WhatsAppSurgical Treatment of Female Pelvic Floor Disorders
Urogynecology provides the surgical treatment of pelvic floor disorders in women, such as stress urinary incontinence, pelvic organ prolapse and urinary tract fistulas. This specialty, positioned at the intersection of urology and gynecology, offers a broad surgical range extending from TVT/TOT sling procedures to robotic sacrocolpopexy. Where required, a coordinated approach is adopted with the urology, gynecology and obstetrics, and physical medicine and rehabilitation departments.
Contents
What Is Urogynecology?
Urogynecology is a specialty positioned at the intersection of urology and gynecology that deals with functional disorders of the lower urinary tract (bladder, urethra) and of the pelvic floor muscles and ligaments in women. The pelvic floor can weaken through factors such as childbirth, menopause, chronic constipation or obesity; this leads to serious quality-of-life problems such as urinary incontinence and organ prolapse. In the department, surgical and non-surgical treatment methods are assessed together and an individualised treatment plan is drawn up.
Which Diseases and Conditions Are Treated Surgically?
- Stress urinary incontinence (SUI): Involuntary leakage of urine during coughing, sneezing or exercise; an indication for mid-urethral sling surgery
- Pelvic organ prolapse (POP): Bladder prolapse (cystocele), uterine prolapse, rectal prolapse (rectocele), small bowel prolapse (enterocele)
- Vaginal vault prolapse: Descent of the upper vaginal segment after hysterectomy; an indication for sacrocolpopexy
- Urinary tract fistulas: An abnormal opening between the bladder or urethra and the vagina (vesicovaginal fistula)
- Overactive bladder that does not respond to conservative treatment; an indication for botulinum toxin injection or sacral neuromodulation
- Chronic pelvic pain, constipation or dyspareunia accompanying pelvic floor dysfunction
- Combined prolapse: Prolapse of more than one pelvic organ at the same time
When Should You Consult Us?
- Leakage of urine when coughing, sneezing or exercising
- Sudden, severe urinary urgency and being unable to reach the toilet in time
- Passing urine eight or more times a day
- A sensation of something descending or protruding in the vagina
- Difficulty passing urine or a feeling of incomplete emptying
- A sensation of chronic pelvic pressure and pain
- Pain during intercourse (dyspareunia) or bleeding
- Continuous fluid leaking from the vagina (suspected fistula): this is not an emergency, but it should be assessed without delay
These symptoms are nothing to be embarrassed about; effective surgical and non-surgical treatment options are available. Consulting a specialist early may reduce the need for surgery.
Preoperative Assessment and Diagnostic Methods
Before urogynecological surgery, a comprehensive functional and anatomical assessment is carried out so that the correct procedure can be selected. The preoperative assessment covers the following steps:
| Method | What it is used for |
|---|---|
| A comprehensive functional test measuring bladder filling and voiding pressures, urethral resistance and detrusor activity. It is the gold standard for distinguishing stress incontinence from urge incontinence and directly determines the choice of surgical method. | |
| The Pelvic Organ Prolapse Quantification system measures the anatomical position and severity of the prolapse in a standardised way; the stage I-IV classification guides the treatment decision. | |
| Pelvic floor anatomy, urethral mobility and bladder neck position are assessed without the use of radiation. | |
| Direct visualisation of the inner surface of the bladder; used in suspected fistula, investigation of bladder lesions and follow-up after a sling procedure. | |
| In complex and combined prolapse cases, the dynamic movement of the pelvic organs is imaged with advanced MRI technique. | |
| Investigates whether the symptoms are due to infection; an active urinary tract infection is treated before surgery. | |
| The choice between spinal and general anaesthesia is planned together with the patient; general anaesthesia is standard practice in robotic procedures. |
Operations and Surgical Procedures Performed
The main surgical procedures performed are as follows:
| Procedure | Description |
|---|---|
| Stress incontinence is treated by placing a thin supporting tape beneath the urethra. Passed through the retropubic route, the tape supports the urethra at its midpoint. With its short operating time (30-45 minutes) and high long-term success rate, it is the international standard surgical method. | |
| An alternative mid-urethral sling technique to TVT in stress incontinence; the tape is passed through the obturator foramen to support the urethra. The risk of retropubic complications is lower. | |
| In the treatment of cystocele (bladder prolapse), the anterior vaginal wall is reconstructed to provide anatomical support to the bladder. | |
