Comprehensive Care for Women’s Urological Conditions
To meet the growing need for female-specific urological services, UC Health Urology provides specialized services designed to treat the complex nature of uro-gynecological conditions and disorders. Ayman Mahdy, MD, assistant professor of surgery at the University of Cincinnati College of Medicine, is leading the charge of bringing the most advanced diagnostic tools and treatment options to women in the Greater Cincinnati region for a variety of urological issues, including the following:
Urinary incontinence
Pelvic organ prolapse
Interstitial cystitis
Overactive bladder
Urogenital fistula
Urinary tract infections
Urinary frequency
Neurogenic bladder
Advanced Testing for Better Patient Outcomes
In addition to other, more traditional modes of urological testing, UC Health urology now offers patients video urodynamics testing, further enhancing the level of care available to patients who suffer from quality of life-impacting challenges related to urinary frequency, urgency and/or urine leakage. As voiding dysfunction is a urological condition that commonly affects women, this new technology will greatly help impact our physician’s ability to test bladder function and treat female voiding dysfunction appropriately.
Video urodynamics combines the traditional urodynamic testing, which looks at bladder function, while also using fluoroscopy (moving X-rays) to evaluate anatomical information about the bladder. Because problems with the urinary system can be related to a host of factors including aging, neurologic diseases, previous pelvic surgeries, and gender-specific conditions, such as pelvic prolapse or prostate enlargement, having both functional and anatomic information allows our physicians to develop more personalized and effective treatment strategies.
Urinary Incontinence
Urinary Incontinence (UI) is an accidental release or leakage of urine. Incontinence affects over 14 million people in the US and is twice as prevalent in women than in men. There are several types of UI, including stress urinary incontinence (SUI), mixed urinary incontinence (MUI) and urgency urinary incontinence (UUI). SUI, the most common form of incontinence in women, occurs when coughing, laughing, sneezing, or jogging. UUI occurs when the patient has the strong desire to urinate but can’t make it to the bathroom on time. MUI is the combination of both SUI and UUI.
To begin the evaluation and diagnosis for urinary incontinence, an in-depth discussion with our physicians will be conducted to uncover medical history, symptoms and the impact on quality of life that incontinence has had on the individual. A physical screening of the patient will include a comprehensive gynecological exam, urine test and bladder ultrasound. When a diagnosis of UI has been reached, most patients will benefit from an initial conservative treatment plan; however, for complex cases or those who failed previous treatments, more sophisticated testing may be necessary.
There are several non-surgical and surgical treatments for urinary incontinence. We offer several conservative treatments for this condition.
Pelvic Floor Rehabilitation- Exercises that strengthen the pelvic muscles (also known as Kegel exercises) are useful to control stress incontinence.
Behavioral Therapy – Methods such as bladder re-training, timed void and double voiding can help control urge and stress incontinence.
Medical Therapy
When non-surgical intervention doesn’t work, the following surgical options may be recommended:
Minimally Invasive Procedures
Neuromodulation – Implantable device that prevents the transmission of impulses to the bladder
Bladder Botox Injection – medication injected into the bladder to help relax the bladder muscle and reduce urgency
Suburethral Sling – a procedure that helps restore the urethra back to its normal position
Urethral Bulking Agent Injection – Using a cystoscope, bulking materials are injected around the urethra to help urethral cooperation
Artificial Urinary Sphincter – an implantable device that recreates the function of bladder sphincter
Complex Surgical Procedures
Bladder Augmentation – a procedure that uses a piece of tissue from the bowel, stomach or ureter (the tube that carries urine from the kidney to the bladder) to enlarge the bladder so that it will hold more urine
Urinary Diversion – diverting the urine flow from the natural urethra to an abdominal stoma. The stoma might be either a continent (dry) stoma in which the patient can self-catheterize, or an incontinent stoma in which a collection bag (pouch) is connected to the stoma to drain the urine and the pouch is evacuated by the patient or caregiver when it gets full.
Female Pelvic Organ Prolapse
When the muscles and ligaments that support a woman’s pelvic organs weaken over time or from childbirth, the pelvic organs can drop (prolapse) from their normal place in the pelvis. This puts pressure on the walls of the vagina and can be uncomfortable or painful. Symptoms of pelvic organ prolapse can include vaginal pain, lower back pain, a “lump” in the vagina, pain during sexual intercourse, vaginal bleeding, urine leakage, constipation, and/or difficulty voiding. Because pelvic organ prolapse can worsen over time, it is important to be evaluated by a physician to determine a diagnosis and the best course of treatment.
