By Debra Wood, RN, contributor

Although some nurses feel urology and urogynecology lack the cache of action-packed emergency medicine or critical care, nurses caring for patients with genitourinary conditions find satisfaction in resolving acute problems and helping patients manage chronic disorders.

“Urology is interesting, and there is a lot more to it than people realize,” said Marie Page, RN, CURN, president of the Society of Urologic Nurses and Associates (SUNA). “You can make a huge impact on somebody’s life if you can address any of these issues. The area of incontinence is huge.”

Incontinence presents a major obstacle to a satisfactory quality of life, yet many people consider it part of aging and never discuss it with their health care professionals. SUNA, in conjunction with the Simon Foundation for Continence, has launched an antistigma campaign to encourage people to seek medical care.

“People are now talking about incontinence, and for so very long they didn’t,” said Nancy Wood, RN, urogynecology nurse at Care New England’s Women & Infants Hospital of Rhode Island. “There are many treatment options available.”

Wood conducts urodynamic testing to evaluate how the body stores and passes urine. Components include measuring postvoid residuals, bladder capacity and pressure, and functional length of the urethra and its closing pressure.

“It’s problem solving,” Wood said. “When a patient presents with a problem, we’re investigators to determine what is causing the problem and to find the right fix.”

Physicians may recommend surgery or diet, exercise and medications to manage incontinence. Wood monitors medical patients’ progress. She said treatments allow most patients to stay dry, but surgery often offers an easier resolution than motivating patients to make lifelong lifestyle changes.

Pediatric nurse practitioner Anne Boisclair-Fahey, RN, MS, CPNP, also helps patients and their parents cope with chronic urolologic disorders. Most of her patients suffer from congenital conditions, but some have bedwetting or other issues.

“I love the variety,” Boisclair-Fahey said. “And there’s an ability to form a longer-lasting relationship with some of these kids.”

Boisclair-Fahey embraces the technical aspects of the field and the advancements that allow children to become more independent. For instance, surgically connecting the bladder to an abdominal stoma have made self-catheterizing easier for children.

Urologic operating room nurses have witnessed changes in procedures as new technologies have enabled less-invasive laparoscopic and robotic surgeries. Reggie Boone, RN, BSN, a team leader in urology services at St. John’s Mercy Hospital in St. Louis, Missouri, finds it fascinating to watch on a video screen as surgeons remove stones in the ureters and perform other procedures.

“The equipment has improved with better visualization, and you get a good grasp of what the physician is doing,” said Boone, who is responsible for ensuring the scopes and other equipment work. “My job is never the same. It’s a different challenge every day. I love my job and see results.”

John Botello, RN, a staff nurse on the urology unit at the University of Texas Medical Branch, in Galveston, Texas, takes care of patients recovering from such surgeries. Most stay 23 hours. He teaches them how to care for a foley catheter and other self-care.

As a urology case manager at the University of Texas Southwestern Medical Center at Dallas, Sally Brown, RN, spends all of her time preparing patients for surgery and coordinating their care after discharge. The hospital performs many specialized urological procedures, such as creating new bladders from bowel tissue, and conducts pioneering research in prostate-cancer treatment.

Taking care of patients with complicated cases keeps urology interesting for Stephanie Huckaby, RNC, urology unit manager at the University of Texas Southwestern Medical Center at Dallas. She did not find the specialty as gratifying in a community setting.

“We have people from all over the country that come here as a last resort,” Huckaby said. “We can fix them up and send them on their way.”

While kidney stones and some other urologic conditions lend themselves to relatively quick operative corrections, other genitourinary ailments require lifelong management. Nancy Brettschneider, RN, BSN, CURN, has worked in private practice for 20 years and specializes in these more difficult cases.

Her current position with Long Island Jewish Medical Center, in Great Neck, New York, includes collaboration with physicians to provide regular follow up to patients with interstitial cystitis. Treatments include instilling DSMO cocktails, anesthetics or other drugs through a catheter into the bladder weekly or biweekly.

“Interstitial cystitis patients have so much anger that it may take two to three visits to gain their trust,” Brettschneider said. “I enjoy working with chronic patients, because they are so grateful after time.”

Brettschneider believes strongly in the value of specialty certification. She actively participates in SUNA and is a past president of the American Board of Urology Allied Health Professionals.

“It’s important to take part at the national and local level in order to improve patient care and be an advocate for your patients,” Brettschneider said.

SUNA holds two conferences annually. Topics at the fall conference include kidney stones, sexual dysfunction, cancer and prostate issues. Members also receive a peer-reviewed journal and newsletters.

Two investigators will receive funding through SUNA’s recently launched research funding program. The association also monitors legislation of interest to its members and educates Congress about the importance of supporting programs to ease the nursing shortage and funding the Training and Research in Urology Act of 2004 (S 2361/HR 1002). The legislation will create new research centers and increase the number of investigators working in the urology through loan-repayment programs.

SUNA collaborates with other nursing organizations that share common interests, such as the Wound, Ostomy and Continence Nurses Society. SUNA educates professionals and the general public about bladder health issues and treatments for incontinence.

Millions of people suffer from urological conditions and many nurses find satisfaction in caring for them and helping them manage their disorders.

“There are many opportunities in nursing to chose from,” Huckaby said. “Urology, as a specialty, is very interesting and rewarding. We have a very low turnover rate. You get to help so many people.”

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