| In the repair of rectocele and enterocele, the posterior vaginal wall is strengthened so that pressure from the rectum on the vagina is relieved; it eliminates difficulty in bowel emptying. | |
| Fixation of the vaginal vault or the uterus by suspending it with mesh to the promontory (the sacral prominence). It is the most durable and long-term effective surgical treatment for apical prolapse. The robotic approach offers precise dissection and a minimally invasive advantage. | |
| In cases of uterine prolapse, removal of the uterus through the vaginal route together with vaginal repair in the same session; this combined procedure is frequently performed. | |
| Surgical closure of the abnormal opening between the bladder or urethra and the vagina; the vaginal or the abdominal route (open/laparoscopic) is chosen. The success rate is high; surgical technique and timing are critically important. | |
| Injected into the bladder muscle under cystoscopic guidance, it is effective in overactive bladder resistant to drug therapy and in neurogenic bladder. The procedure is completed in 15-30 minutes, its effect lasts 6-9 months and it can be repeated. | |
| A small implant that regulates the sacral nerve provides long-term control in chronic urinary urgency and urge incontinence; it is preferred in patients who do not respond to medication and botulinum toxin therapy. |
The Postoperative Period
Although recovery after urogynecological surgery varies according to the procedure, discharge is early in most cases and patient adherence is extremely important.
| Topic | What to expect |
|---|---|
| TVT/TOT sling surgery is usually completed as a day case or with a single overnight stay. With combinations of sacrocolpopexy and vaginal hysterectomy the hospital stay may extend to 2-3 days; after fistula repair the bladder catheter stays in place for 10-14 days. | |
| Adequate pain control is achieved with oral analgesics and anti-inflammatory medication. After vaginal repairs, local tenderness lasts a few days; a cold compress is helpful in the first 24 hours. | |
| After TVT/TOT, avoiding heavy lifting and intense physical activity for 4-6 weeks is recommended. Light daily activities can be resumed within 1-2 weeks. Full recovery after sacrocolpopexy takes 6-8 weeks. | |
| After surgery, pelvic floor exercises and biofeedback both accelerate recovery and support long-term success. In combined prolapse cases in particular, physiotherapy is an integral part of postoperative follow-up. | |
| After vaginal surgery, avoiding intercourse for 6-8 weeks is generally recommended; this period supports tissue healing and mesh integration. | |
| Some patients may experience temporary voiding difficulty after sling surgery; this is managed with bladder training and, where necessary, clean intermittent catheterisation. | |
| Check-ups are carried out at 6 weeks, at 6 months and annually after surgery; recurrence of prolapse, continence status and mesh-related complications are assessed. |
You can request an appointment for a urogynecological assessment.
Book an AppointmentUrogynecology at Academic Hospital
The Academic Hospital Urogynecology Department carries out both diagnostic assessment and surgical treatment of pelvic floor disorders under one roof; vaginal, laparoscopic and robotic methods are considered in every suitable case. The treatment plan is drawn up in cooperation with the following departments:
- Urology: lower urinary tract assessment, urodynamics and cystoscopy
- Gynecology and Obstetrics: gynecological examination, hysterectomy and vaginal surgery planning
- Physical Medicine and Rehabilitation: pelvic floor physiotherapy and biofeedback
- Urinary Incontinence and Bladder Health: conservative treatment options and bladder training
- Menopause: management of vaginal atrophy and urinary complaints linked to declining oestrogen
- Pelvic Pain Treatment: management of chronic pain accompanying pelvic floor dysfunction
- Treatment of Urethral Diseases: assessment of urethral complaints and urethrovaginal fistulas
Frequently Asked Questions
Answers to the most frequently asked questions about urogynecology are given below.
References
The general information given on this page about pelvic floor disorders, surgical treatment options and postoperative follow-up is supported by the reliable health sources listed below.
- American Urogynecologic Society, "Pelvic Floor Disorders, Patient Resources", augs.org
- American College of Obstetricians and Gynecologists, "Practice Bulletin: Pelvic Organ Prolapse", acog.org
- Nambiar AK et al., "EAU Guidelines on Assessment and Nonsurgical Management of Urinary Incontinence", ncbi.nlm.nih.gov
The information on this page is for informational purposes only; it does not replace medical examination, diagnosis or treatment. Please consult a healthcare institution regarding your complaints.
