Comprehensive Care for Women’s Urological Conditions
UC Health Urologist Ayman Mahdy, MD, is the only physician in southern Ohio fellowship trained in the subspecialty of female urology and pelvic floor dysfunction. His expertise, combined with our advanced diagnostic and treatment facilities, enable us to provide comprehensive care and treatment for the full range of female urologic conditions, including the following:
- Pelvic organ prolapse
- Interstitial cystitis
- Urogenital fistula
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.
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
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)
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.