There are several organs that may be affected by pelvic organ prolapse and may include all or some of the following:
Bladder prolapse (cystocele) – The most common type of prolapse; Occurs when the bladder pushes down on the wall of the vagina.
Urethral prolapse (urethrocele) – Often occurs along with bladder prolapse and is when the urethra pushes on the wall of the vagina.
Rectum prolapse (rectocele) – Type of prolapse that occurs when the rectum pushes on the back wall of the vagina.
Uterine prolapse – Type of prolapse that occurs when the uterus descends through the vaginal opening.
Vaginal vault prolapse/herniated small bowel – These often occur when the ceiling of the vagina drops down in patients who have had hysterectomy.
Small bowel prolapse (enterocele) – This is when the small bowel pushes through the vaginal wall.
To diagnose the type and severity of each patient, multiple tests may be performed, including a cotton swab test, urodynamics study, imaging tests (MRI, ultrasound) or cystoscopy. A treatment plan and mode of therapy will then be recommended based on the results of the diagnostic evaluation. The treatment plan may be conservative and non-surgical, involving the use of estrogen replacement therapy, vaginal pessaries and/or physical therapy to restore strength to the pelvic floor muscles.
Surgical interventions may be necessary to repair a pelvic organ prolapse and our physicians will provide each patient with the various pros and cons of each surgical option. There are several types of reconstructive procedures that can be performed vaginally and you will work with our surgeons to determine the best option for you. These surgeries typically require an overnight stay in the hospital and the patient is able to return to her normal routine shortly after surgery.
Interstitial Cystitis (IC)
Interstitial cystitis (bladder pain syndrome) is a chronic condition characterized by pain related to the bladder becoming full that usually resolves with the bladder emptying. Pain is usually felt in the bladder, urethra, vagina and/or pelvis. The pain can range from a mild burning or discomfort to severe pain. Other symptoms include frequent urination, nocturia (frequently urinating at night), and urgency.
While interstitial cystitis can affect children and men, most of those affected are women. In fact, of the estimated 1.3 million Americans affected with the condition, more than 1 million are women. Interstitial cystitis can have a long-lasting, adverse effect on your quality of life. The severity of symptoms caused by interstitial cystitis often fluctuates, and some people may experience periods of no symptoms. Although there is no treatment that reliably eliminates interstitial cystitis, a variety of medications and other therapies offer relief.
A comprehensive medical history, physical exam and pelvic exam will be performed to properly diagnose interstitial cystitis. It may also be necessary for you to keep a diary of your fluid intake and voiding performance to be monitored by our physicians. A urine sample and evaluation of your pain will be necessary to determine a diagnosis. Based on the initial results, more specialized tests could be ordered for further evaluation, including a cystoscopy or urodynamics test to evaluate bladder function.
There are several options for therapy once a diagnosis has been reached, and the most recent clinical guidelines recommend beginning with the least invasive and most conservative measures. An initial conservative approach involves the use of medications, behavioral modification, diet changes, patient education and stress relief.
The next steps in management of interstitial cystitis may include:
Physical therapy
Instillation of medication (including DMSO) into the bladder
Bladder hydrodistention under anesthesia (distending the bladder with water)
Cauterization of bladder (Hunner’s) ulcers
Sacral neuromodulation (Interstim – an implant that uses mild electrical pulses to relieve pelvic pain and, in some cases, reduce urinary frequency)
Intravesical injection of Botox
Bladder augmentation (surgery to increase the size of the bladder using the patient’s own tissue, such as a part of the stomach or intestine)
Overactive Bladder
Overactive bladder is a common condition that affects one of every six Americans. Overactive bladder describes a problem with bladder storage function and can cause the sudden urge to urinate. The urge may be difficult to suppress and/or control, and overactive bladder can lead to accidental loss of urine (incontinence).
Overactive bladder can cause embarrassment and is often left untreated because the patient does not wish to seek treatment. Luckily, new treatments and therapies allow our physicians to provide our patients with several options to manage or eliminate symptoms that will help you return to your normal quality of life.
To provide a diagnosis of overactive bladder, it is first necessary to review symptoms and their impact on your quality of life. This will also help to rule out other conditions that could mimic the symptoms of overactive bladder and/or incontinence. A comprehensive gynecological exam, urine test and bladder ultrasound are also typically completed during this initial screening process. At the end of your office visit, our physicians will discuss the findings and make further recommendations for an appropriate course of treatment and/or therapy.
