Urogynecologic

Urogynecology, or urogynecologic medicine, is a medical subspecialty within obstetrics and gynecology and urology focused on disorders of the female pelvic floor and lower urinary tract. The field addresses problems such as urinary incontinence and pelvic organ prolapse, as well as associated pelvic floor dysfunction. In some regions the specialty is referred to as female pelvic medicine and reconstructive surgery.

Common conditions include stress urinary incontinence, urge incontinence, mixed incontinence, pelvic organ prolapse, overactive bladder, nocturia, and fecal incontinence. Urogynecologic care also covers pelvic floor dysfunction, dyspareunia, and chronic pelvic pain. These disorders often arise from factors such as pregnancy and childbirth, aging, menopause, obesity, chronic cough, constipation, and prior pelvic surgery.

Diagnosis typically involves history, a physical examination focused on the pelvic floor, urinalysis, bladder diaries, and tests such as urodynamics and imaging when needed. Treatment begins with conservative measures: pelvic floor muscle training (often with physical therapy), lifestyle changes, vaginal pessaries, and topical estrogen for tissue atrophy. Pharmacologic options include antimuscarinic or beta-3 agonist medications for overactive bladder. Surgical management may include midurethral slings, bladder neck suspensions, and pelvic floor reconstructive procedures, with approaches varying by compartment and patient factors; mesh use is increasingly scrutinized and selective.

Urogynecology emphasizes a multidisciplinary approach, often involving urology, gynecology, physical therapy, and continence nurses. The goal is to improve urinary and pelvic floor function, reduce symptoms, and preserve quality of life. Research continues to refine techniques and minimize complications, with ongoing attention to patient-centered outcomes and conservative first-line therapies.