A Timeline of the Development of Urogynecology and Female Pelvic Medicine and Reconstructive Surgery in the US
The Early Years
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
Development of a Society
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
Development of an ABOG Subspecialty
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.
Development of Female Pelvic Medicine and Reconstructive Surgery
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.
Deborah L. Myers MD
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.