Female urology also called Female Pelvic medicine and reconstructive surgery is a subspecialty of urology that focuses on the diagnosis and treatment of urological conditions that affect the quality of life of women.
Because women have different anatomic and hormonal milieu than men, the urologic conditions and treatment options vary significantly. Over the past ten years that has been a significant advances in the field of Female Pelvic Medicine and reconstructive surgery (FPMRS) in both understanding of the disease processes and management options. Furthermore severe guidelines for management have been developed based on evidence-based studies to guide the clinician.
Common Urologic conditions which fall within the domain of Female Urology include, recurrent UTIs, overactive bladder, pelvic organ prolapse, urinary incontinence, urethral syndrome, urinary fistula, interstitial cystitis ( Bladder Pain Syndrome ), urethral diverticula, female urethra stricture
WHAT ARE CHRONIC URINARY TRACT INFECTIONS (UTIS) ?
Many women suffer from recurring urinary tract infections (UTIs), otherwise known as chronic UTIs. Recurrent UTIs are defined as having at least two infections in six months or three infections in one year. This condition is typically caused by gram negative , greater than 10^5 colony forming units per unit bacterial infection. In most cases each new infection is caused by a different strain of bacteria. Common symptoms of UTIs include urinary frequency, urgency dysuria, suprapubic discomfort and cloudy foul smelling urine. More severe symptoms may include fever or chills, flank pain, nausea and emesis typically involve the upper urinary tract ( kidneys and associated collecting systems ) . Patients with febrile UTis are considered cases of complicated UTIs and should undergo an upper urinary tract student to evaluate the kidneys and have a more aggressive course of antimicrobial agents.
WHAT IS PELVIC ORGAN PROLAPSE ?
Pelvic organ prolapse (POP) is a condition associated with laxity and defects of the muscles, ligaments and skin surrounding a woman’s vagina . These anatomic weaknesses cause pelvic organs such as the uterus, rectum, bladder, urethra, small bowel or vagina to prolapse out of their normal position. There are several grading systems which illustrate the degree of POP. Cystocele ( Bladder prolapse) , rectocele ( prolapse of the rectal wall/posterior compartment ), enterocele ( weakness of the cul de sac associated with bowel and intestinal herniation ), vaginal prolapse are the most common pathologies. Often POP is more a diffuse disorder of the pelvic floor and involve multiple comportment simultaneously .
This condition most commonly affects older women whose pelvic muscles and tissues are weakened or stretched from the effects of gravity, increased body mass index (BMI), loss of estrogren, strain of childbirth or previous pelvic surgery. Symptoms may include pelvic pressure and discomfort, sexual discomfort and problems urinating or defecating.
In severe cases female patients may develop bladder outlet obstruction and even bilateral hydronephrosis. However, many women remain asymptomatic.
Numerous transvaginal, abdominal, laparoscopic, or even robotic techniques have been developed to treat pelvic prolpase. Recent controversies and FDA warnings in the US have diminished the usage of synthetic mesh in the over the past 3 years. Usage of biologic allograft or native tissues have become more popular. Some patients prefer a non-surgical approach such as the usage of pessaries .A specialist in female urology should be familiar with the various types of pessary- they look like plastic donuts .
WHAT IS URINARY INCONTINENCE ?
Urinary incontinence, or the involuntary leakage of urine is one of the most common problems treated in female urology. It is important for the clinician to realize that there are several different types of urinary incontinence, each with a different cause and potential treatment options. These include stress incontinence, urge incontinence overflow incontinence, mixed incontinence ( simultaneous stress and urge incontinence ) , total incontinence and functional incontinence.
Improper diagnosis of the type of urinary incontinence is probably the most common reason for treatment failure. A detailed history and physical examination is of paramount importance in the proper diagnosis and sub typing of urinary incontinence. In select cases urodynamic testing or cystoscopy may be useful. A neurologic history and physical examination should be obtained in order to rule out neurogenic bladder.
Patients with “pure” stress urinary incontinence describe activity–related urinary leakage which interferes with their quality of life. Any increase in abdominal pressure such as coughing, sneezing, laughing, exercising, jumping, running, or event sexual activity may precipitate urinary leakage. Stress incontinence may or may not co-exist with pelvic organ prolapse. In most cases urethral hypermobility is noted with rotational descent of the urethra upon straining. The need for treatment is largely dictated by the degree that it affects the quality of life. Pad usage and pad weight are sometimes used to gauge disease severity
The current most popular surgical treatment to treat stress urinary incontinence is the suburethral sling . Transurethral bulking agent is another less successful and shorter duration treatment option. The suburethral sling can be performed using a synthetic mesh or biologic allograft, autologous rectus fascia . Abdominal procedures such as Burch urethropexy are effective but more invasive than the transvaginal sling procedures.
Currently, there is no approved medication for stress urinary incontinence. There is no evidence that estrogen therapy is effective in the management of stress urinary incontinence,
Patients with urge urinary incontinence report involuntary urinary leakage with bladder spasm and strong urges to void. Urge incontinence is one of the symptoms associated with overactive bladder . Overactive bladder is not necessarily aging or prior surgery. Most cases of overactive bladder and urge incontinence are idiopathic. Urge urinary incontinence is often associated with urinary urgency and frequency. However, a neurologic cause should always be ruled out ,particularly in younger patients.
Conclusion:
Female urologic disorders affect a large segment of the population. Female Urology also known know as Female pelvic medicine is a broad field. The surgical techniques are varied and technically challenging. The treatment options are best dictated by an accurate diagnosis. The most successful female urologists are the most astute diagnosticians.
Dr Angelo Gousse is a fellowship trained and Board Certified Female Urologist ( FPMRS ) . He currently directs a Female Urology Fellowship Program at the Bladder Health and Reconstructive Urology Institute in Florida . He is nationally recognized leader in the field.
Angelo E. Gousse, MD
Memorial Hospital Miramar,South Broward Hospital District 1951 SW 172 Avenue, Suite 305, Miramar,
FL, 33029 Tel: 954-362-2720 | Fax: 954-362-2761