Many patients will benefit from a conservative initial treatment plan.. For complex cases or those who failed previous therapy, more sophisticated tests may be considered to uncover more information. There are several non-surgical and surgical treatments for overactive bladder. At UC Health, our urologists offer several conservative, minimally invasive procedures, as well as complex surgical procedures for this condition. Minimally-invasive approaches include pelvic floor rehabilitation (kegel exercises), behavioral therapy (bladder retraining, timed voiding), and medical therapy. When non-surgical intervention doesn’t work, several surgical options are available:
Minimally Invasive Procedures:
Sacral Neuromodulation (Interstim) - A small implantable device that prevents the transmission of urgency impulses to the bladder
Posterior tibial nerve stimulation – a fine needle is inserted into your skin at the ankle area and the needle is stimulated by a low voltage device for 30 minutes. The session is done in the office and repeated once a week for a total of 12 weeks.
Pudendal nerve stimulation – stimulation of the pudendal nerve, which is located in the pelvic region
Bladder Botox Injection – medication injected into the bladder to help the muscle relax and reduce urgency, frequency and incontinence.
Complex Surgical Procedures:
Bladder Augmentation- a procedure that uses a piece of tissue (usually bowel or stomach) to enlarge the bladder so that it will hold more urine.
Bladder Removal- a last resort procedure in which the entire bladder is removed and the urine is diverted.
Urogenital Fistula
A urogenital fistula is a collective term for fistulas (holes) that occur between the urinary system (bladder, ureters or urethra) and the vagina or rectum. It is estimated that as many as 2 million women worldwide are living with unrepaired urogenital fistulas. If left unrepaired, these urogenital fistulas result in constant vaginal leakage of urine. Another type of fistulas are those which develop between the rectum and vagina which will result in leakage of feces from the vagina. UC Health Urology offers customized treatment options for these types of conditions.
A complete medical history is necessary to identify any risk factors that may lead to a urogenital fistula, such as recent pelvic surgery, foreign bodies, trauma, infection or prior pelvic radiation. An initial exam usually includes a vaginal exam with a speculum. Additional diagnostic testing may include imaging studies and cystoscopy.
Conservative (non-surgical) therapy is rarely effective; most vaginal fistulas require surgery to close the opening. Vaginal fistulas are usually treated vaginally on an outpatient basis. The patient usually goes home with a catheter for 2-3 weeks. Other approaches may include abdominal laparoscopic or robotic surgery.
Neurogenic Bladder
Neurogenic bladder is when a person lacks bladder control due to a brain or nerve disease caused by a birth defect, tumor or injury to the spinal cord. Medical conditions such as Alzheimer’s Disease, Parkinson’s Disease, Multiple Sclerosis and stroke can also cause neurogenic bladder. Symptoms can mimic those of overactive bladder (frequent urination, loss of bladder control) or underactive bladder (trouble urinating or unable to tell when bladder is full). This condition may be further complicated by recurrent urinary tract infections (UTIs), urinary stones or cancer.
Because neurogenic bladder involves the nervous system and the bladder, our urologists will conduct a variety of tests to determine the status of both. Video urodynamic studies are conducted to measure bladder capacity, bladder pressures, urine flows, and bladder emptying. Imaging studies of the skull, spine, and urinary tract may be completed with x-rays, magnetic resonance imaging (MRI), or computed tomography (CT). An electroencephalogram (EEG) may be taken to study brain activity.
Therapies for neurogenic bladder fall into four categories: behavioral, electrical-stimulatory, medication and surgery.
Behavioral therapy
Methods such as bladder training, timed voiding and double voiding can help resolve urinary retention and urinary incontinence in cases of neurogenic bladder.
Electrical-stimulatory therapy
Small bladder stimulators may be implanted to either help with bladder emptying in cases of urine retention or to help suppress urgency in cases of urine frequency. This procedure is performed in an outpatient setting. The device has been approved by the U.S. Food and Drug Administration to treat urge incontinence, urgency-frequency syndromes, and urinary retention in patients for whom other therapies have failed.
Medication
There are currently no medications that specifically target muscles that help control urine, such as the sphincter; however, there are medications available that reduce symptoms of neurogenic bladder, such as urinary incontinence and overactive bladder.
Surgery
Catheterization, although not strictly a surgical procedure, is commonly employed to ensure complete bladder drainage. It involves the insertion of a thin tube through the urethra and into the bladder. A number of patients can learn to insert the catheter themselves. The therapy is called Clean Intermittent Catheterization (CIC). Exceptional sanitary procedures must be followed as the risk of urinary tract infection is significant with any type of catheterization. Another therapy, indwelling catheterization, places a catheter in the bladder for extended periods. These prevent bladder distension by continually draining urine into a bedside collector.
