Urologists, Gyns. Vie for Pelvic Turf.

The proposed joint urology-gynecology subspecialty of pelvic floor medicine and reconstructive surgery continues to expand despite concerns by some ob.gyns. that this is but one example of urologists trying to take more business from their specialty.

The proposed subspecialty, which focuses largely on treating pelvic floor disorders, including prolapse and urinary and fecal incontinence, was approved in 1996 by the American Board of Obstetrics and Gynecology. About 18 months ago, the American Board of Urology and ABOG agreeed to make pelvic floor medicine a joint subspecialty. Physicians receive their training in 1 of 18 approved fellowship programs, including 2 programs that were approved in January. A total of 25 such programs are needed before pelvic floor medicine can be considered for formal subspecialty status.

Almost all of the programs are in ob.gyn. departments, and most fellows are ob.gyns. Still, there is some concern among ob.gyns. that urologists are encroaching on gynecologists' territory.

Dr. Donald Ostergaard, professor of ob.gyn. at the University of California, Irvine, said he thinks that urologists' increasing interest in urogynecology is a resuit of changes in the treatment of male urologic problems.

"Various [surgeries] have been taken away from them," said Dr. Ostergaard, who is also chief of the urogynecology division at Long Beach (Calif.) Memorial Medical Center. "There's no more stone surgery because of lithotripsy and no more surgery for benign prostatic hypertrophy [because it's treated medically]. So they're looking for other things to do."

Dr. Ostergaard is concerned that joining the proposed subspecialty may be part of a larger plan by urologists to provide more gynecologic services. He worries that the urologists will not be adequately trained to deal with women's problems.

"You have to have a lot of experience dealing with women and their problems--like menopause and contraception. The urologists are more procedure oriented; they take a year of surgery training before they start urology training. They're not used to a big office practice with annual exams for women," he said.