Louisville Medicine Volume 69, Issue 3 | Page 11

She expressed that her prolapse and her urge urinary incontinence was dramatically affecting her life and she chose surgery . Given her young age , active state and severe symptoms , we elected to proceed with a robotic assisted laparoscopic sacrocolpopexy , which is known to be the gold standard for treating post hysterectomy vaginal vault prolapse . 4 We also discussed that if she still had urge incontinence despite having her anatomy restored , there would be other options as well .
Surgery went smoothly . She followed every direction I gave her , including taking stool softeners to avoid constipation and to avoid straining in any way to ensure maximal healing . On her post-op visits , the repair looked excellent and her urinary urgency , urge incontinence and sense of incomplete bladder emptying had all disappeared . This woman is one of many patients , especially women , whom I have been fortunate enough to treat and help with something that may seem benign and not life-threatening . Yet , these issues are completely life-altering .
Up to 27 % of men and 43 % of women have overactive bladder , which is defined as “ a condition characterized by urinary urgency , with or without urge incontinence , usually with urinary frequency and nocturia .” 5-13 Importantly , overactive bladder is not a disease , but rather a symptom complex . 14 Therefore , a careful and methodical approach to help patients achieve improved bladder control requires patience and time .
It ’ s prudent for a urologist to rule out anatomical etiologies for patients ’ urinary concerns such as bladder cancer , urolithiasis , pelvic organ prolapse or other pelvic malignancies . A thorough pelvic exam is crucial in the evaluation of female patients . In certain complex voiding dysfunctions , additional tests such as cystoscopy are necessary to evaluate the bladder mucosa . A urodynamic study of bladder capacity and function is another important tool to delineate the various types of urinary incontinence .
Urology has traditionally been a specialty that emphasizes male urologic conditions . My training in five years of urology residency also seemed to be dominated by male conditions . But my fellowship training in neuro-urology , female pelvic medicine and urologic reconstruction with my mentor Dr . Steven Siegel gave me a tremendous opportunity to better understand urologic conditions unique to women . As a board-certified urologist with an emphasis on female urologic conditions , I feel equipped to manage complex voiding dysfunction , which could include robotic surgery , synthetic slings , bulking agents , autologous fascial slings and sacral nerve modulation . Sacral nerve modulation especially can be a viable option for patients who have failed other treatments and something I have studied and researched extensively under Dr . Siegel .
UROLOGY : CLINICAL UPDATES FROM THE PRACTICE as well as urge incontinence symptom relief after pelvic floor physical therapy . 15 Such multimodal therapies offer the chance of maximum improvement to such patients , who afterwards may consider surgical options , if their results fall short with non-invasive treatment .
My hope is that many women with these urologic conditions will no longer suffer in silence and seek appropriate help for their well-deserved quality of life .
References :
1
“ Post hysterectomy vault prolapse | Oxford Gynaecology and Pelvic Floor Centre ” https :// www . oxfordgynaecology . com / conditions-we-treat / vaginal-prolapse / post-hysterectomy-vault-prolapse /
2
Roovers JP , Everhardt E , Dietz V , Milani F , et al . Richtlijn prolapse van de nederlandse vereniging obstetrie en gynaecologie . Dutch Society of Obsetrics and Gynaecology . www . nvog . nl . 2017 .
3
The treatment of post-hysterectomy vaginal vault prolapse : a systematic review and meta-analysis ” https :// www . ncbi . nlm . nih . gov / pmc / articles / PMC5705749 /
4
“ Long-term Outcomes Following Abdominal Sacrocolpopexy for Pelvic Organ Prolapse ” https :// www . ncbi . nlm . nih . gov / pmc / articles / PMC3747840
5
Abrams , P , Cardozo , L , Fall , M . The standardisation of terminology of lower urinary tract function : report from the standardisation sub-committee of the International Continence Society . Am J Obstet Gynecol . 2002 ; 187:116 – 126 .
6
Choo MS , Ku JH , Lee JB et al : Cross-cultural differences for adapting overactive bladder symptoms : results of an epidemiologic survey in Korea . World J Uro 2007 ; 25 : 505 .
7
Corcos J and Schick E : Prevalence of overactive bladder and incontinence in Canada . Can J Urol 2004 ; 11 : 2278 .
8
Coyne KS , Sexton CC , Vats V et al : National community prevalence of overactive bladder in the United States stratified by sex and age . Urology 2011 ; 77 : 1081 .
9
Tikkinen , KA , Auvinen A , Tiitinen A . et al : Reproductive factors associated with nocturia and urinary urgency inin women : A population-based study in Finland . Am J Obstet Gynecol 2008 : 199 : 153 e1 .
10
Irwin DE , Milsom I , Hunskaar S et al : Population-based survey of urinary incontinence , overactive bladder , and other lower urinary tract symptoms in five countries : Results of the EPIC study . Eur Urol 2006 ; 50 : 1306 .
11
Stewart WF , Van Rooyen JB , Cundiff GW et al : Prevalence and burden of overactive bladder in the United States . World J Uro 2003 ; 20 : 327 .
12
Herschorn S , Gajewski J , Schulz J , et al : A population-based study of urinary symptoms and incontinence : The Canadian Urinary Bladder Survery . BJU Int 2008 ; 101 ; 52 .
13
Milsom I , Abrams P , Cardozo L et al : How widespread are the symptoms of an overactive bladder and how are they managed ? A population-based prevalence study . BJU Intl 2001 ; 87 : 760
14
“ Overactive Bladder ( OAB ) Guideline - American Urological Association ” https :// www . auanet . org / guidelines / guidelines / overactive-bladder- ( oab ) -guideline
15
Hagen S , Stark D , Glazener C , et al . Individualised pelvic floor muscle training in women with pelvic organ prolapse ( POPPY ): a multicentre randomized controlled trial . Lancet 2014 ; 383:796 – 806 .
Dr . Choi is an Assistant Professor and Director of Female Urology and Reconstructive Urology at the University of Louisville , Department of Urology .
I feel blessed to be able to help a wide variety of patients in a busy academic practice , especially in an institution widely praised for surgical excellence . Pelvic floor physical therapy is often incorporated into our practice . Several randomized trials have demonstrated improvement in pelvic organ prolapse , stress urinary incontinence ,
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