The subspecialty of female urology is concerned with the diagnosis and treatment of those urinary tract disorders most prevalent in females. These include:
- Urinary Incontinence and Pelvic floor Prolapse
- Voiding Dysfunction
- Recurrent Urinary Tract Infection (UTI)
- Urethral Syndrome
- Interstitial Cystitis
Expert evaluation of these conditions includes a complete history and physical exam. Urodynamics (bladder function test) and imaging studies may be required to fully evaluate the urinary tracts. Additional bladder studies such, as cystoscopy may be necessary.
Urinary Incontinence
Incontinence is an involuntary loss of urine. It is further defined by type as either stress (leakage with straining, coughing, sneezing), urge, mixed, overflow, functional or reflex incontinence.
Treatment is dependent on the type of incontinence. Current therapies include dietary changes, scheduled voiding, bladder retraining, pelvic muscle exercises, biofeedback, electrical stimulation therapy, medication, collagen implants and minimally invasive surgery.
The tension-free vaginal tape (TVT) has become popular for the surgical treatment of urodynamic stress incontinence. The procedure includes insertion of polyester tape in the pelvic floor to support the urethra. This surgery is done through minimal incision.
Voiding Dysfunction
Voiding dysfunction can take many forms. The main symptoms are urinary frequency, urgency, painful urination and/or incomplete bladder emptying.
Treatment is aimed at decreasing or eliminating symptoms. Treatment may involve medications or pelvic floor relaxation exercises.
Recurrent Urinary Tract Infection (UTI)
A recurrent urinary tract infection (UTI) may be generally defined as three or more infections within one year. This may be idiopathic (no obvious cause or related to a urologic disorder such as stones, tumor, reflux (urine flows backwards toward the kidney) or ineffective bladder emptying.
Treatment is aimed at identifying the cause and/or proper antibiotic therapy to break the cycle of recurrent infection.
Urethral Syndrome
Urethral syndrome is a condition involving pain at the urethra that can occur during urination or without regard to urination.
Treatment may consist of oral medication or local estrogen replacement therapy. Urethral syndrome may exist as a component of interstitial cystitis.
Interstitial Cystitis (IC)
Interstitial cystitis (IC) is a urologic syndrome characterized by excessive urinary urgency, frequency, nocturia (nighttime urination) and pain in the lower abdomen and/or perineum. It can occur at any age, however, the median age at diagnosis is between 42 and 46 years. The cause of IC is unclear. It is believed to be related to irregularities in the bladder lining and/or an allergic/immune response. IC can severely affect an individual's quality of life.
Promising developments in the treatment of IC include medications. Hydrodistention of the bladder under anesthesia is a common therapeutic and diagnostic procedure. In the most severe cases, surgery including denervation, urinary diversion and augmentation cytoplasty may be performed.
Impotence and Infertility
Vericocele Ligation
Varicocele is defined as an abnormal dilatation of testicular veins in the pampiniformis plexus caused by venous reflux.
There are a number of treatments avaiable to treat a varicocele. Treatment depends on symptoms and seriousness of the condition.
Surgery is recommended for men with a varcocele where pain, damage to the testicles, atrophy or where treatment is required for sterility. The procedure is surgical ligation (tying off) of the distended veins. This can be carried out under a general or local anesthesia.
Keyhole surgery is sometimes available and results in a smaller scar.
Penial Prosthesis
ED is the loss of the ability to produce and maintain a functional erection caused by pathology of the nervous or vascular system or deformation of the penis. The surgical treatment of ED largely involves the placement of penile prosthesis.
Before 1960, urologic therapy for erectile dysfunction (ED) was rare. ED was branded a psychiatric disorder with little surgical role. More recently, insight has been gained into the pathophysiology of male sexual dysfunction, and both medical and surgical treatments of ED now are common.
Treatment
Medical therapy: Nonsurgical treatments for ED, such as vacuum devices, intraurethral alprostadil pellets (medicated urethral system for erection [MUSE]), oral sildenafil (Viagra), and intracavernosal prostaglandin injection, should be attempted prior to undertaking penile prosthesis implantation.
Surgical therapy: The criterion standard for erectile surgery is penile prosthesis implantation. However, in the rare patient whose discrete and focal arterial lesion can be identified on arteriography, then revascularization procedure(s) may be indicated.
The most fundamentally basic prosthesis is the semirigid rod prosthesis, which consists of 2 rodlike cylinders that are implanted in the corpora cavernosa.
Penile Curvature Correction
Penile curvature may be ventral, dorsal or lateral. Most of ventral curvatures are associated with hypospadias due to chordee or ventral dysplasia of cavernous bodies. The isolated anomaly is usually not recognized until later in childhood because the appearance of the penis is normal. The curvature is only observed during erections.
Treatment
The treatment is surgical. An artificial erection is used to determine the degree of curvature and to check the
symmetry after the repair.
Vaso-vagal Reanastomosis
Vas ligation, vasotomy, and vasectomy are three operations to induce male sterility. Vasectomy is the most effective but least likely to be reversible. The operation can be performed in a polyclinic under local anesthesia and takes 15-30 minutes.
