efforts to forge a stronger allegiance between these two organizations. And last year, I was honored to discuss the value of surgical registries, including a choir registry, at the SUFU meeting in Miami. So today, I'm happy to welcome the president of SUFU, Dr. Kathleen Kobashi, to present on behalf of SUFU. I'm sure you all know Dr. Kobashi. She's a clinical professor of urology at the University of Washington in Seattle, and is the head of the section of urology and renal transplantation at Virginia Mason Medical Center. And today, she's gonna speak to us on a very apt topic, a natural partnership, AUGS and SUFU. Kathleen? Thank you. Thank you. Thanks. Thanks. Thank you. Thanks. So, good morning. I'd like to thank Dr. Kunda for that very nice introduction. And most importantly, thank you so much for the opportunity and the privilege of being here to speak to you today. I think it's critical that we have that partnership, and I'm really appreciative of the opportunity. So, I don't stand behind the podium, because then you wouldn't be able to see me, and then a little nervous energy, and I might walk back and forth. So, I gotta tell a little story. Last night, I came in a little bit after midnight, and I was speaking with my fellow who said, I'm really looking forward to your talk tomorrow. And I said, no, it's on Friday. And he said, no, it's tomorrow. And I said, no, I think it's on Friday. And he sent me a screenshot, and I'm like, ah. So, I say that because if I have been remiss in including someone's picture or something that I should, please forgive me for that. Also, I think the moral of that story is that thank God for our fellows. And I think that's very apropos for this talk, because the fellows really are at the interface of our two fields that really should be one field in many ways. And they're the glue that bring us together. And I think that's something that really drives us to come together. We've got a responsibility to our successors and the up-and-comers to make sure that this goes forward in partnership. And I think that there's been a lot of great effort between AUGS and SUFU and IUGA and ICS to try to make that happen. I think it's always really important to think about where we came from. And if we can learn the history of where we came from, I think that helps us understand why we are where we are today and what the opportunities are for us moving forward. So, FPMRS was a long time coming. In the beginning, back in the 1960s, there were two visionaries, two gynecologists, Dr. Jack Robertson and Dr. Don Ostergaard. And I'm gonna interject a little bit of a story here as well, because I think that the seeds for urology and gynecology coming together at this interface might have actually started a little bit earlier. And I'll tell you, my dad's chief resident, both urologists, my dad and his chief resident, of course, Dr. John Prince was actually roommates with Dr. Ostergaard in college, as I understand. So, maybe it all started back then. But in any case, these two visionaries actually put together the first continence clinic in Orange County or in Southern California way back in the 60s, realizing that there was a whole contingent of patients who could really benefit from care regarding the pelvic floor. And eventually, these two were responsible for graduating the first fellows in urogynecology, as it was gonna come to be known, in the 70s. And in parallel with that, Urodynamic Society was started in 1969. And we just celebrated the 50th anniversary of the Urodynamic Society, which was held at the American Urologic Association meeting at the San Francisco Hilton in 1969. So, in parallel, there was a lot of interesting work going on. And I think you see that in history, a lot of interesting thoughts happen in parallel, but it's very important for us to come together because that makes us all the better. Again, we celebrated Dr. Tanago at the SUFU meeting this year. He was the only one who was still with us who was on that original sign-in sheets. It was a real honor to have him with us. But there are a lot of pioneers, a lot of urology side and a lot of gynecology side, who really were forward thinkers and brought us all together. And again, if I'm missing anybody, please let me know that, but please forgive me. But a lot of wonderful names that we all recognize here who are very much responsible for the foundation upon which we stand and the reason why we're here today. So a little bit of history. Back in the 1970s, there were a couple of, again, pioneers who had the vision to approach the OBGYN, the board, and ask for subspecialty, excuse me, there were subspecialty boards that were being formed and there was a group of people who thought maybe pelvic floor medicine, as it was gonna come to be known, should be one of those subspecialties. It didn't come to pass in the early 70s and I'll talk to you about why that is in a few minutes. But the Aerodynamic Society, which was established in 1969, had its first separate business meeting in 1973. And then in 1975, again, Dr. Ostergaard, on his sabbatical, really came to realize that we had a fragmented field that had the huge potential to coalesce into a wonderful field. Aerodynamic Society was incorporated in 1978 and OGGS, or the predecessor to OGGS, which was the Gynecologic Urology Society, was formulated at the same time, 1979. As I understand it, in someone's living room. So I suspect, it's in Orange County, so I suspect that might have been Dr. Ostergaard. But in any case, again, a pioneer and a huge forward thinker of our field. Urodynamics was an important focus from both the urology and the gynecology people who were thinking about this. The early urodynamic publications came from Dr. Hinman and Dr. Boyarsky and they looked at the dynamics of how the lower and upper urinary tract functioned. Again, however, Dr. Ostergaard and Dr. Robertson and then Dr. Hurt, bringing it back to Dr. Fantel, who was a resident at that time, went and studied urodynamics and brought it back to their institutions. And really, there was a lot of thinking going on about the role of this wonderful tool for us to diagnose lower urinary tract function. In the 1980s, the first annual GUS, which was going to be AUGS, soon to be AUGS, a meeting happened in New Orleans. And then in 1982, the term urogynecology, like I learned a lot putting this talk together. I didn't realize that it had been around for that long. But the president of GUS at that time was really pushing forward this terminology of urogynecology, which seemed like a very appropriate coming together of the fields. And then AUGS became officially AUGS in 1986. But the state of the state in the 70s and 80s, as I alluded to before, even though urodynamics was