From an early age, Alex Berger knew he wanted to be a doctor, having witnessed the compassionate care his mother received during her battle with breast cancer. After medical school, he began training in general obstetrics and gynecology, but during his residency he got a chance to work with experts in a new subspecialty - female pelvic medicine and reconstructive surgery. Though it had only been certified as a subspecialty a few years earlier, in 2013, Berger quickly saw how much the field had to offer. Patients came in suffering and debilitated by uncomfortable conditions, such as a prolapsed uterus, often also feeling embarrassed by related problems, such as incontinence. "But then through our therapies, treatments and surgeries, they really got better," he recalls. "It was just so nice to see." The experience inspired him to pursue additional training in the subspecialty. Last year, he joined the UCSF's Gynecologic Surgery and Urogynecology clinic. We talked to him about why he finds his practice fulfilling and the promise he sees in his field's future.
Doctor Q&A: Alex Berger
Q: What does it mean to be a specialist in female pelvic medicine?
A: In general terms, it means taking care of the pelvic floor. You know, there's the bony pelvis, and then there's muscles and nerves and ligaments within it that support the organs inside. I treat the conditions that affect that area. If someone's bladder isn't working, or their rectum isn't working, I figure out why and help with treatments and surgery that will make that person feel better.
Q: How is your care different from what a general urologist or gynecologist does?
A: Specialists in my field have an additional three years of fellowship training where we see thousands of patients with pelvic floor disorders and do hundreds of surgeries and procedures and take exams to demonstrate our proficiency. So, if patient comes in with a prolapsed rectum, maybe that's something urologists or gynecologists have only seen once in their training many years ago, but they don't actually perform the surgery to fix it. Or maybe they know one type of surgery but not the variety of procedures we do in our office. Because of my training, I can provide patients with more options and more comprehensive care. I can be focused on what they need, rather than what I know how to do.
Q: Do a lot of women have pelvic floor problems?
A: It's huge. Probably two-thirds of women have one of these disorders in their lifetime. And the problems are widely misunderstood. Women think, "I had a baby, so it's normal that I'm leaking urine. It's normal for me to have pain." People don't realize there are treatments – that we exist and are here to help them.
Q: Is surgery the only treatment for these disorders?
A: Not at all. Probably 20 percent to 30 percent of my patients with incontinence or prolapse go to physical therapy. We also use biofeedback and other behavioral therapies to treat incontinence or constipation. If surgery is needed, 99.99 percent of the time, I use minimally invasive procedures with very small incisions. We used to do big incisions – but not anymore. In fact, I can do most procedures in my office, which is easier on patients and they can go home the same day. Just yesterday, I did a robotic-assisted laparoscopic prolapse repair and the patient went home that night.
Q: What brought you to UCSF?
A: I was excited by the opportunity to help develop our Women's Center for Bladder & Pelvic Health. We have a whole team here, including urologists, colorectal surgeons, specially trained nurses and physical therapists – not to mention the network of physicians throughout UCSF that I can consult with. So we're really able to provide options and comprehensive care for this population of women who often don't get the care they need. Just recently, I had a patient who had a fistula, which is a hole between the vagina and rectum that allows feces to leak into the vagina. She couldn't find a surgeon in her hometown who knew how to treat it. When she came to us, one of our colorectal surgeons and I worked together to evaluate her, come up with a treatment plan and perform surgery. Having it all under one roof makes things easier for the patient and gives them better care…. Another thing that made UCSF appealing to me is that it's an academic institution where there's the opportunity to do research.
Q: What is the focus of your research?
A: My research is all about improving and advancing the care of women who have surgery for the conditions I treat. Probably my most impactful study was one looking at 13,000 or 14,000 patients over 10 years to see whether there was any difference in outcomes if they stayed in the hospital overnight after surgery or went home the same day. I found there wasn't any difference. The study showed there's no medical reason to keep patients in the hospital overnight. Patients like that, too: They don't want to stay in the hospital. They want to be back home in their own beds. I'm excited to do research that improves options for our patients and makes them safer. Since this is a new field, it's evolving quickly. I think we have a lot of opportunities to advance it over the next few years.
Q: What's one thing you love about your job?
A: In my specialty, I get to sit and really talk to people. So often in medicine, we only get five minutes with a patient, but I can spend as much as 45 minutes with someone going over the situation and exploring treatment options. Spending that time getting to know them and figuring out how I can help is really a joy.