UROLOGY : CLINICAL UPDATES FROM THE PRACTICE
MANAGEMENT OF UROLOGIC CONDITIONS IN FEMALE PATIENTS : NEED FOR COMPREHENSIVE APPROACH AUTHOR Kellen Choi DO , FACOS
“ Thank you ! I thought I just had to live like this .”
With her eyes tearing up , this middle-aged mother of four thanked me for helping with her urinary incontinence . She was embarrassed for having “ accidents ” and felt no one would be able to help her . She felt isolated and ashamed . I have unfortunately heard very often from mothers who felt blessed with childbirth and loved being a mother , but very troubled that their urinary symptoms increased with each pregnancy . A few years after her hysterectomy , she felt as though she were sitting on a golf ball and needed to push her vaginal bulge aside simply to urinate , while feeling like she could never really empty her bladder . She thought , “ This must be how I ’ m going to be .”
Approximately 40 % of women develop a vaginal vault prolapse after a hysterectomy . 1 Additionally 40 % of all women over the age of 40 have some component of pelvic organ prolapse . 2 , 3
I was grateful that she found me and that I could help her . She wanted to see a female urologist and had searched online for quite some time . She told me I was the only female urologist in Louisville who sees adult patients . She expressed that in her culture , women prefer to be seen by women physicians , especially when it comes to genitourinary symptoms .
As expected , her pelvic exam revealed a post hysterectomy vaginal vault prolapse . She had microscopic hematuria on two separate occasions . Imaging performed on her genitourinary system was unremarkable . A cystoscopy was performed and was unremarkable as well . She did not have any stress urinary incontinence , where she would leak with coughing and sneezing , but when she really had to use the bathroom she often could not make it on time and had urge incontinence .
After listening to her troubles and discussing her problems , we had to now decide what to do next . We discussed a wide range of treatment options including observation , pelvic floor physical therapy , pessary or surgery to address her vaginal vault prolapse .
8 LOUISVILLE MEDICINE