What are Urogynecologic Disorders?

Penn urogynecology services cater to all problems women may have related to their bladder or female organs. Some primary urogynecology disorders are:

• Urinary incontinence
• Stress incontinence - involuntary loss of urine caused by strenuous physical activity, laughing, coughing or sneezing
• Urge incontinence or overactive bladder - involuntary loss of urine that occurs due to a sudden urge to urinate
• Fecal incontinence - the involuntary loss of solid or liquid stool that can result in impaired quality of life for an individual
• Pelvic organ prolapse - described as a fallen bladder, uterus, vagina or rectum
• Fistulas: vesicovaginal or rectovaginal - an opening between the wall of the vagina and the wall of the bladder or rectum which can lead to urine leakage
• Complex benign conditions of the vagina and urethra such as vaginal cysts, absence of vagina, and urethral diverticulums
• Other problems with urination or pelvic floor

A variety of therapies can be used to treat or manage these problems. Bladder or pelvic problems should not be considered as a result of the aging process.

Evaluation

Our goal is to provide diagnostic and therapeutic options tailored to your urogynecologic needs. Our approach is to efficiently complete your evaluation in a comfortable and friendly environment. We keep you informed of your condition, enabling you to make educated decisions and take control of your situation.
Your evaluation may include:

• History and physical examination
  The first office visit consists of an interview and consultation followed by a physical exam and pelvic exam. Following the exam, the doctor may recommend specialized testing.
• Urine examination
  A urine analysis and culture are performed to detect infection, inflammation, blood or other underlying kidney problems.
• Cystoscopy
  This in-office test enables the physician to look directly inside the bladder through a small camera inserted through the urethra. It is a common test used to detect inflammation, stones or tumors.
• Multi-channel urodynamics
  Urodynamic testing evaluates the bladder's function. These in-office tests are particularly useful for women with urinary incontinence or urinary frequency.
• Electrodiagnostic testing (EMG) of the pelvic floor
  This testing evaluates nerve function of the pelvic floor. EMG determines the pelvic floor's muscle response to a series of small electrical impulses.

Depending on your condition, additional tests such as anal manometry, defecography, anal ultrasound and pelvic magnetic resonance imagery (MRI) may be performed. We strive to evaluate your problem, offer a diagnosis, and recommend the best treatment options for you.

Q & A Sessions

Our experienced physicians from the Division of Urogynecology at Penn answered your questions about urogynecology.

Danielle asks:
What, if any, solutions are doctors offering to women with interstial cystitis?

Response:
Solutions to interstitial cystitis include diet modification and pelvic physical therapy, instillation of medications into the bladder, oral medications, and for severe cases, procedures such as sacral nerve stimulation.

Skinny asks:
Can you explain "sacral nerve stimulation," which is used to help urge continence? Is it necessary to be sedated for this procedure? Could this procedure help curve the immediacy to urinate?

Lily Arya, MD, MS:
Sacral nerve stimulation is a minimally invasive outpatient procedure for the treatment of urge incontinence and urinary frequency. It is performed in two parts. Part one involves testing to see if patient is eligible for the procedure. It is performed under local anesthesia. Two weeks later, if the patient is eligible, the placement of the pulse generator is done under sedation and local anesthesia. Studies show that it is successful in 75-85% women in curbing the "urgency" to urinate