around, there wasn't really a standardized methodology by which we were all diagnosing or studying pelvic floor function. And because of that, the treatments weren't unified. The options were very few. Things like overactive bladder weren't even defined yet. And so there wasn't really, I mean, if somebody leeched, they got a birch or they got a needle suspension. It wasn't really scientific yet. I mean, it was really going that way, but it wasn't anything like what we are practicing nowadays. And so there really wasn't enough substance in the early 70s for the board to think that it warranted becoming a subspecialty of itself. And that was soon to change because everything was evolving. And as urodynamics really came into its own, it made it possible for us to assess the lower urinary tract function quantifiably. And that facilitated our being able to define normal and pathological states or abnormal states, and therefore provided the foundation for us to develop therapies to address these conditions. So in the early 90s, again, multi-society lobbying to the American Board of OBGYN Board of Directors was started again to define a formalized training and a formalized subspecialty, which again was going to become, come to be known as a FPMRS. Urogynecology and reconstructive pelvic surgery is what it was called then. And it was established in 1995, which was a very big year for us. ABOG and ABU formalized a relationship and a fellowship training initiative. And onward we went in partnership. We actually did approach our colorectal colleagues at that time, who declined at that time, but we do have a really nice working relationship with that sector of pelvic floor medicine as well. This is 24 years ago. Is that zero, right? Okay. It's like, did I? Okay, let me know if I get the X. So the name was changed to FPMRS in 2000. And then there was a joint application between urology and gynecology going forward together to the American Board of Medical Specialties to define us as an ACGME recognized subspecialty, which as you know, has come to pass. And the first exam, the first board exam was given in 2013. So the first research is coming up now. And I, again, that's part of the stuff that we're doing together in partnership, trying to iron out how that's gonna look. I'm not gonna say that it's not, we haven't hit some bumps in the road. It's not been all smooth sailing. However, as I tell my kids, if you're not uncomfortable, you're not growing, right? So you're gonna hit some bumps in the road. That happens with every interface between medicine to between specialty psych of, you know, plastics and orthopedics for hand plastics and derm, you know, whatever, sorry, for facial plastics, et cetera. But I mean, there's always gonna be interfaces because you're coming together, you're bringing two different groups together, but there is a Venn diagram and there's a lot in common that we have and we can do a lot better together. And I believe that's true for us. So fellowships, we now have, I think plus or minus if I miscounted, but 52 gynecology based fellowships, 13 urology based FPMRS fellowships, six of which I think are combined. And I might be off by a one or two, but the point is that we've really come together and move this field forward. Now, I'm also gonna say from our experience at Virginia Mason, you know, it doesn't come pre-packaged. Not every fellowship is gonna look the same. We don't have a fellowship trained urogynecologist from the gynecology side at Virginia Mason, but I've got a wonderful friend of mine, Julie Lacalme, who is fellowship trained and she's in one of our hospitals, Overlake Hospital. And she's been wonderful and gracious and has taken on our fellows for the urogynecology side. And I swear my fellows prefer to go spend time with her now than with me, but it's wonderful. So you gotta get creative and we can bring it together and really make a good partnership. So, you know, we've got urology and gynecology, but we've got much more overlapping here in the middle. First and foremost, care of our patients, excellent care of our patients, training our future, our responsibility to our up-and-comers and the successors and advancing the field through research and excellent record keeping and registries and that sort of thing. Now, I do think, and Dr. Cundiff and I have talked about this and I spoke with Dr. Menafee about it a little bit. You know, there are some things that we just don't overlap, like advocacy, maybe registries, that sort of thing. And we should support each other, but there's a lot in the middle that we could do together. So I think that's what I would foresee is sort of the vision that we would have to keep things moving forward. How have we done this? It's collaboration, collegiality, communication, really building the bridges. And it takes time and it takes effort, but I think it just makes sense. So what is a partnership? A partnership is a cooperation between two groups or however many groups to reach mutual interest. And I think the benefit of a partnership is that it amplifies the reach of the groups that come together and it increases the likelihood of both groups or however many groups in the partnership to achieve the goals. So looking forward, we have a huge opportunity to continue growing that. I think there's a great foundation that we've already started. And then we're gonna continue moving that forward. Multidisciplinary care, multidisciplinary research and discussions, learning from each other on all levels, meaning from attendings down to our interns, I think that's, and medical students, I think that's critical for us to do. There, and again, if I didn't have a picture on here, who's missing? Maybe Dr. Kondov, our president. So thank you again for allowing me to come here and talk to you about this and hopefully open up some roads. This is actually Dr. Kondov giving the Oggs Lecture at SUFU this year. And so thank you for doing that. It was wonderful. And we have an opportunity to reach out to other societies who interface with us also. And Dr. Menefee and Dr. Rosenblatt have been really great starts with trying to get communications open amongst all of our groups. And certainly there's more opportunity beyond that. So I think there's a lot of societies that touch this field. And then I think it's all nicely summarized in a quote that Dr. Menefee said to me the other day, we have a lot more in common than not. So I think that's that Venn diagram. And with that going forward, I think to steal what Peggy said, what Becky said, the future is bright. And I would like to continue growing that relationship. So thank you very much. Thanks. Thank you. Thank you.

partnership

pelvic floor medicine

collaboration

urology

gynecology