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Urogynecology and Pelvic Floor Surgery

Urogynecology and pelvic floor surgery  is the gynecology unit that diagnoses and treats women with pelvic floor disorders. It deals with the treatment of pelvic floor organs, urinary incontinence, vaginal deformity or loss of function, bladder complaints, which belong to the branches of urology.

Current diagnosis and treatment options are available today for women with complex pelvic floor disorders such as urinary incontinence, overactive bladder syndromes, pelvic organ prolapse, voiding and defecation disorders, sexual dysfunctions, gas and stool incontinence, fistulas, and congenital absence of the vagina.

Some of the common problems treated by a urogynecologist are urinary incontinence or leakage, pelvic organ prolapse (droopy vagina, uterus, cystocele, rectocele), and overactive bladder.

The diseases that pelvic floor surgery treats are usually those that are considered quite shameful, taboo for women, and the treatment or control is delayed. After birth, pelvic floor diseases may occur due to deformation, age and hormones.

Pelvic floor disorders are troubling and can seriously affect a woman's quality of life. Patients experiencing a pelvic floor disorder, such as urinary incontinence or uterine prolapse, should consult a specialist in urogynecology and pelvic floor surgery before the disease progresses.

Pelvic organ prolapse  occurs when a woman's pelvic area falls (droops) from its normal position to push one or more organs against the walls of the vagina. The sagging occurs because the downward pressure of the pelvic organs is greater than the strength of the supporting muscles and ligaments. With pelvic organ prolapse, many women feel fullness in the vagina, and as the sagging increases, the tissue may protrude out of the vagina.

Urinary and fecal incontinence and pelvic floor disorders can be caused by many things, including damage to the pelvic floor muscles, nerves, or supporting tissues, including birth and genetics. Smoking and obesity can also contribute to urinary incontinence. Pelvic floor disorders can be caused by aging, repeated heavy lifting, chronic diseases, genetics or previous surgery.

Pelvic floor disorder cannot go away on its own. In some cases of pelvic organ prolapse, a urogynecologist may recommend doing nothing and monitor the condition over time, provided the symptoms are not too bothersome for the woman. 

Depending on the problem, it's also possible for incontinence or pelvic floor dysfunction to worsen if left untreated. As a result, a problem that may have responded to a simpler treatment early on may require more complex treatment later on.

The main diseases that are diagnosed, treated and followed are listed as follows.

Urinary Incontinence (Urinary Incontinence)

Urinary incontinence or involuntary urinary incontinence is a phenomenon that affects many women and complicates their social life. Although it is usually seen in older women, urinary incontinence is not a natural part of the aging process and there is often effective treatment available.

There are basically two types of urinary incontinence:

stress incontinence

In this type of urinary incontinence, the person leaks urine when the intra-abdominal pressure increases, such as coughing, laughing, straining and sometimes even walking. The problem here is that the tissues around the bladder weaken over time. In this type of urinary incontinence, satisfactory results can be obtained with surgical treatment.

Urge incontinence

In this type of urinary incontinence, patients describe an incontinence that comes with a sudden urge to urinate. In this type of urinary incontinence, drug therapy may be beneficial.
Pelvic Relaxation (Uterine Prolapse)

Pelvic Relaxation (Uterine Prolapse)

Due to the advancing age, previous surgeries, and vaginal birth, a loosening and weakness may occur in the uterus and the connective tissue around it. In this case, the uterus and other female organs are displaced by sliding down from the chamber. Patients often apply to the physician with a feeling of pressure or fullness.

Vaginal Fistulas

Vaginal fistulas are connections between the vagina and other organs that should not normally exist. It can also occur between the vagina and the intestine, urinary bladder and other organs. The treatment of these conditions, which are mostly due to surgeries, radiation therapy or trauma, is surgery.

Vesicovaginal Fistula or Bladder Fistula

Defines fistula between urinary bladder and vagina. It is manifested by the continuous flow of urine from the vagina.

Rectovaginal fistula or Intestinal

Fistula It indicates the development of fistula from the intestines to the vagina, and stool and/or gas coming from the vagina is the main complaint of the patients.

Urogynecology and Pelvic Floor Surgery Treatment

Pelvic Medicine and Reconstructive Surgery – Conditions Treated

  • Conditions related to connective tissue disorders such as Ehlers-Danlos syndrome
  • Fecal incontinence (inability to control bowel movements)
  • Fecal/rectal fistula (abnormal opening in the skin near the anus)
  • gender dysphoria
  • Mixed incontinence (combination of urge and stress incontinence)
  • Neurogenic bladder (impaired nerves of the urinary system)
  • Neurogenic gut (impaired nerves of the gastrointestinal tract)
  • Nocturia (waking up at night to urinate)
  • Pelvic floor dysfunction (disorders due to pelvic floor weakness)
  • Pelvic network complications/erosions
  • Pelvic organ prolapse (cystocele, rectocele, uterine prolapse, vaginal prolapse)
  • Previous pelvic floor surgery and mesh complications
  • Urinary/bladder fistula (abnormal connection between bladder/ureter and vagina)
  • incontinence
  • Stress incontinence (incontinence with activity such as coughing)
  • Urgent incontinence (overactive bladder)
  • Vaginal atrophy/dryness

Minimally Invasive Gynecological Surgery – Conditions Treated

  • Adenomyosis (displaced endometrial tissue)
  • Endometriosis (You can review my article on this subject at https://drdermanbasaran.com/endometriosis/ )
  • Infertility (in coordination with our fertility specialists)
  • Ovarian cysts (such as endometrioma and dermoid cysts)
  • painful or heavy periods
  • Uterine anomalies
  • Uterine fibroids (non-cancerous growths of the uterus)

Chronic Pelvic Pain – Conditions Treated

  • Dyspareunia (sexual pain)
  • Endometriosis
  • High-toned pelvic floor muscle dysfunction (chronic muscle tension)
  • Myofascial pelvic pain syndrome (localized chronic pain)
  • painful periods
  • Pelvic floor tension myalgia (muscle pain or soreness)
  • Pudendal neuralgia (chronic nerve pain)
  • Vulvodynia (pain around the mouth of the vagina)

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