URPS + MIGS: Why seek a doctor that does both?

Many women have multiple conditions.  For example, they may want to keep their uterus but have symptomatic fibroids that need treatment.  They may also have a number of other conditions such as pelvic organ prolapse, bladder and bowel dysfunction, sexual dysfunction, and pelvic pain.  Combining URPS and MIGS allows women to have comprehensive care with a single physician.

About

Steven M. Minaglia, MD, MBA, FACOG, FACS works in the Division of Urogynecology and Reconstructive Pelvic Surgery in the Department of Obstetrics and Gynecology at the Queen's University Medical Group in Honolulu, Hawaii.  Dr. Minaglia is a Professor in the Department of Obstetrics and Gynecology and Women’s Health at the University of Hawaii, John A. Burns School of Medicine in Honolulu.  In 2016, he achieved the position of Associate Editor of Urogynecology, the official journal of the American Urogynecologic Society, The European Urogynaecological Association, The Mediterranean Incontience and Pelvic Floor Society, and the Italian Association of Urogynecology after beginning in 2010 as the journal's website editor.  As of June 30, 2024 he stepped down from the journal and began a 10-year tenure as a board examiner for the American Board of Obstetrics and Gynecology.

Dr. Minaglia is the only doctor in Hawaiʻi that is board certified in both Urogynecology & Reconstructive Pelvic Surgery and Obstetrics & Gynecology that holds an advanced practice designation in Minimally Invasive Gynecologic Surgery (MIGS). He holds both B. A. and M. D. degrees from the University of Chicago, where his undergraduate major was in the History, Philosophy, and Social Studies of Science and Medicine. He received special honors for his bachelor’s thesis entitled, “Articulating a professional ethic for the treatment of patients with contagious diseases”. He completed both a residency in Obstetrics and Gynecology and a 3-year accredited fellowship in Female Pelvic Medicine and Reconstructive Surgery at the University of Southern California where he received the Daniel R. Mishell, Jr., MD resident teaching award. More recently, he received the Masters of Business Administration degree from the University of Hawaii.

Dr. Minaglia specializes in vaginal and laparoscopic surgical approaches to treat uterine and vaginal prolapse, as well as treatments for fibroids, urinary and fecal incontinence and those that restore sexual health. He has a passion for teaching and lectures internationally on clinical advancements in urogynecology and trains physicians worldwide in techniques and procedures of minimally invasive reconstructive pelvic surgery, including advanced training programs beyond residency in Europe, South America, China, mainland US and Hawaii.  

Dr. Minaglia offers all urogynecologic and MIGS procedures as same-day discharge procedures.  Additionally he strives to provide the following procedures where appropriate:

Uterine preserving pelvic organ prolapse repairs and fibroid treatments

Mesh-free pelvic organ prolapse and urinary incontinence repairs

Dr. Minaglia enjoys long distance swimming, competes internationally and holds several local swimming records.  He has recently been inducted in multiple categories into the Hawaiʻi Swimming Hall of Fame Class of 2025.

Philosophy of care

"My philosophy of care is highly focused on patient choice.  I feel a strong sense of responsibility to each of my patients to give my expert opinion while at the same time to remain flexible and provide alternatives when they are safe and appropriate.  One of the most important parts of any medical visit is for a patient to feel heard and to be understood.  Problems can be solved and goals achieved through shared decision making when patients are most comfortable with their providers.  Over the years many patients have asked me what I would recommend to my own mother or my own wife in their situation.  Well, I have a mother, a wife, two sisters, three daughters, three nieces, and I work with almost exclusively women at this point in my career many of whom I care for as their physician.  I don't see or feel any differences in how I advise patients and I make it a point to be this way."

What is a Urogynecologist?

A urogynecologist is an obstetrician/gynecologist who specializes in the care of women with pelvic floor disorders. This field of medicine is also known as Urogynecology and Reconstructive Pelvic Surgery.  The pelvic floor is the muscles, ligaments, connective tissue, and nerves that help support and control the rectum, uterus, vagina, and bladder. The pelvic floor can be damaged by childbirth, repeated heavy lifting, chronic disease or surgery.

Although your primary care physician, Ob/Gyn, or urologist may have knowledge about these problems, a fellowship-trained urogynecologist offers considerable expertise. You should see or be referred to a urogynecologist when you have problems of prolapse, and/or troublesome urinary and/or fecal incontinence or when your primary doctor recommends consultation.

Other problems for which you or your doctor might think about consulting a urogynecologist include: problems with emptying the bladder or rectum, sexual dysfunction, and the need for special expertise in vaginal, vulvar, and/or labial surgery.

After medical school and a four-year residency in obstetrics/gynecology, a urogynecologist must complete a fellowship in Urogynecology and Reconstructive Pelvic Surgery (fka Female Pelvic Medicine and Reconstructive Surgery). This is an intensive, three-year surgical fellowship concentrating on treatment of the entire female pelvis including the vagina, uterus, bladder, and rectum.  Most urogynecologists have robust rotations in other fields like Urology and/or Colorectal Surgery during their fellowships.

In the past, women had to see several physicians to treat different components of pelvic floor disorders. Now, women can see one physician who is trained in managing the entire pelvic floor.

Urogynecologists are specialists in the evaluation and treatment of conditions that affect the female pelvic organs, and the muscles and connective tissue that support the organs. Their additional training focuses on the surgical and non-surgical treatment of non-cancerous gynecologic problems.

What is a Focused Practice Designation in Minimally Invasive Gynecologic Surgery (MIGS)?

Minimally invasive gynecologic surgery (MIGS) refers to a group of surgical procedures performed to treat various gynecological conditions such as fibroids, ovarian and intrauterine diseases, pelvic organ prolapse, and urinary incontinence using the most advanced techniques that require smaller incisions, resulting in less pain, faster recovery, and reduced risk of complications compared to traditional open surgery.  The American Board of Obstetrics and Gynecology grants this designation to surgeons meeting several rigorous standards.   Click here for more details.