Female Urology / Urodynamics Fellowships

Numerous training programs are available in this growing field. Fellowship accreditation, however is very confusing.

The American Board of Urology (ABU) and the American Board of Obstetrics and Gynecology (ABOG) have created a combined accreditation board for fellowships in female pelvic surgery. The fellowship requires 2 years of training for urologists and 3 years for gynecologists; urologists may enter programs for which a gynecologist serves as program director and vice versa. One year must be dedicated to research, with no more than 10% of the urology fellow’s time spent on non–research-related activities. Further, the program mandates graduate coursework in biostatistics/epidemiology and completion of a thesis project. The Board also monitors clinical case volume/diversity and the level of didactic teaching received. At present, there are 31 accredited fellowships under ABU/ABOG sponsorship.

Under the umbrella of the specialty of Urology, there are excellent fellowships that are not accredited by the ABU/ABOG. Some of these programs also incorporate neurogenic and male voiding dysfunction.

To make matters more complex, the American Board of Obstetrics and Gynecology (ABOG) also offers accreditation in urogynecology independent of the ABU. One 3-year position is generally available to gynecologists at each institution. Interestingly, a urologist serves as a program director for two of these programs.

In the future, Society for Urodynamics and Female Urology (SUFU) accreditation of fellowship programs is expected. Current leaders envision training of fellows in five separate modules: (1) urodynamics (mandatory); (2) lower urinary tract symptoms and urinary incontinence in the male and female (mandatory); (3) pelvic organ prolapse; (4) voiding dysfunction (neurogenic and non-neurogenic); and (5) genitourinary reconstruction. Participating physicians will need to complete only four modules, including the mandatory components, to finish training, allowing physicians the flexibility to personalize their education based on their personal interests. A combined ABU/ABOG/SUFU-accredited program represents the fellowship of the future; ABU/ABOG certification (remember, different from accreditation) may follow.

Why do a Female Urology / Urodynamics Fellowship?
Almost all training programs afford in-depth training in surgical reconstruction of the female pelvic floor and urodynamics. A few fellowships also incorporate training in neurogenic and male voiding dysfunction. Clinical problems addressed in this field effect a huge proportion of the population. As the baby-boomers age, skills acquired in these fellowships are likely to only grow in demand. Such expertise are clearly extremely valuable both in academics and in private practice. In the current reimbursement environment, this field is considered quite lucrative. There are also very few, if any, emergencies. For those with a passion for academics, research opportunities abound.

Why not?
Commitment of 1-2 years is significant and may be unnecessary for some who had strong training in this urologic sub-specialty during residency and are planning to go into private practice. Caring for female patients with voiding dysfunction is certainly challenging, and some individuals' personalities and clinical approach may not be suited for this particular patient population.