Female urology is a subspecialty of urology that focuses on the diagnosis and treatment of urological conditions that commonly affect women. These conditions are due to the unique anatomy of the female urinary tract and reproductive system. Our expert team of urologists, including Dr. Yvonne Koch, one of the select few female urologists in South Florida to specialize in the unique urological needs of women, utilizes the latest technology to offer a comprehensive evaluation and treatment plan for these patients.
Urological Conditions in Women
Chronic urinary tract infections (UTIs)
Many women suffer from recurring urinary tract infections (UTIs), otherwise known as chronic UTIs. Chronic UTIs are defined as having at least two infections in six months or three infections in one year. This condition is typically caused by bacterial infection, with each new infection caused by a different strain of bacteria. It is unknown why some women are more prone to chronic UTIs. Symptoms of UTIs include frequent or intense urges to urinate; pain or burning sensation during urination; and milky, cloudy or reddish-brown urine. More severe symptoms may also include fever or chills, pain in the back or side, nausea and vomiting.
Find out more about Recurring Urinary Tract Infections: Your Questions Answered.
Pelvic floor prolapse
Pelvic floor prolapse is a condition in which the muscles, ligaments and skin surrounding a woman's vagina weaken or break, causing pelvic organs such as the uterus, rectum, bladder, urethra, small bowel or vagina to fall out of their normal position. This condition most commonly affects older women whose pelvic muscles and tissues are weakened or stretched from the effects of gravity, loss of estrogren, strain of childbirth or surgery. Symptoms may include pelvic pressure and discomfort, sexual discomfort and problems urinating or defecating. However, some women do not experience any symptoms.
Urethral syndrome is similar to a lower urinary tract infection, but the infection cannot be attributed to conventional bacterial. It may be caused by trauma, allergies, abnormal anatomical features or surgical scarring. Symptoms typically include the frequent urge to urinate, accompanied by pain or burning. Urine may appear cloudy or dark, or have an unpleasant odor. Women with urethral syndrome may also experience lower abdominal discomfort, bloating or vaginal discharge.
Urinary fistula is an abnormal opening within a urinary tract organ or an abnormal connection between a urinary tract organ and another organ. There are several types of urinary fistulas, with the most common being a fistula between the urinary tract and the vagina. The most common type of urinary fistula results from injury to the bladder during pelvic surgery, such as a hysterectomy or a caesarean section for childbirth. Other causes of urinary fistula include pelvic cancer, radiation therapy and inflammatory diseases. Symptoms of fistula may include constant urine leakage from the vagina, chronic urinary tract infections (UTIs), irritation in the vulva (external female genital organ), leakage of gas or feces into the vagina or fluid drainage from the vagina. They may also include diarrhea, abdominal pain, fever, weight loss, nausea or vomiting.
Urinary incontinence, or the involuntary leakage of urine, is a medical problem that can be treated or cured. There are several different types of incontinence, each with a different cause. These include stress incontinence, urge incontinence (also called "overactive bladder"), overflow incontinence, mixed incontinence, total incontinence and urogenital incontinence.
Learn more about the types of urinary incontinence.
Vaginal prolapsed is a type of pelvic floor prolapse in which the muscles of the vagina are weakened and allow other pelvic organs to push into the vaginal wall. These are several different types of vaginal prolapse, including rectocele (prolapsed rectum), cystocele (prolapsed bladder), urethrocele (prolapsed urethra), cystourethrocele (prolapsed bladder and urethra), enterocele (herniated small bowel), prolapsed uterus and vaginal vault prolapse.
Voiding dysfunction is a condition in which the bladder is not able to empty properly. Symptoms typically include frequent urination (urinating more than eight times per day), urgency (strong urge to urinate) and inability to empty the bladder.
Chronic Urinary Tract Infections Treatments
The common treatment for chronic urinary tract infections are low dose antibiotics taken daily for a period of six months or longer. Single doses of antibiotics may also be taken after sexual intercourse or a short course of antibiotics taken when symptoms appear. Steps to prevent or reduce the occurrence of infection are encouraged. This includes drinking plenty of water, drinking cranberry juice, urinating soon after you feel the urge to urinate (avoid "holding it"), wiping from front to back, taking showers instead of baths, cleaning the genital area before sexual intercourse and avoiding the use of scented douches or feminine hygiene products.
Pelvic Floor Prolapse and Vaginal Prolapse Solutions
Treatment will depend on the type of pelvic floor prolapse or vaginal prolapse you have. Your doctor may try several nonsurgical techniques to strengthen your vaginal muscles, but most women eventually require surgery.
- Medications. Menopause results in lower estrogen levels, which weakens the muscles of the vagina. Estrogen replacement therapy (ERT) may strengthen these muscles, although some people should not use ERT.
- Physical therapy. Physical therapy can include electrical stimulation and pelvic floor exercises. During electrical stimulation, the doctor applies small electrical currents to certain muscles in your vagina or pelvic floor. The current causes your muscles to contract, which strengthens them. You can also perform pelvic floor exercises, better known as Kegel exercises, to strengthen vaginal muscles.