Urethral stents, which can be described as an internal catheter, can be surgically inserted through the sphincter muscle to expand it and allow urine to be drained.
Intraurethral Botox Injection can be performed to weaken the sphincter at the site of the injection.
Sphincterotomy, a procedure which involves incision of the uretheral sphincter using cystoscope and knife.
Intravesical Botox injection, which involves using the bladder scope to inject Botox into the bladder wall.
Artificial sphincter
Bladder Augmentation, which is a procedure that uses a piece of tissue (usually bowel or stomach) to enlarge the bladder so that it will hold more urine.
Urinary diversion creates an opening through which urine is diverted to a collection pouch.
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Female Urology
Comprehensive Care for Women’s Urological Conditions
To meet the growing need for female-specific urological services, UC Health Urology provides specialized services designed to treat the complex nature of uro-gynecological conditions and disorders. Ayman Mahdy, MD, assistant professor of surgery at the University of Cincinnati College of Medicine, is leading the charge of bringing the most advanced diagnostic tools and treatment options to women in the Greater Cincinnati region for a variety of urological issues, including the following:
Advanced Testing for Better Patient Outcomes
In addition to other, more traditional modes of urological testing, UC Health urology now offers patients video urodynamics testing, further enhancing the level of care available to patients who suffer from quality of life-impacting challenges related to urinary frequency, urgency and/or urine leakage. As voiding dysfunction is a urological condition that commonly affects women, this new technology will greatly help impact our physician’s ability to test bladder function and treat female voiding dysfunction appropriately.
Video urodynamics combines the traditional urodynamic testing, which looks at bladder function, while also using fluoroscopy (moving X-rays) to evaluate anatomical information about the bladder. Because problems with the urinary system can be related to a host of factors including aging, neurologic diseases, previous pelvic surgeries, and gender-specific conditions, such as pelvic prolapse or prostate enlargement, having both functional and anatomic information allows our physicians to develop more personalized and effective treatment strategies.
Urinary Incontinence
Urinary Incontinence (UI) is an accidental release or leakage of urine. Incontinence affects over 14 million people in the US and is twice as prevalent in women than in men. There are several types of UI, including stress urinary incontinence (SUI), mixed urinary incontinence (MUI) and urgency urinary incontinence (UUI). SUI, the most common form of incontinence in women, occurs when coughing, laughing, sneezing, or jogging. UUI occurs when the patient has the strong desire to urinate but can’t make it to the bathroom on time. MUI is the combination of both SUI and UUI.
To begin the evaluation and diagnosis for urinary incontinence, an in-depth discussion with our physicians will be conducted to uncover medical history, symptoms and the impact on quality of life that incontinence has had on the individual. A physical screening of the patient will include a comprehensive gynecological exam, urine test and bladder ultrasound. When a diagnosis of UI has been reached, most patients will benefit from an initial conservative treatment plan; however, for complex cases or those who failed previous treatments, more sophisticated testing may be necessary.
There are several non-surgical and surgical treatments for urinary incontinence. We offer several conservative treatments for this condition.
When non-surgical intervention doesn’t work, the following surgical options may be recommended:
Minimally Invasive Procedures
Complex Surgical Procedures
Female Pelvic Organ Prolapse
When the muscles and ligaments that support a woman’s pelvic organs weaken over time or from childbirth, the pelvic organs can drop (prolapse) from their normal place in the pelvis. This puts pressure on the walls of the vagina and can be uncomfortable or painful. Symptoms of pelvic organ prolapse can include vaginal pain, lower back pain, a “lump” in the vagina, pain during sexual intercourse, vaginal bleeding, urine leakage, constipation, and/or difficulty voiding. Because pelvic organ prolapse can worsen over time, it is important to be evaluated by a physician to determine a diagnosis and the best course of treatment.
There are several organs that may be affected by pelvic organ prolapse and may include all or some of the following:
To diagnose the type and severity of each patient, multiple tests may be performed, including a cotton swab test, urodynamics study, imaging tests (MRI, ultrasound) or cystoscopy. A treatment plan and mode of therapy will then be recommended based on the results of the diagnostic evaluation. The treatment plan may be conservative and non-surgical, involving the use of estrogen replacement therapy, vaginal pessaries and/or physical therapy to restore strength to the pelvic floor muscles.
Surgical interventions may be necessary to repair a pelvic organ prolapse and our physicians will provide each patient with the various pros and cons of each surgical option. There are several types of reconstructive procedures that can be performed vaginally and you will work with our surgeons to determine the best option for you. These surgeries typically require an overnight stay in the hospital and the patient is able to return to her normal routine shortly after surgery.
