Female Pelvic Medicine and Reconstructive Surgery

During this third-year rotation, you will gain further experience in the diagnosis and management of pelvic floor disorders such as urinary incontinence and pelvic organ prolapse.

You will care for a mature female population that will often discuss issues such as menopausal symptoms and sexual dysfunction at the time of their preventative screening. You will learn how to address these issues with patients during their visits.

You will learn how to obtain a complete history from a patient, how to conduct a physical examination to evaluate urinary incontinence and genital prolapse in both standing and supine positions, and how to draw appropriate conclusions from the clinical examination.

Under the guidance of an attending physician, you will also be instructed how to perform urethrocystoscopy and identify ureteric orifices, stones, polyps and urethral abnormalities, and how to interpret urodynamics for evaluation of urinary tract symptoms.

You will be required to keep a case list of all office and surgical patients seen, to be reviewed at the end of the rotation.

Conditions Seen

You will be taught to understand risk factors for, etiologies of, and prevalence of the following common pelvic floor disorders:

  • stress urinary incontinence
  • overactive bladder
  • neurogenic bladder
  • fistula (urinary/bowel)
  • recurrent urinary tract infection
  • interstitial cystitis/Painful Bladder Syndrome
  • voiding dysfunction
  • pelvic organ prolapse
  • fecal incontinence
  • defecatory dysfunction

For the above disorders, you will be expected to prepare standard management plans that include:

  • conservative approach
  • medical approach (medical options, indications, contraindications, side effects)
  • surgical approach (indications for surgery, various surgical approaches, risks and success rates of such procedures)

Procedural Skills Objectives

During your rotation, you will be expected to:

  • demonstrate skill, appropriate for level of training, in cystoscopy (office and intra-operatively); vaginal surgery, including anterior, posterior and enterocoele repairs; and vaginal hysterectomy
  • fit the appropriate type of pessary for incontinence and prolapse
  • participate in advanced minimally invasive surgical procedures for stress incontinence and genital prolapse

Caseload

  • Eight to 10 patients, on average, per day