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 1972-73, while the three other Ob-Gyn subspecialty boards were being formed, the past president of ACOG, George 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 did a literature review which revealed the fragmented nature of the field. This motivated him to begin evaluating the need for an organization focused on female incontinence. Dr. Ostergard visited the current leaders at the time: gynecologists Dr. Stuart Stanton in London, Drs. Torkel Rud and Mogens Asmussen both 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 visited Dr. Paul Hodgkinson at Henry Ford Hospital in Detroit, MI to watch urodynamics. Dr. Glenn Hurt also visited and brought back the diagnostic technique to his institution at the Medical College of Virginia. At the Medical College of Virginia, Dr. Glenn Hurt taught urodynamics to Dr. Andy Fantl who was a resident at the time. Subsequently, Dr. Henry Thiede visited the Continence Program for Women at the Medical College of Virginia to learn urodynamics from Dr. Andy Fantl.
Dr. C. Paul Hodgkinson used hand-made catheters for urodynamic testing. The Micro-tip® transducers were adapted 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. In the late 1970’s, Dr. Tanagho of San Francisco used a double balloon catheter for a hand-made transducer.
Development of a Society
The first steps toward organization and increased awareness of the field involved providing postgraduate courses 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) was formed in a living room in Orange County, California by Drs. Jack Robertson, Finis 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 previous association management company Smith Bucklin. Dr. Earl Fuller wrote a quarterly newsletter reviewing current publications of interest to the membership. Also in 1979, the Gynecologic Urology Society had its first meeting in California, and 16-20 providers attended and joined the society. In 1980, the first annual scientific meeting of GUS was held in New Orleans, Louisiana.
However, the name “Gynecologic Urology” was not well accepted as the name specifically stated “Gynecology” and “Urology”. A new name “Urogynecology” was suggested by Dr. Axel Ingelman – Sundberg who was Professor and Head, of Department of Obstetrics and Gynecology, in Stockholm, Sweden from 1949-1979. The proposed name “Urogynecology” was promoted by Dr. Hugh Shingleton who was president of GUS in 1982. In 1986, the society name, Gynecologic Urology Society (GUS), was changed to the American Urogynecologic Society (AUGS).
Early Research and Publications
In the 1970’s, Dr. Andy Fantl met with the executive director of the American Board of Obstetrics and Gynecology (ABOG), Dr. Merrill to discuss the need for research funding for the subspecialty. Further discussions and meetings between the NIA, ABOG and Drs. Fantl and Thiede were held to continue the quest for research dollars. In 1979, Dr. Fantl received a grant from the NIH/NIA. In 1981, GUS wrote the first edition of Educational Objectives for Postgraduate Education in Gynecologic Urology (the “little red book”). It was written by Drs. Linda Cardozo, Stuart Stanton, Henry Thiede, 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 guideline for Urinary Incontinence in Adults was published.
Development of an ABOG Subspecialty
In the 1970’s- 1980’s, it was felt there was not enough substance in area of Urogynecology to need another subspecialty. In 1989 Dr. Henry Thiede, then president of AUGS, asked ABOG to consider credentialing of fellowships. In 1990, Dr. Clarence Ehrlich of ABOG met with Dr. Fantl in Washington DC to further discuss the need for NIH funding to advance the research in the subspecialty which sparked their interest. Subsequently, in the spring of 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. Drs. Henry Thiede and Clarence Ehrlich led the conference and many presented mini-lectures. Dr. Ehrlich was named to be the next executive director of ABOG, but unexpectedly passed in October 1992. Dr. Fantl however, contacted Dr. Norman Gant who became executive director of ABOG in January 1993, to continue discussions. A meeting was held between Drs. Gant, Fantl, and Thiede. In April 1993, ABOG hosted a retreat to discuss the issue further; Dr. Thiede attended.
On December 4, 1993, at an ABOG meeting in Dallas, with AUGS and SGS leaders: Drs. David Nichols, Henry Thiede, Ray Lee, Neil Jackson, Andy Fantl, Richard Bump, Donald Ostergard, Thomas Benson, Linda Brubaker, John DeLancey and Jeff Cornella convened 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. Drs. Nichols, Lee and Cornella advocated the inclusion of the word ‘surgery’ in the subspecialty name. A key individual at the meeting was Dr. Ray Lee, who helped "broker" some of the compromises between AUGS and SGS members. The name “Urogynecology and Reconstructive Pelvic Surgery” was developed to incorporate both aspects of the field- the surgical and the non- surgical aspects, thus satisfying the AUGS urogynecologists and the SGS pelvic surgeons. 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 1995, the Urogynecology and Reconstructive Pelvic Surgery (URPS) subspecialty was formalized. A committee was formed, chaired by Dr. Morton Stenchever of ABOG, to write URPS learning objectives; two representatives of SGS were chosen Drs. Ray Lee and David Nichols and two representatives of AUGS were chosen, Drs. Richard Bump and Nicolette Horbach. The committee also included Dr. Butch Fowler, who had experience in developing the subspecialty of Gynecologic Oncology. Representatives of the Society of Urodynamics and Female Urology (SUFU) were involved as well.
In 1995, 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. This ABOG/ABU committee then became responsible for accreditation of fellowships. In 1996, the first fellowship program to be accredited was Dr. Tom Benson’s program in Indianapolis, ID.
The growth of the AUGS society quickened with many key events as noted:
- 1992- SmithBucklin assumed management of AUGS
- 1997 – Kimberly Clark provides endowment for creation of the June Allyson Foundation
- 1999 – 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 - Female Pelvic Medicine and Reconstructive Surgery is AUGS’ official journal
- 2011- AUGS and the AUGS Foundation Boards merge
- 2013 AUGS Foundation is renamed the PFD Research Foundation
- 2015 AUGS transitions to a stand-alone organization
Development of Female Pelvic Medicine and Reconstructive Surgery
- 1995 - Subspecialty is named Urogynecology and Reconstructive Pelvic Surgery
- 2000 - Urogynecology and Reconstructive Pelvic Surgery URPS is changed to Female Pelvic Medicine and Reconstructive Surgery (FPMRS).
- 2010 - 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 - June 2013 exam date for FPMRS is announced
- 2012 – FPMRS Exam test questions are written with collaboration of urology and gynecology
- 2013 FPMRS Fellowships accredited by ACGME for the first time
- 2013 - “Grandfathering” FPMRS written exam given
- 2015 - FPMRS oral boards given
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.