Interstitial Cystitis (IC)
Interstitial cystitis (bladder pain syndrome) is a chronic condition characterized by pain related to the bladder becoming full that usually resolves with the bladder emptying. Pain is usually felt in the bladder, urethra, vagina and/or pelvis. The pain can range from a mild burning or discomfort to severe pain. Other symptoms include frequent urination, nocturia (frequently urinating at night), and urgency.
While interstitial cystitis can affect children and men, most of those affected are women. In fact, of the estimated 1.3 million Americans affected with the condition, more than 1 million are women. Interstitial cystitis can have a long-lasting, adverse effect on your quality of life. The severity of symptoms caused by interstitial cystitis often fluctuates, and some people may experience periods of no symptoms. Although there is no treatment that reliably eliminates interstitial cystitis, a variety of medications and other therapies offer relief.
A comprehensive medical history, physical exam and pelvic exam will be performed to properly diagnose interstitial cystitis. It may also be necessary for you to keep a diary of your fluid intake and voiding performance to be monitored by our physicians. A urine sample and evaluation of your pain will be necessary to determine a diagnosis. Based on the initial results, more specialized tests could be ordered for further evaluation, including a cystoscopy or urodynamics test to evaluate bladder function.
There are several options for therapy once a diagnosis has been reached, and the most recent clinical guidelines recommend beginning with the least invasive and most conservative measures. An initial conservative approach involves the use of medications, behavioral modification, diet changes, patient education and stress relief.
The next steps in management of interstitial cystitis may include:
Overactive Bladder
Overactive bladder can cause embarrassment and is often left untreated because the patient does not wish to seek treatment. Luckily, new treatments and therapies allow our physicians to provide our patients with several options to manage or eliminate symptoms that will help you return to your normal quality of life.
To provide a diagnosis of overactive bladder, it is first necessary to review symptoms and their impact on your quality of life. This will also help to rule out other conditions that could mimic the symptoms of overactive bladder and/or incontinence. A comprehensive gynecological exam, urine test and bladder ultrasound are also typically completed during this initial screening process. At the end of your office visit, our physicians will discuss the findings and make further recommendations for an appropriate course of treatment and/or therapy.
Many patients will benefit from a conservative initial treatment plan.. For complex cases or those who failed previous therapy, more sophisticated tests may be considered to uncover more information. There are several non-surgical and surgical treatments for overactive bladder. At UC Health, our urologists offer several conservative, minimally invasive procedures, as well as complex surgical procedures for this condition. Minimally-invasive approaches include pelvic floor rehabilitation (kegel exercises), behavioral therapy (bladder retraining, timed voiding), and medical therapy. When non-surgical intervention doesn’t work, several surgical options are available:
Minimally Invasive Procedures:
Complex Surgical Procedures:
Urogenital Fistula
A urogenital fistula is a collective term for fistulas (holes) that occur between the urinary system (bladder, ureters or urethra) and the vagina or rectum. It is estimated that as many as 2 million women worldwide are living with unrepaired urogenital fistulas. If left unrepaired, these urogenital fistulas result in constant vaginal leakage of urine. Another type of fistulas are those which develop between the rectum and vagina which will result in leakage of feces from the vagina. UC Health Urology offers customized treatment options for these types of conditions.
A complete medical history is necessary to identify any risk factors that may lead to a urogenital fistula, such as recent pelvic surgery, foreign bodies, trauma, infection or prior pelvic radiation. An initial exam usually includes a vaginal exam with a speculum. Additional diagnostic testing may include imaging studies and cystoscopy.
Conservative (non-surgical) therapy is rarely effective; most vaginal fistulas require surgery to close the opening. Vaginal fistulas are usually treated vaginally on an outpatient basis. The patient usually goes home with a catheter for 2-3 weeks. Other approaches may include abdominal laparoscopic or robotic surgery.
Neurogenic Bladder
Because neurogenic bladder involves the nervous system and the bladder, our urologists will conduct a variety of tests to determine the status of both. Video urodynamic studies are conducted to measure bladder capacity, bladder pressures, urine flows, and bladder emptying. Imaging studies of the skull, spine, and urinary tract may be completed with x-rays, magnetic resonance imaging (MRI), or computed tomography (CT). An electroencephalogram (EEG) may be taken to study brain activity.
Therapies for neurogenic bladder fall into four categories: behavioral, electrical-stimulatory, medication and surgery.
Behavioral therapy
Electrical-stimulatory therapy
Medication
Surgery