Urogynecology and Pelvic Reconstructive Surgery
If you are affected by a pelvic floor condition, we can help you take the most conservative approach possible to improve your quality of life.
These conditions include incontinence, urinary tract infections and vaginal prolapse. We also treat many conditions that may occur during or after childbirth, including vaginal tearing and bladder leakage.
Most women improve with nonsurgical approaches, including behavioral therapies and medications.
Our specialists in urogynecology and reconstructive pelvic surgery can help you lead a more comfortable and active life.
We lead the nation in training the next generation of pelvic reconstructive surgeons. Our physicians are involved in clinical trials and research and work side-by-side with highly skilled nurse practitioners, residents and fellows to give you the most innovative and high-caliber treatment options available.
Women's Pelvic Medicine
Your first appointment is an opportunity to meet your provider team, discuss your medical history and learn more about treatment options.
What to Expect at Your First Appointment
While every patient is unique, we perform standard assessments and tests on the day of your first visit. Depending on your symptoms, these may include:
- Standing "stress test" with a full bladder to look for leakage
- Urinary flow study
- Urine analysis and urine culture
- Pelvic exam
- Post-void residual measurement by urethral catheterization
We will ask you to explain your symptoms and urinary habits; for example, how often you need to urinate, when you leak urine, how much fluid and what kinds of fluids you drink, and whether you have any other symptoms along with incontinence. Your answers will provide clues about the cause of your incontinence.
Our team will send you an intake questionnaire before your appointment. Your initial exam will be the most productive if you complete it along with a voiding diary and bring it with you to your first visit.
Sometimes additional office tests may be necessary at a later visit. These may include:
- Cystoscopy: A small telescope is placed in the urethra so that the doctor can visually assess the condition of the bladder and urethra
- Urodynamic Test: Small tubes are placed in the bladder and the rectum in order to measure the pressure and function of the urethra and bladder as they store and empty the urine
- Videourodynamics: Studies that X-ray the bladder and measure its pressure during filling and emptying
Nonsurgical Treatment for Pelvic Floor Conditions
Most pelvic floor conditions don't require surgery. In many cases, your problem can be treated with behavioral therapies, physical therapy and medications or devices.
Our urogynecology and reconstructive pelvic surgeons work side-by-side with highly skilled nurse practitioners to offer you the most innovative and effective treatment options. This includes non-surgical treatments for:
Overactive Bladder and Urinary Incontinence
- Bladder control strategies and bladder training
- Pelvic floor muscle training (Kegel exercises) and physical therapy
- Incontinence pessary, a silicone device that fits in the vagina, or over-the-counter devices such as Impressa
- Medications, vaginal estrogen and Botox bladder injections
- Peripheral tibial nerve stimulation or sacral neuromodulation
Pelvic Floor Prolapse
- Physical therapy to strengthen and tone the pelvic muscles
- Vaginal inserts or pessaries placed into the vagina to provide support for the uterus, bladder, urethra and rectum
Surgical Treatment for Pelvic Floor Conditions
Pelvic Floor Prolapse
If surgery is needed, your surgeon will discuss options with you. Some of the common types of prolapse and their surgical treatments include:
- Urethral bulking agent, an injection into the muscular wall of the urethra
- Slings: mid-urethral sling (the "gold standard" surgical treatment), which places a thin strip of permanent mesh under the urethra, or autologous fascia sling, which uses your own tissue
- Retropubic suspension, a procedure where the surgeon places stitches to help lift the vaginal wall and urethra
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