Urogynecological training, testing and treatment among gynecologists in Germany

OBJECTIVE: A survey was conducted to evaluate the urogynecology training of German gynecologists and the diagnostic tests and therapeutic options offered to women with incontinence or prolapse in hospital departments and private practices. STUDY DESIGN: Questionnaires were mailed to 3000 gynecologists in private practice and to 500 consultants in gynecology departments. The questionnaire included items on urogynecological training, diagnostic workup as well as conservative and surgical treatment options. RESULTS: The response rate was 16.8% with 589 of the 3500 questionnaires being returned. Less than one third of the respondents (28.6%) regard their training in urogynecology as good, 41% rate their training as moderate and 30.4% state that their urogynecology training during residency was inadequate. Male physicians significantly more often consider themselves well trained than women (p=.00006). The majority of gynecologists in private practice (74.7%) refer patients to a gynecological clinic for assessment of urogynecologic symptoms, 37.7% refer their patients to urologists in private practice, 10.4% to other gynecologists in private practice, and 10.4% to a urological clinic (percentages add up to more than 100% because multiple answers were allowed). Among the gynecologists who offer surgery, 81.2% perform retropubic TVT-operation and 80.1% colposuspension. Seventy-seven percentage of the gynecologists in private practice who do operations on an inpatient basis still perform anterior colporrhaphy to treat stress urinary incontinence compared to 62% of consultants in gynecological clinics (p<.05). CONCLUSION: One third of German gynecologists consider themselves inadequately trained in urogynecology. The results of our survey show that there is a need for improved general training during residency and for subspecialist training.