Urogynecology

Urogynecology is a medical subspecialty that brings together obstetrics and gynecology and urology to diagnose and treat disorders of the female pelvic floor that affect urinary and pelvic organ function. It focuses on conditions such as urinary incontinence (stress, urgency, and mixed incontinence), pelvic organ prolapse (anterior, apical, and posterior prolapse), overactive bladder, nocturia, urinary retention, fecal incontinence, and related pelvic floor dysfunction.

Evaluation in urogynecology typically involves a detailed medical history and physical examination, assessment of pelvic floor muscles, and specialized tests such as urodynamics, cystoscopy, and imaging when indicated. Risk factors include childbirth, aging, obesity, prior pelvic surgery, and hormonal changes. Management emphasizes a spectrum from conservative to surgical approaches, tailored to the patient’s symptoms, anatomy, and preferences.

Conservative therapies include pelvic floor physical therapy, bladder training, lifestyle modifications (weight management, caffeine reduction), and the use of vaginal pessaries for prolapse. Pharmacologic options may address overactive bladder symptoms. Vaginal estrogen may be considered to improve tissue quality in postmenopausal patients. When surgery is indicated, options vary by problem area and may include mid-urethral slings or other continence procedures for incontinence, and anterior/posterior colporrhaphy, or abdominal, vaginal, or robotic-assisted sacrocolpopexy or related suspensions for prolapse. The use of vaginal or abdominal mesh has declined in some regions due to safety concerns and regulatory actions, with emphasis on safer, evidence-based practices.

Training for urogynecology typically occurs within obstetrics and gynecology or urology and includes a fellowship in female pelvic medicine and reconstructive surgery (FPMRS) or urogynecology, leading to board certification in the subspecialty.