Urogynecology

Urogynecology

A urogynecologist is a gynecologist or urologist with advanced training, education, and certification in the evaluation and treatment of women with urinary symptoms (including involuntary leakage, frequent urination, and bladder pain), bowel symptoms (including involuntary leakage and constipation), and pelvic relaxation defects (loss of support of the pelvic organs such as the bladder, uterus, and rectum).  The formal name for our specialty is Female Pelvic Medicine & Reconstructive Surgery.

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Urogynecologist treats problems with leakage (urinary incontinence), pelvic prolapse, cystocele, rectocele, and overactive bladder. Urinary incontinence is a problem more common in women and vaginal childbirth is just one of the risk factors associated with it. Others include genetic predisposition, diuretic medication, chronic constipation, smoking, and obesity. Overactive bladders often mean experiencing leakage as well as frequent urges to urinate. Reasons are most commonly neurological, inflammations and in some cases – unknown.
Pelvic floor conditions as previously described are the main focus of urogynecology, and incontinence is just one manifestation. Others, more sever forms, include pelvic organ prolapse. Risk factors are the same as with urinary incontinence, with emphasis on obesity which dramatically increases the chances of pelvic prolapse

In case you experience any of the following symptoms:

  • Sense of heaviness, aching or fullness in the vagina
  • Leaking pee when coughing, laughing or spasming stomach muscles during exercise
  • Sudden and urgent need to pee, frequently
  • Repetitive infections of the urinary tract
  • Hard time emptying the bladder
  • A bulge or visible protrusions on the vagina

The majority of these problems tend to develop over time and are not congenital. Having a strong relationship of trust with your doctor and urogynecologist is vital. Trustful and meaningful sharing of all problems that you may have will lead to understanding and adequate healing. 

Urodynamics is a series of tests that evaluate how well your bladder, urinary sphincter, and urethra work.  These tests focus on how well the bladder empties and fills, and also help to diagnose incontinence.

Pelvic floor physical therapy is performed by a therapist that has specialized in the pelvic floor and its supporting structures.  They evaluate, manage, and treat pelvic floor dysfunction. This therapy is extremely useful for many disorders such as urinary and fecal incontinence, overactive bladder, pelvic pain, and pain with intercourse.

Bladder training can help control urinary symptoms such as leakage and overactive bladder.  This is a method of treatment that can avoid medications and/or surgery, and is great for motivated patients. 

A vaginal culture can easily be obtained in the office to help diagnose a vaginal infection and direct the appropriate treatment towards the organism found. 

A decline in estrogen levels after menopause can lead to changes in the skin of the vagina, urethra, and vulva.  This can lead to vaginal and bladder infections, urinary symptoms and vaginal dryness, which can lead to pain with intercourse.  Vaginal estrogen is a local (not systemic) treatment that can help with many problems we encounter later in life. 

A vaginal pessary is a silicone device, similar to a vaginal diaphragm, that is used to treat urinary incontinence or prolapse.  It is a good option for patients that are not good surgical candidates or those that would like to avoid surgery. 

A urinalysis is used to assess for urinary tract infection, and a urine culture is used to definitively diagnose a urinary tract infection. 

Midurethral slings are the best-studied incontinence surgery in history.  They have high levels of success and satisfaction and are done on an out-patient basis with minimal discomfort.  They are safe and treat stress urinary incontinence. 

Urethral bulking is a procedure that involves injecting a material, called a bulking agent, around the walls of the urethra in order to narrow its width.  This is a treatment for stress urinary incontinence. This procedure is done in an ambulatory setting, often times in the office.

Botox can be injected into the bladder to treat overactive bladder symptoms.  It has a success rate of 60 to 90%. This procedure can be done in the office or an ambulatory setting.

Cystoscopy is a procedure that lets your doctor look inside of your urethra and bladder using a special camera, called a cystoscope. This can be performed in the office.

Interstim is an implantable device that sends mild electrical impulses to the sacral nerves to treat urinary and fecal incontinence, urinary frequency, and incomplete bladder emptying. 

PTNS is a low risk, non-surgical treatment that provides electrical stimulation to the nerves responsible for bladder and pelvic floor function.  It is done in the office and is used to treat overactive bladder and urge urinary incontinence. 

This is an outpatient procedure that can help diagnose and treat interstitial cystitis. 

Bladder instillation is a combination drug therapy used to help painful bladder or interstitial cystitis symptoms.  It works by reducing inflammation and discomfort within the bladder and can be done in the office. 

Intermittent Self Catheterization is a method of manually draining the urine from your bladder.  This is ordered when different medical conditions lead to failure to fully empty the bladder or chronic retention of urine.  Your doctor or nurse will train you on how to perform this. 

A hysterectomy is a surgical procedure where the uterus is removed.  A robotic hysterectomy is when it is performed in a minimally invasive manner using the DaVinci Robotic platform.  This avoids the traditional “c-section” incision. 

Sacrocolpopexy is an abdominal operation to correct uterine prolapse or vaginal vault prolapse (in women who have had a hysterectomy).  This surgery offers long-term treatment of apical prolapse with success rates greater than 80%. If done robotically, it is a minimally invasive procedure that avoids the “c-section” incision and leads to faster recovery with minimal blood loss. 

Vaginal prolapse can be repaired with surgery through the vagina (as opposed to the abdomen).  Stitches are placed to support the vaginal walls to deep ligaments of the pelvis. 

Colpocleisis, or vaginal closure, is a procedure to correct bladder, uterine, or vaginal vault prolapse.  It is done for women who are no longer sexually active, often those who are older. 

These are useful links to describe common urogynecologic conditions and treatments.

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Urogynecology

A Urogynecologist is a specialist physician with training in both obstetrics and gynecology and urology. Focus tends to be placed on pelvic floor disorders involving the urinary tract and/or the bowel and rectum.

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