Counseling in Urogynecology: A Difficult Task, or Simply Good Surgeon-Patient Communication? EDITORIAL COMMENT

Surgical treatments used for pelvic organ prolapse (POP) and urinary incontinence (UI) have markedly changed in recent years. Concomitant with these changes, the patient-physician relationship has evolved over the last several years in large part due to patients asking for more information about their conditions as well as their desire to play an active role in the treatment decision-making process. Increasing reports of adverse outcomes in patients undergoing POP and UI surgery have prompted several scientific societies and researchers to emphasize the need to provide patients with thorough counseling before surgery. A Swedish National Register study documented the lack of adequate information provided before urogynecological surgery and also found that counseling is rarely provided. The criterion standard for excellence in clinical care has become patient-centered communication. To reach a shared understanding with patients of the risks and possible outcomes of surgery, clini-cians must be cognizant of their patients' perspectives, expectations, motivations, fears, concerns, and social contexts. Many patients believe that their urge urinary incontinence (UUI) is actually stress UI and may be confused and disappointed when SUI surgery does not successfully treat overactive bladder. The clinical aspects of the intended procedure must be clearly explained to help balance patients' expectations with realities of what is achievable during the procedure. Although it is clear that well-informed patients are more satisfied with results of surgery and recover faster, women with vaginal POP are poorly informed about their treatment options and potential outcomes. Urogynecology counseling is a crucial process through which patients can gain a clear understanding of their clinical condition, and the risks and benefits of potential treatment options. A patient-centered approach (providing information and allowing patients to participate in the decision-making process) is associated with better patient coping skills and treatment adherence as well as better care and outcomes. Many urogynecologists still believe that a proposed treatment plan and providing only enough detail to secure informed consent constitutes counseling. This article describes good counseling practice for female patients undergoing urogynecological surgery and suggests optimal methodologies for implementation