“This fellowship was one of the first FPRMS fellowships and one of only three ever created which fully incorporated both urology and gynecology in a single training program,” said Roger Dmochowski, MD.
A two-year urology fellowship training program focused on women’s urologic health and reconstruction, known as Female Pelvic Medicine and Reconstructive Surgery (FPMRS), is celebrating its 20th anniversary and graduating its 20th fellow in June at Vanderbilt University Medical Center.
FPMRS fellows, selected one per year after completing a urology residency, spend two years learning to manage adult patients with urinary and pelvic conditions including urinary incontinence, pelvic organ prolapse, voiding dysfunction and neurogenic lower urinary tract dysfunction. Additional aspects of pelvic and urinary reconstruction include surgical repair of urinary fistulas, diverticular disease, urinary diversion and cancer survivorship. FPMRS is a multidisciplinary subspecialty that includes both urologists and gynecologists, all of whom complete the same fellowship-level training regardless of background.
There continues to be a growing and critical need for FPMRS-trained specialists. It is estimated that half of all women will suffer from urinary incontinence during their life, which will represent about 28.4 million U.S. women by the year 2050. About 20% will undergo some form of pelvic surgery in their lifetime.
“This fellowship was one of the first FPRMS fellowships and one of only three ever created which fully incorporated both urology and gynecology in a single training program,” said Roger Dmochowski, MD, professor of Urology and Surgery, who started the fellowship in 2002. The VUMC program was first accredited in 2013 and has trained both urologists and gynecologists as a combined program since 2008.
“The intent of these programs was to improve the care of women with pelvic health disorders. Our program was and remains still a pioneer in training the next generation of specialists in the field and has contributed substantially to the advancement of care of women. This is a tremendous group of practitioners, and it is humbling to be a part of such an amazing effort,” he said.
Three urologists now on faculty — Stuart Reynolds, MD, Melissa Kaufman, MD, PhD, and Elisabeth Sebesta, MD — completed the fellowship after their urology residency and decided to stay at VUMC to continue specializing in FPMRS practice.
The multidisciplinary faculty also includes Niels Johnsen, MD, MPH, who specializes in male urologic reconstruction, and Lindsey McKernan, PhD, MPH, a health psychologist, as well as urogynecologists Rony Adam, MD, Daniel Biller, MD, and Carl Zimmerman, MD, gastroenterologists and colorectal surgeons. Shelli Burton, APRN, ANCP-BC, and Sara Francescon, MSN, RN, FNP-C, are the nurse practitioners who are a vital part of the care delivery, Dmochowski said.
“Dr. Dmochowski was visionary setting up the program when he came here and recognized the need for it,” said Reynolds, an associate professor of Urology who replaced Dmochowski as director of the FPMRS in 2020. “It is one of the best training programs in the country with lots of experience and exposure across a wide range of conditions and complexity, including the simplest of cases, as well as the most complex. We see people from the entire Southeast who come here as the last line of care, desperate for someone to help them, and we’re able to really change the course and quality of their life.
“As a fellow we all got the experience and exposure that motivated us to stay here at VUMC and be a part of this program that we had contributed to and wanted to carry into the next chapter. Along with that is the commitment from our department, and from the institution, to continue to build this from a one or two-person group to now a four or five-person group,” he added.
In July 2023, the FPMRS program will split into two distinct programs, with a new program separately administered by the Department of Obstetrics and Gynecology as well as the current program in the Department of Urology.
Graduates of the fellowship have gone on to be leaders in academic centers and private practices around the country, including as urology department chairs, division chiefs and leaders. Kaufman is now chief of the Division of Reconstructive Urology and Pelvic Health at VUMC.
“It remains a singular honor to have trained with Dr. Dmochowski,” Kaufman said. “The culture fostered in this program through the decades truly reflects the very definition of fellowship as ‘a community of interest, activity, feeling or experience.’ Although that certainly applies at Vanderbilt FPMRS, it is the accessory definitions that resonate most: a company of equals or friends, the quality or state of camaraderie.”
“Under Reynolds’ thoughtful leadership, Vanderbilt FPMRS will continue to provide opportunity to develop both clinical skills and lifelong relationships that will serve patients and develop careers. I came to Vanderbilt 21 years ago because of my perception of the prospect to obtain comprehensive urologic surgical training in an atmosphere of camaraderie. I stayed because my perception was reality. Providing care to the breadth of patients we encounter is truly an exceptional privilege, and contributing to the evolution of our fellows, who are my current and future colleagues, as they learn to approach each patient with professional passion is a profound privilege and a hallmark of our Urology FPMRS program.”
Sebesta, an assistant professor of Urology who completed the fellowship in 2022, said she considers the FPMRS urology fellowship at Vanderbilt as one of the best training programs in the country to specialize in pelvic reconstruction and complex urologic care for patients who are often marginalized.
“It is a huge honor to have trained here, and even more so to have the opportunity to continue as a faculty member in the program and to contribute to the training of future fellows. Dr. Dmochowski created a fellowship and a division at Vanderbilt that is second to none, and he has trained so many of the top leaders in the field—including Drs. Reynolds and Kaufman,” Sebesta said.
“More important than the excellent training, however, is the people and the relationships formed here. The fellowship radiates a culture of lifelong mentorship coming from the top down. And all the past and current fellows of the program count each other as a family. It is my distinct privilege to be a part of something so special.”