Urogynecology

Urogyn Soft Edges

Division Summary:

Our growing division of three urogynecologists cares for patients at the Urology and Urogynecology Clinic at University of Washington Medical Center in Seattle and the Eastside Specialty Center in Bellevue. We offer comprehensive care for women with pelvic floor disorders, including pelvic organ prolapse, urinary incontinence, fecal incontinence, postpartum perineal issues, recurrent urinary tract infections, pelvic pain issues, mesh complications and fistulas. This group cares for more than 500 new patients per year in a professional, caring environment. We have practiced collaboratively with Urology since 1992. This has expanded to include multi-disciplinary care with Urology, Colorectal Surgery, Gastroenterology, Radiology and Physical Therapy when needed to provide the highest quality of care for our patients. We are regional leaders in the medical and surgical treatment of women with pelvic floor disorders and excel in our roles as mentors and educators.

Our mission for the Division of Urogynecology:

  • To provide high-quality patient-centered care
  • To provide excellent education for UW Medicine and the WWAMI region for urogynecologic conditions
  • To be national leaders in our field

Our Services:

We offer complete pelvic health care, including:Pelvic Health Center crop2 022

  • Lifestyle changes
  • Physical therapy:
    • Pessaries
    • Medications
    • Postpartum perineal care issues
    • Percutaneous tibial nerve stimulation
  • Surgeries for prolapse:
    • Anterior repairs
    • Posterior repairs
    • Hysterectomy
    • Uterosacral ligament suspensions
    • Sacrospinous ligament suspensions
    • Open or robotic sacrocolpopexy
    • Colpocleisis
    • Mesh and non-mesh prolapse surgeries
  • Surgeries for urinary incontinence
    • Midurethral slings with mesh
    • Burch urethropexies
    • Fascial slings without mesh
    • Transurethral bulking injections
    • Bladder Botox injections
    • Sacral neuromodulation (InterStim)
  • Surgeries for fecal incontinence
    • Anal sphincteroplasty
    • Sacral neuromodulation (InterStim)

Clinical Care:

Physicians at the University of Washington and throughout the Pacific Northwest refer patients to the three urogynecologists in our division for management of pelvic organ prolapse and urinary and fecal incontinence, as well as other complicated conditions of the female pelvic floor. Our urogynecologists also work collaboratively with Female Urology. We see over 500 new patients per year with urogynecologic problems at the Urology and Urogynecology Clinic at the University of Washington Medical Center, and the UW Eastside Specialty Clinic in Bellevue. The physicians in our Division also perform over 200 major surgical cases per year. Many of our patients present with very complex conditions with multiple overlapping conditions and prior operations for pelvic organ prolapse and/or urinary incontinence, fecal incontinence and mesh complications.

We work as a multidisciplinary team with physical therapy experts, colorectal surgeons, gastroenterologists for defecatory dysfunction, pain relief medicine clinic, and radiology with expertise if defecatory problems. Our treatment options range from behavioral changes, physical therapy, medications, minimally invasive implants or injection therapy to complex vaginal reconstruction, laparoscopic approaches, robotically assisted abdominal sacral colpopexies and uteropexies, mesh slings, traditional Burch colposuspension and autologous fascial pubovaginal slings. Our comprehensive program offers individualized care and support during

Our comprehensive program offers individualized care and support during evaluation and surgical or nonsurgical management. As Urogynecology specialists, we are proud of the care we provide and value time we devote to each patient in order to understand concerns.


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 Urogynecology and Female Urology

Urinary Leakage Overview:

Overview

Urinary incontinence is the accidental or involuntary leaking of urine and is very common in women. In general, there are two types of urinary incontinence:

  1. Stress urinary incontinence (SUI) is the result of weak urethral muscle and support. Patients with SUI usually complain of urine leakage with activities like coughing, sneezing, running or exercise. When one coughs, for example, their bladder pressure rises with the cough. Because the urethral muscle and/or support is weak, it can't resist that pressure rise and urine will leak out.

  2. Urge urinary incontinence (UUI) is the result of overactive bladder muscles. Patients with urge urinary incontinence typically complain of leakage when they get an urge to go to the bathroom and can't make it in time. In this case, it is the bladder itself that is contracting and forcing the urine out. The leakage amount might be quite large at times. Many women describe triggers that cause their leakage, such as hearing or seeing running water, placing a key in the door upon returning home, or when they stand up from a chair or get out of bed.

Some women have both types of leakage. This is called mixed urinary incontinence (MUI).

Causes

Unfortunately, we do not know with certainty what causes SUI, but it is believed that certain experiences, such as vaginal delivery or repetitive heavy lifting, injure the support to the bladder and urethra. Women who are obese or have a chronic cough also seem to be at risk. The causes of UUI are not known but likely relate to changes in the nerves and or muscles of the bladder.

Complications

The effect that incontinence may have on a patient's quality of life can be substantial. Some women stop exercising, avoid travel or even leaving their home for any duration of time for fear of embarrassing accidents. Urinary tract infections (UTIs) can be a common complication.

Diagnosis

Some physicians may not ask about urinary symptoms as part of a general exam, so patients should discuss any symptoms with a doctor who may then evaluate or refer them to a specialist. With a referral, we will discuss your medical history and conduct a physical examination, including a vaginal exam. Sometimes other tests, such as a bladder diary, urine test, or bladder function tests (urodynamics) are necessary before recommending therapy.

Options for Care

Fortunately, there are non-surgical and surgical approaches to this problem that most often significantly improve, if not completely resolve, one's symptoms. Amongst the possibilities are pelvic muscle exercises, fluid changes, physical therapy, medications, vaginal inserts and sometimes minor surgeries. Don't be afraid to start the discussion with your healthcare provider. It's an important first step in improving your quality of life.