Urogynechology

About the Department

In women; The medical branch that deals with the treatment of pelvic floor disorders is called urogynecology. Specialist gynecologists and obstetricians in the treatment of problems related to pelvic floor disorders called urogynecologists.

What are pelvic floor disorders?

Pelvic floor;  the organs that are located in the pelvis, the bladder, the uterus (uterus), the vagina and muscles, ligaments, nerves and fascia that are supporting the rectum from the bottom. In particular, this intertwined complex structure of the pelvic floor not only supports the organs and holds them in place; at the same time it plays a key role in the fulfillment of their duties. If this integration is impaired in the pelvic floor, disruption of bladder or bowel control, urinary or fecal incontinence, sagging of pelvic organs, difficulty in urination, pelvic pain and sexual problems may occur.

What is urinary incontinence?

Incidentally, urinary incontinence is a condition that should always be investigated, except for certain age limits (e.g. under 2 years of age).  As a result of these investigations, the type of urinary incontinence is determined and medical or surgical treatment is performed.

What are the types of urinary incontinence?

  1. Stress type urinary incontinence: Low levels of urinary incontinence occur during physical activities such as coughing, sneezing and exercise.
  2. Urge incontinence:This is involuntary urinary incontinence which develops suddenly after the bladder is full or empty that develops after the sudden need to go to the wc. In particular, the sound of water (e.g. dishwashing), cold drinks or exposure to cold can trigger this.  In this situation, which may occur in unexpected times or even in sleep, large amounts of urinary incontinence is possible.
  3. Mixed urine incontinence:Stress and congestion-type urinary incontinence conditions are observed together.
  4. Functional urinary incontinence:This is an untimely urinary incontinence due to physical insufficiency, external obstacles or thoughts preventing an individual from going to the toilet or communication disorders that cause the same. Movement limitation, diabetes, heart failure, hypercalcemia (blood calcium levels above normal), atrophic urethritis, constipation, acute confusion (confusion) are conditions in which this type of incontinence may be observed. In some cases, the cause is temporary or reversible.
  5. Overflow urine incontinence:An unexpectedly low amount of urinary incontinence, due to a full bladder, bladder outflow or bladder muscle incontinence.
  6. Temporary urinary incontinence:Occasionally urinary incontinence is often the result of infection or use of certain drugs.
  7. Continuous urinary incontinence:Fistulas that develop frequently after pelvic surgery or after difficult labor can lead to continuous urinary incontinence.
  8. Psychogenic urinary incontinence:Often causes such as mood disorders or depression may cause loss of urinary retention. Sudden fear or changes in emotion may be accompanied by urinary incontinence.
  9. Laughter Related Urinary Incontinence:This is rarely observed, especially in young girls. Partial or complete urination occurs during or immediately after laughing.
  10. Urinary incontinence during sexual intercourse: Urinary incontinence during vaginal penetration or orgasm (sexual or masturbation)

What is the treatment of stress type urinary incontinence?

The ideal treatment of this type of urinary incontinence is surgery. For this purpose, the most common and most effective surgical treatment is the placement of a patch, i.e. a mash under the urinary tract. This patch, which resembles a small fish net, supports the urethra and prevents urinary incontinence. This patch can be placed in 4 ways:

  1. TVT (Tension free Vaginal Tape):Vaginal operation is performed. A 1 cm small incision is made under the urethra and the needle is placed under the urethra and the patch arms are left dangling behind the pubic bone.
  2. TOT (Trans Obturator Tape):Vaginal operation is performed. Entrance is performed through the “obturator” present bilaterally in the pelvis via a hook and the patch is placed under the urethra.
  3. Mini Suspension:Vaginal operation is performed. The placement of a patch that is shorter than 20 cm and the width is about 1 cm is performed. Since a short patch is used in this surgery, passage of long anatomical distances are not required.
  4. Pre-pubic suspension:Vaginal operation is performed. A small incision of 1 cm is made under the urethra, entrance is performed via a needle and the a patch is placed below the urethra, the arms of the patch are placed such that they remain in the front section of the bone.

What is the most common problem related to patch surgery performed for stress type urinary incontinence?

A section of the placed patch may be visible (excursion) due to the inability of the body to close the patch.  It is most often not life threatening. It is sufficient to cut the part visible under local anesthesia and simply suture the tissue. If the apparent size of the patch is smaller than 0.5 cm and the patient is in menopause, an estrogen containing crème treatment may be sufficient without the need for surgery.

Are problems relate to patch surgery performed for stress type urinary incontinence possible?

Bleeding may occur if the hook damages a vital vessel, especially during operation. Postoperatively, inability to urinate, abdominal and groin pain, fistulas, numbness and difficulty walking may occur. It is very important that this operation is carried out by physicians who are specialized in and located in a fully equipped center and area.

Are there other operations for the treatment of stress type urinary incontinence?

The “Burch colposuspension” procedure is one of these. Following evaluation of the patient It is decided which surgery will be performed on which patient.

Should urodynamic testing be performed on every woman with urinary incontinence?

This examination should be performed on appropriate patients. For example, on patients who had previous operation due to urinary incontinence but have continuous complaints, had sudden urinary incontinence, had severe genital organ sagging, and had unclear complaints; those who had a history of urinary retention (inability urinating despite full bladder), patients over 65 years of age, urinary incontinence at night, or suspected neurological disease, then these investigations may be performed.

Is there any medical treatment for urinary incontinence?

There are various opinions about the place of medical treatment in stress type urinary incontinence. Medication treatment may be planned for urinary incontinence with sudden onset of urge which is called an overactive bladder.

Medications may have some side effects in the medical treatment of urinary incontinence. These are: 

  • Dry mouth
  • Constipation
  • Blurry vision
  • Headache
  • Drowsiness
  • Confusion
  • Malaise
  • Memory impairment
  • Psychotic behavior
  • Insomnia
  • Nausea
  • Tachycardia (increased heart rate)
  • Orthostatic hypotension (drop of blood pressure when standing up)
  • Mental disorder called delirium

 Who should not use medical treatment for urinary incontinence?

  • Those with; closed angle glaucoma
  • with a muscle disease called myasthenia gravis
  • Cardiovascular diseases with transmission defects
  • These medications should not be used in case of GIS obstructions (stomach or intestinal obstructions).

When should the medication be stopped?

There is no clear information about when the drug should be discontinued when the patient complains resolve.  This is because a short time after stopping the medication, the symptoms may reappear. With the approval of the patient, it is appropriate to discontinue these medications 3 months after the resolving of the complaints.