What is Female Pelvic Medicine and Reconstructive Surgery?

Female pelvic medicine and reconstructive surgery is a medical specialty that focuses specifically on the treatment of pelvic floor disorders in women. A pelvic floor disorder is any pain or dysfunction that occurs in the area surrounded by the pelvis: the uterus, cervix, vagina, bladder, or rectum. There are many kinds of pelvic floor disorders, but by far the two most commonly treated by female pelvic medicine specialists are incontinence and prolapse.

Urinary incontinence is the unexpected release of small amounts of urine. It can be embarrassing, but it is extremely common. Because of the way women’s bodies are shaped, incontinence is much more common in women than in men. It can happen at any age, but is much more common in older women as age and pregnancy relax the muscles that support the bladder. There are two types of incontinence. Stress incontinence happens when sudden movements, such as coughing or laughing, cause slight leakage of urine. It is more likely to be caused by a problem with the muscles around the bladder. Urge incontinence is when a woman has a very sudden need to empty her bladder for no reason, sometimes because of hearing or touching water, and she cannot always make it to the bathroom in time. It is more likely to be caused by a problem with the nerves that signal the bladder to empty.

Prolapse of an organ is a condition that sounds and feels very frightening to most women, but it is also incredibly common and can usually be repaired without problems. One-third of all women will experience a prolapse at some point in their lives. Like incontinence, prolapse is also more common with age because the supporting muscles of the pelvic floor become weaker. A prolapsed organ occurs when the internal organ slips out of its supporting muscle sling and droops or falls into the vagina or rectum. The most common prolapse is when the bladder falls partially into the vagina, but the uterus, urethra, bowels, and even the vagina and rectum themselves can prolapse. Symptoms vary, depending on which organ has shifted, but may include:

• a heavy feeling or abdominal pressure
• feeling something in the vagina
• urinary problems
• painful intercourse

Treatment varies, depending on the type and severity of the prolapse, and may include strengthening exercises, pushing the organ back into place, or surgery.

What is Urology?

The specialty of urology focuses on the structures of the body that produce urine and remove it from the body, such as the kidneys, ureters, bladder, and urethra. Since related structures in men are responsible for both reproduction and the transportation of urine, urologists specialize in men's sexual health in addition to disorders of the urinary tract. Urologists treat both men and women, as well as patients ranging in age from newborn to elderly.

Certain urologic conditions are specific to male or female patients. Women are especially prone to stress incontinence, recurrent urinary tract infections, interstitial cystitis (a condition causing pain in the bladder), and urethral diverticuli (a structural issue where a small pouch develops from the urethra into the vagina). Some of these conditions may be adequately treated by a gynecologist, but patients may prefer to see a urologist because of their expertise in the urinary tract system. As for men, male infertility and sexual problems can be treated by a urologist. For example, urologists treat erectile dysfunction with medications or prosthetics. They may also perform surgeries such as vasectomies or vasectomy reversals.

Some other conditions that urologists treat include:

• Kidney stones, which are mineral deposits that can form anywhere in the urinary tract. The stones can be quite painful, and some large stones may be impossible to expel naturally. Fortunately, kidney stone treatments have advanced quite a bit in recent years, and a urologist may recommend a procedure such as shockwave lithotripsy (where sound waves are used to break down the stones), or percutaneous extraction (where telescopic tools are inserted through tiny incisions in the back to remove the stones). There can be some pain associated with these treatments, but they are far less invasive than the older methods of removal.
• Urinary tract infections, which are extremely common. However, if they happen over and over again, there may be an underlying problem within the urinary tract.
• Congenital abnormalities, which refers to problems that are present at birth. Congenital abnormalities affect the genitourinary tract more often than any other system of the body, and they range from mild to severe in appearance and effect. The most common abnormality (in male infants) is cryptorchidism, where a testicle does not descend from the body down into the scrotum. Another common problem is hypospadias, where the opening of the urethra appears on the underside of the penis.
• Renal disease, which is the loss of kidney function. For patients with renal disease, their urologist may be their primary surgeon or a coordinating member of their care team.
• Tumors and malignancies, which are especially common in the case of prostate cancer. Urologists are most often consultants to oncologists in these cases.

The American Urological Association recognizes seven subspecialties of urology:

• Pediatric Urology, the treatment of genitourinary tract disorders in children and infants
• Urologic Oncology, the treatment of cancers within the genitourinary tract
• Renal Transplantation, the treatment of severe kidney disease by replacing a non-functioning kidney with a donor kidney
• Male Infertility, the treatment of infertility due to problems with sperm, semen, or male sexuality
• Calculi, the treatment of kidney stones
• Female Urology, the care of women's urinary health
• Neurourology, the treatment of urinary disorders caused by problems with the nervous system. For example, certain voiding disorders happen when the bladder does not receive signals appropriately, and erectile dysfunction is sometimes due to nerve loss.

Urinary and sexual problems can be especially distressing for many people. Fortunately, urologists are experts at managing these health conditions.