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What is UroGynecology?

Uro-Gynecology, or urogynecology, is a specialized area of medicine that combines gynecology and urology with the study and management of structural and functional changes of both the urological and gynecological systems in women.

What is Gynecologic Urology?

Gynecologic Urology, also referred to as Uro-gynecology, is a subspecialty within the field of Obstetrics and Gynecology. Uro-gynecology's specialty is female pelvic disorders such as pelvic organ prolapse (bulges that extend from the uterus into the vagina or extend out of the vagina), urinary incontinence, fecal incontinence and constipation.

Doctors that complete their residency in Obstetrics and Gynecology, then go onto complete fellowship training in Uro-gynecology, where they spend several years focusing only on Uro-gynecology and female pelvic disorders.

Pelvic Organ Prolapse and Pelvic Prolapse
Information, Resources & Physician Referrals

Pelvic Organ Prolapse also referred to as Pelvic Prolapse, is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown.

Pelvic Organ Prolapse is also referred to as; genital prolapse, pelvic relaxation, pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor dysfunction, urogenital prolapse, vaginal relaxation or vaginal vault prolapse.

Pelvic Prolapse is another term used for "Pelvic Organ Prolapse." Pelvic Prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown.

Pelvic Prolapse may also be called; genital prolapse, pelvic relaxation, pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor dysfunction, urogenital prolapse or vaginal vault prolapse.

What are the symptoms that indicate a woman is suffering from Pelvic Prolapse?

What is "Colposuspension" surgery?

Age and vaginal childbirth takes it toll on women's pelvic organs and this has lasting effects that cause a number of problems for women.

"Female Urinary Incontinence" is one of the most problems that most women - over 50% - that delivered one or more babies vaginally, have to contend with.

Women with female urinary incontinence have problems relating to urine "leakage" whenever they; strain, cough, laugh or run. This condition is also called "stress urinary incontinence" meaning the stress of physical activity, not emotional stress is causing her to "leak" urine.

The problems associated with female urinary incontinence are corrected in the the "floor" of the woman's pelvis by several methods or types of surgeries - one of which is called Colposuspension.

A woman's pelvic floor is a sheet of special muscles and ligaments that stretch across the inside of the female pelvis. Women can feel it "tighten" when they try to hold back the flow of urine - or when they strain, cough, laugh or run. The uterus and bladder are located above the pelvic floor. The vagina and the opening of the bladder (the urethra) pass through the pelvic floor. If the pelvic floor weakens, the uterus and bladder "drop" down. The control of the urine is thereby weakened.

Colposuspension surgery strengthens the pelvic floor to lift, or "suspend" the uterus and bladder back up to their correct position within the woman's pelvis.

The word "Colposuspension" comes from the Greek word for vagina, which is "colpos."

What is a "Suburethral Sling"?

A "Suburethral Sling" is a type of pelvic support that is constructed (surgically) from muscle, ligament, or synthetic mesh material that elevates the bladder from underneath in the treatment of stress urinary incontinence.

What happens during Suburethral Sling surgery?

In Suburethral Sling surgery, the surgeon inserts a supportive strap of material (called the suburethral sling) which elevates the woman's urethra and bladder neck, and then "anchors" it to each side of her pubic bone.

A Suburethral Sling is a medical "device" that is made from either a synthetic mesh, or the device can be fashioned from donor tissue or the patient's own tissue, which is cut from her abdominal wall. Although it is a more invasive procedure, some patients prefer using their own tissue, because synthetic material may erode into the urinary tract and cause infection or reduce effectiveness.

Newer techniques for Suburethral Sling insertion are minimally invasive, allowing for smaller incisions and shorter hospital stays. These techniques are "variations on the Suburethral Sling and they conceptually work the same way to provide a little hammock for support to the urethra.

What is a "Midurethral Sling"?

The "Midurethral Sling" is a minimally-invasive surgical procedure that is performed to treat women with Stress Urinary Incontinence.

What is a "Transobturator Sling"?

The Transobturator Sling is another minimally-invasive surgical procedure that is performed to help women with Female Stress Urinary Incontinence.

The Transobturator Sling surgery is performed by the doctor placing a narrow strip of tape or mesh in a position that provides support for the woman's urethra. The Transobturator Sling procedure eliminates some of the potential complications that come about from other Sling type surgical procedures that blindly passes a large needle carrier through the retropubic space.

What is Pelvic Reconstruction?

Pelvic Reconstruction is a surgical procedure performed by gynecologists or uro-gynecologies to repair pelvic organ prolapse and vaginal vault prolapse, among types of prolapse, and to correct the problem(s) and relieve the symptoms.

Typically, Pelvic Reconstruction is performed vaginally and uses an implant to reinforce the strength of the weakened pelvic tissues.

A Prolapsed Uterus refers to a collapsed uterus, or descended uterus, or other change in the position of the uterus in relation to the surrounding structures within the pelvis. The pelvis contains many soft tissue structures vital to normal body functions, supported primarily by the diaphragms, layers of muscles, fibrous coverings called fasciae, and various ligaments and tendons. These soft tissues of the pelvis derive their ultimate support from the bony pelvis.

A Prolapsed Uterus may be one of three types, depending on the severity:

• First-degree prolapse occurs when the uterus sags downward into the upper vagina.

• Second-degree prolapse occurs when the cervix is at or near the outside of the vagina.

