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About Urogynaecology Surgery

Urogynecology is a subspeciality of gynaecology, which treats all conditions of the female urinary and reproductive tract. A urogynaecologist is a gynaecologist who has also trained in female pelvic health and pelvic reconstructive surgery. He or she performs evaluations, diagnoses and treats female patients through surgical and non-surgical services, with a focus on symptoms associated with urinary incontinence, prolapse, and other pelvic floor disorders.

Conditions treated by urogynecology specialists include:

1. Congenital anomalies of the lower reproductive tract like vaginal septum (a wall of tissue dividing the vagina into two sections) imperforate hymen (when the hymen covers the whole opening of the vagina) and uterine anomalies.

2. Faecal incontinence. Also called bowel incontinence, this is the involuntary loss of bowel control, which causes stool (faeces) to leak unexpectedly from the rectum. It ranges from mild, occasional leakage of stool to complete loss of control.

A urogynaecologist will treat fecal incontinence in a variety of non-surgical approaches, but sometimes surgery is necessary.

These procedures include sphincteroplasty, to repair a torn anal sphincter; artificial anal sphincter, in which an inflatable cuff is placed around the anus to control the passage of stool; and colostomy, a procedure to provide an alternative channel for stools which are collected in a bag on the outside of the abdomen.

3. Pelvic organ prolapse. This occurs when one or more pelvic organs move out of position and drop into the vagina. Prolapse affects the vagina, uterus, cervix, bladder, rectum and the bowel or small intestine. Pelvic floor reconstruction can repair severe symptoms of prolapsed pelvic organs and the structural issues which cause the condition.

4. Urinary incontinence. This is an involuntary loss of bladder control, which can be mild to severe. The two most common types are stress incontinence, caused by coughing, sneezing, laughing, exercise or heavy lifting, and urge incontinence, or an overactive bladder, which causes an intense need to urinate. Stress incontinence surgery usually uses a ‘sling procedure’ or a bladder neck suspension. Procedures for overactive bladder can involve implanting a device that uses small, electrical impulses which stimulate the urge to urinate.

5. Urethral diverticulum. This is a pocket or pouch that forms along the urethra which fills with urine and can lead to infections, a painful vaginal mass, pelvic pain and repeated urinary tract infections (UTI) Surgical excision is the preferred treatment.

6. Vesicovaginal and rectovaginal fistulas. A vesicovaginal fistula is an opening between the vagina and bladder, which will result in urine leaking into the vagina. This can cause urine incontinence. A rectovaginal fistula is an abnormal connection between the lower part of the large intestine (rectum) and the vagina, which can cause gas or faeces to leak into the vagina. Surgery is the most common treatment.