- Medical Devices. Pessaries are rubber devices that come in a variety of shapes and can be inserted into the vagina to support the vaginal wall and help restore urinary continence. Pessaries are often used as a temporary solution to managing pelvic floor prolapse or as an option for women unable to undergo surgery.
- Surgery. Mount Sinai doctors commonly use robotic surgery to treat pelvic floor prolapse due to the complexity of these procedures. Below is each type of pelvic floor prolapse and vaginal prolapsed. Below is a brief description of the procedure used to correct each condition.
- Cystocele (bladder prolapse). The surgeon pushes the bladder back into place, repairs the connective tissue between the bladder and vagina to keep the bladder in its proper place, and removes extra tissue. If you have urinary incontinence, the surgeon will use a bladder neck suspension (a procedure that involves suturing the top of bladder to surrounding tissue for support) or sling to support your bladder and urethra.
- Enterocele (herniated small bowel) and vaginal vault prolapse. The surgeon performs a robotic sacrocolpopexy to secure the vaginal vault (the top of the vagina) to the sacrum (the base of the spine where it connects to the top of the pelvis).
- Rectocele (rectal prolapse). The surgeon secures the tissue between the vagina and rectum to keep the rectum in its proper place, and removes extra tissue.
- Uterine prolapse. In some cases, the surgeon may use a graft of human tissue or synthetic material to anchor the uterus and support other pelvic organs. However, most cases require a hysterectomy (removal of the uterus).
Urethral Syndrome Treatments
Symptoms of urethral syndrome typically respond to antibotics. If hormonal imbalance is suspected, hormone replacement therapy and oral contraceptive pills may also be used to manage symptoms.
Urinary Fistula Treatments
Small fistulas that are detected early may be treated by catheter drainage. However, the treatment for most fistulas is surgical repair. If you have infection associated with the fistula, your doctor may also prescribe antibiotics or other medications.
Urinary Incontinence, Overactive Bladder and Voiding Dysfunction Solutions
There are many options available to treat incontinence, depending on the cause of your incontinence, overactive bladder or voiding dysfunction. Behavioral training, lifestyle changes, pelvic floor exercises and medicines are usually tried first. If the problem does not resolve, your doctor may recommend medical devices, injections or surgery.
- Behavioral training. This generally includes bladder training and timed urination. Bladder training teaches individuals how to hold their urine for increasingly longer periods of time to prevent emergencies and leaks. Timed urination involves following a fixed urination schedule, whether you feel the urge to urinate or not.
- Lifestyle changes. Avoid drinking too much fluid, which can increase incontinence. Losing weight often helps stress incontinence by relieving pressure on bladder muscles. Identify and avoid foods that can irritate your bladder, such as citrus fruits, chocolate, tomatoes, vinegars, dairy products, aspartame and spicy foods. Also, avoid alcohol and caffeine. If you smoke, try to quit. This may reduce coughing, which can trigger stress incontinence.
- Exercises. Pelvic floor muscles, also called Kegel exercises, can help strengthen bladder muscles and help improve any type of urinary incontinence, including overactive bladder.
- Medication. These are several medications that can benefit individuals who suffer from stress incontinence and urge incontinence (overactive bladder).
- Medical devices. Medical devices like pessaries, urethral inserts and external urethra barriers help treat stress incontinence by keeping urine from leaking from the urethra.
- Self-catheterization. Total incontinence is usually treated by using a catheter to empty the bladder regularly.
- Injections. There are several injections that are used to treat incontinence.
- Collagen: The doctor injects collagen through a needle into the wall of the urethra. The collagen bulks up the urethral tissue and allows it to close up, preventing urine leakage.
- Botulinum toxin type a: Individuals with urge incontinence (overactive bladder) can receive injections of the toxin into the bladder muscle. The toxin paralyzes the bladder muscle and prevents the release of urine.
- Surgery. There are several surgical alternatives available to address different types of incontinence.
- Interstim: The surgeon implants a bladder pacemaker, which uses mild electrical stimulation of sacral nerves to regulate the behavior of the bladder and pelvic floor muscles.
- Vaginal sling: The surgeon introduces a synthetic or natural sling to support the bladder neck and urethra like a hammock. The sling, which is secured inside the abdomen, helps treat stress incontinence by keeping the urethra closed during physical activity.
- Bladder neck suspension: The surgeon secures the bladder neck to the pubic bone or a ligament connected to the pubic bone, which reinforces the urethra and bladder neck to prevent urinary leakage.
- Bladder reconstruction: The surgeon harvests tissue from the intestine or stomach and uses it to create a larger bladder. The surgeon may also reposition the ureter and urethra when creating the larger bladder.
If these methods of treating incontinence fail, absorbent pads or disposable underwear allow individuals with incontinence to manage the condition.
See a urologist for any of these symptoms:
- Abdominal pain
- Bloody urine
- Cloudy urine
- Fluid drainage from the vagina
- Frequent urination or urge to urinate
- Frequent urinary tract infections
- Irritation of the vulva (external female genital organ)
- Pain or burning sensation during urination
- Pelvic pain
- Urinary leakage