• Third-degree prolapse (sometimes referred to as total prolapse) occurs when the entire uterus extends outside the vagina.

Colpopexy is the surgical suturing of the prolapsed vagina to a surrounding structure - such as the abdominal wall or the sacrum, which is then called Sacral Colpopexy or Sacrocolpopexy

Sacral Colpopexy, also referred to as also referred to as also referred to as also referred to as Sacrocolpopexy, is the preferred surgical procedure for treating and correcting Vaginal Vault Prolapse with excellent results. Sacral Colpopexy (Sacrocolpopexy) has a very high rate of success and the surgical procedure involves suturing a synthetic mesh that connects and supports the vagina to the sacrum, or tailbone. The Sacrocolpopexy operation is performed from the abdomen to support the vagina to the ligament on the spine (after previous or present surgery to remove the uterus) by using a synthetic mesh.

Why Is Sacral Colpopexy Performed?

Sacral Colpopexy is performed to treat severe protrusion or bulge(s) of the vagina after removal of the uterus.

A woman's vagina that has one or more of these vaginal protrusion(s) may experience one or more of the following:

• The vaginal lump/bulge or protrusion feels uncomfortable or causes pain.
• Difficulty with urination (e.g. unable to completely empty the bladder)
• Bowel difficulties (e.g. constipation, incomplete emptying of bowels)
• Pain
• Infection
• Bleeding

The objective of the Sacral Colpopexy operation is to relieve the woman's symptoms and to restore her vagina and her vaginal anatomy (as much as possible) and recover her sexual function.

Are there any risks associated with Sacral Colpopexy surgery?

Sacral Colpopexy surgery is a very common and relatively safe operation with excellent prognosis and outcomes. However, like any surgical procedure, there are complications which may occur. Possible complications from Sacrocolpopexy surgery may include:

• Bleeding
• Infection
• Injury to surrounding tissues (e.g. nerve or blood vessels, ureter, intestines)
• Formation of blood clot(s) in the legs or lungs
• Recurrence of problem
• Slow return of bowel or bladder function
• Erosion of synthetic material through vaginal mucosa

What Happens Before Sacral Colpopexy Surgery?

1. Blood tests, electrocardiography (ECG) and chest X-ray may be done to ensure that you are in optimal health for Sacral Colpopexy surgery.

2. Your doctor may prescribe oral or vaginal estrogen (hormone) if you are already menopausal. It is important to comply with this medication as it ensures that your vaginal tissues are optimal for surgery and healing.

3. You will be admitted to the hospital one day before Sacral Colpopexy surgery.

4. You will be given preparations to clear your bowels.

5. Your pubic hair surrounding your vagina and on your vulva will be shaved.

6. You will not be allowed to eat or drink after midnight on the day before the surgery.

7. All your medical and surgical conditions, if any, must be made known to the doctor and must be optimally controlled.

8. If you are on aspirin, please keep your doctor informed. You must stop taking aspirin at least one week before Sacral Colpopexy surgery.

What happens during the Sacral Colpopexy surgery?

The surgery is done under general or regional anesthesia. The anesthesiologist will discuss with you the advantages and disadvantages of both methods.

An abdominal incision is made. The synthetic mesh is stitched to the posterior surface of the vagina and to the ligaments in front of the spine.

A tube / drain may be inserted into the abdomen to monitor the bleeding.

Another tube will be inserted into the urethra as there may be difficulty in urination after the Sacral Colpopexy procedure.

Painkillers, laxatives and antibiotics would generally be prescribed after the procedure.

What happens after Sacral Colpopexy surgery?

1. Immediately after the operation, you may experience one or more of the following:

• Tiredness - You should rest and gradually increase your mobilization until you feel fit to return to your normal activities.

• Discomfort - In the lower part of the abdomen, over the incision. This is to be expected and painkillers should help to relieve the discomfort.

• Vaginal bleeding - Mild to moderate amount of reddish watery discharge after surgery is quite normal. You will need to wear a menstrual pad during the recovery period, but you will not be permitted to use tampons for obvious reasons.

2. One day after surgery, you will usually be allowed to drink and eat. You will be encouraged to move around. Blood chemistries and normal follow-up visits will be performed.

3. The catheter that was placed in your urethra is usually removed the day after surgery. The drain is usually removed two days after the operation.

4. You may be discharged on the third or fourth day after surgery if the doctor is pleased with your progress and the outcome of the Sacral Colpopexy procedure.

5. You should refrain from:

• Strenuous exercise for 2 months. You may return to normal activity after that, or upon clearance by your doctor.

• Using tampons, douching, sexual intercourse and driving for 4 weeks.

• Carrying heavy weights (> 10 pounds) for 6-8 weeks after Sacral Colpopexy surgery.

6. You should (immediately) return to the hospital or notify your doctor if you notic any of the following:

• Heavy vaginal bleeding
• Foul smelling vaginal discharge
• Severe abdominal distension and / or pain not relieved by painkillers
• High fever
• Pain associated with passing urine
• Difficulty in passing urine
• Constipation

Follow-up doctor visits after Sacrocolpopexy surgery

You will be examined by your doctor (at your doctor's office) at approximately; 2 weeks, 4 weeks, six months and and one year after Sacrocolpopexy surgery.

It is important to keep your follow-up appointments to ensure the best possible results.