Female pelvic floor disorders—including incontinence, pelvic organ prolapse, urinary tract infections, fistulas, and others—can significantly impact one’s quality of life and, as the population ages, are becoming more common. In fact, 300,000 prolapse repairs and 100,000 urinary incontinence procedures were performed in the past year alone.
To meet the growing need for expert urogynecology care, Weill Cornell Medicine’s Department of Urology established the Center for Female Pelvic Health in early 2016.
Dr. Patrick Culligan, a nationally recognized leader in urogynecology, joined Weill Cornell Medicine to lead the program. Under his direction, the Center has three goals: to facilitate cutting-edge research, train the next generation of urogynecology specialists, and offer the best possible surgical and non-surgical treatments to patients.
Becoming a leader in the field
Dr. Culligan was first drawn to obstetrics and gynecology because of the interesting mix of medicine and surgery. “Delivering babies is wonderful; it’s true,” he says. “But I found myself more and more interested in surgery.”
“Urogynecology is particularly interesting,” explains Dr. Culligan, “because each patient has a specific problem associated with their unique anatomy and severity of symptoms. It’s like a puzzle.” He finds it very gratifying to improve a patient’s quality of life, and surgery is one of the tools Dr. Culligan uses to do this.
After completing his training, he practiced at the University of Louisville and co-founded a board-certified fellowship program in Female Pelvic Medicine and Reconstructive Surgery. He also earned a reputation as an expert in advanced minimally invasive surgical techniques, including laparoscopic sacrocolpopexy.
Dr. Culligan then founded the Division of Urogynecology and Reconstructive Pelvic Surgery at The Atlantic Health System in New Jersey. There, he developed another fellowship program and continued his clinical research focusing on improving minimally invasive surgical techniques. He became a world-renowned expert in robotic-assisted laparoscopic surgery. Robotic assistance improves the surgeon’s visualization, control, and comfort, so that the procedure can be performed more efficiently.
Dr. Culligan’s passion for research and teaching led him to Weill Cornell Medicine. “I am surrounded by like-minded peers here,” he explains. “It’s a good fit for me.” He can tap into Weill Cornell Medicine’s academic and clinical resources to help shape the future of the field.
Personalized approach to patient care
Urogynecologic conditions can be uniquely frustrating and embarrassing for patients, so physicians must be personable and easy to talk to, in addition to being expert diagnosticians and surgeons. Throughout Dr. Culligan’s extensive training, he has earned a reputation for providing excellent patient care that focuses on individualized treatment and education.
“I never assume what’s going on with the patient,” he says. “It comes down to doing an individualized assessment with a discussion of treatment goals.” This leads to a personalized plan that includes discussion and consideration of all surgical and non-surgical options. Dr. Culligan and the patient take it one step at a time. He usually begins with the non-surgical option.
One patient praised this approach, writing, “He is a skilled surgeon and someone who can relate to patients in a way that makes them comfortable enough to ask questions. He is clear in explaining procedures and his demeanor is calm and reassuring.”
Approximately half of Dr. Culligan’s patients choose non-surgical treatments, which include pelvic floor muscle exercises, medications, pessaries for pelvic organ prolapse, and new technologies, such as posterior tibial nerve stimulation, to treat overactive bladder and incontinence.
For patients who elect or require surgery, Dr. Culligan strives to offer minimally invasive options as often as possible. Most procedures are performed laparoscopically, which is safer and reduces the patient’s blood loss and recovery time.
Committed to patient education
One of Dr. Culligan’s central goals when meeting with patients is helping them better understand their treatment options. To do this, Dr. Culligan uses a variety of presentations and resources, including an interactive application that he developed called POP-Q. This app visually demonstrates pelvic organ prolapse to the patient with images before and after the repair. The app can be individualized to the patient’s specific anatomy and treatment plan.
“Not only did he perform a successful surgery,” wrote one patient, “but he also collaborated with other experts to ensure a comprehensive approach to my care. His gentle demeanor and professionalism before, during and after my hospital stay has been consistent. He is reachable, approachable and sincerely interested in my well-being.”
Helping women advocate for themselves
Dr. Culligan believes education is vital for patients to choose the best treatment plan for themselves, but knows that it can be difficult for women to make the first step to find treatment. He advises women seeking help for a urogynecologic condition to find someone who has had specialized training in the field, preferably someone board certified in Female Pelvic Medicine and Reconstructive Surgery. He also believes that it’s important to find someone with broad training in vaginal and laparoscopic surgical approaches.
“If you find a doctor who has one go-to approach, he or she will tailor all patients to that one approach,” he explains. “As a patient, you want to have all the options and sub-options available for your treatment to get the best result and quality of life that you’re looking for. Next, it’s a matter of finding someone that you’re comfortable talking to.”
A growing and rapidly changing field
Urogynecology is a relatively young and growing specialty within urology: it became recognized in 2011 by the American Board of Medical Subspecialties and the first board certification exam in female pelvic medicine was given in 2013.
“Due to our aging population, the demand for urogynecology specialists will increase significantly in the years to come,” Dr. Culligan explains. “There’s a strong need to train more doctors.”
Furthermore, he hopes that urogynecology academic research will lead to advancements in laparoscopic and robotic-assisted surgical procedures, including a laparoscopic approach to inserting vaginal mesh. This will improve short- and long-term results, as well as patient safety.
“Currently, most surgeries are minimally invasive—which is a great thing,” says Dr. Culligan. “To that end, we need more high-quality clinical research studies and good long-term outcome measurement tools. And that’s what we’re working on here at Weill Cornell.”