2010-2011

    P.S. The events noted above are my best interpretation from a collection of memories from our AUGS members. Please excuse any inaccuracies or oversights.

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