Female Urology is a specialized field of medicine that focuses on the diagnosis and treatment of urinary tract conditions in women. It addresses a wide range of issues, including urinary incontinence, overactive bladder, recurrent urinary tract infections, pelvic organ prolapse, and other disorders affecting the bladder, urethra, and pelvic floor.

These conditions can significantly impact a woman’s quality of life but are often treatable through medical, surgical, or lifestyle interventions. This field combines elements of urology, gynecology, and pelvic floor therapy to provide comprehensive care tailored to women’s unique anatomical and physiological needs.

What is female urology?

Female urology is a subspecialty of urology that focuses on diagnosing and treating urinary tract disorders that are specific to or more common in women. It deals with conditions affecting the bladder, urethra, and pelvic floor, often overlapping with gynecology due to the close relationship between the urinary and reproductive systems in women.

Female urology aims to improve bladder function, relieve pain or discomfort, and enhance quality of life by addressing both functional and anatomical problems.

Female urology related diseases

Here is a list of common diseases and conditions related to female urology, along with brief explanations:

1. Urinary Incontinence

• Stress Incontinence: Leakage of urine during physical activities such as coughing, sneezing, or exercising.
• Urge Incontinence (Overactive Bladder): Sudden, intense urge to urinate followed by involuntary leakage.
• Mixed Incontinence: A combination of stress and urge incontinence.

2. Urinary Tract Infections (UTIs)

• Infections of the bladder (cystitis), urethra (urethritis), or kidneys (pyelonephritis), more common in women due to shorter urethra.

3. Pelvic Organ Prolapse

• When pelvic organs (bladder, uterus, rectum) drop from their normal position and press against the vaginal walls, often due to weakened pelvic floor muscles.

4. Interstitial Cystitis (Bladder Pain Syndrome)

• A chronic condition causing bladder pressure, bladder pain, and sometimes pelvic pain, often mistaken for recurrent UTIs.

5. Urethral Diverticulum

• A pocket or pouch that forms along the urethra, which can cause pain, infection, and dribbling of urine.

6. Fistulas

• Abnormal connections between the urinary tract and other organs, such as the vagina (e.g., vesicovaginal fistula), often due to surgery, childbirth trauma, or radiation.

7. Neurogenic Bladder

• Bladder dysfunction caused by neurological disorders (e.g., multiple sclerosis, spinal cord injury) affecting control of urination.

8. Bladder Stones and Tumors

• Though less common in women than men, stones or growths in the bladder can lead to urinary symptoms and need medical evaluation.

These conditions often require a multidisciplinary approach involving urologists, gynecologists, and pelvic floor therapists to provide effective treatment and improve quality of life.

Diagnostic methods in female urologic diseases

Commonly used diagnostic tests in female urologic disease:

• Medical History and Symptoms Review: A detailed history of symptoms, lifestyle factors, and previous medical conditions is crucial for diagnosis.
• Physical Examination: Includes pelvic exams to assess pelvic organ prolapse, tenderness, or abnormal findings.
• Urinalysis: Laboratory testing of urine to detect infections, blood, or abnormal cells.
• Ultrasound: Non-invasive imaging to assess bladder, kidneys, and pelvic organs.
• Cystoscopy: A procedure where a camera is inserted into the bladder to view the interior for abnormalities like tumors or stones.
• Urodynamic Testing: Measures how the bladder and urethra function, commonly used for diagnosing incontinence and neurogenic bladder.
• Pelvic MRI or CT Scan: Provides detailed images of pelvic organs to identify prolapse, tumors, or other structural abnormalities.
• Post-Void Residual Measurement: Assesses how much urine remains in the bladder after urination, often used for urinary retention problems.

Symptoms in female urological diseases

Common symptoms in female urologic related conditions:

• Urinary Incontinence: Leakage of urine during physical activities (stress incontinence), sudden, intense urge to urinate (urge incontinence), frequent or mixed incontinence
• Frequent Urination: Increased urgency to urinate, especially at night (nocturia)
• Painful Urination: Burning or discomfort during urination (dysuria)
• Pelvic Pain: Pain in the lower abdomen or pelvic region, often associated with bladder or reproductive organs
• Recurrent Urinary Tract Infections (UTIs): Frequent urinary infections with symptoms like pain, burning, and cloudy urine
• Urinary Retention: Difficulty fully emptying the bladder
• Blood in Urine (Hematuria): Presence of blood in the urine, which may be visible or detected through tests
• Pelvic Organ Prolapse: Sensation of pressure or bulging in the vagina, often accompanied by urinary incontinence or difficulty with urination
• Bladder Pain: Persistent bladder discomfort, often mistaken for recurrent UTIs (Interstitial Cystitis)

These symptoms can significantly affect a woman’s quality of life and require medical attention for proper diagnosis and treatment.

Treatment of female urology-related diseases

The treatment of female urologic conditions depends on the specific disease, its severity, the patient’s overall health, and personal preferences. Treatments range from lifestyle changes to medications and surgical interventions. Below is an overview categorized by condition:

1. Urinary Incontinence

• Conservative Treatments:
  • Pelvic floor muscle exercises (Kegel exercises)
  • Bladder training
  • Fluid and diet management
  • Use of pads or protective garments
• Medications:
  • Anticholinergics or beta-3 agonists for urge incontinence
• Procedures/Surgery:
  • Urethral bulking agents
  • Mid-urethral sling surgery (for stress incontinence)
  • Botox injections into the bladder
  • Sacral neuromodulation (nerve stimulation therapy)

2. Urinary Tract Infections (UTIs)

• Acute UTIs:
  • Antibiotic therapy based on culture and sensitivity
• Recurrent UTIs:
  • Low-dose or post-coital antibiotics
  • Vaginal estrogen for postmenopausal women
  • Lifestyle changes (hydration, hygiene practices)

3. Pelvic Organ Prolapse

• Non-Surgical:
  • Pessary (a vaginal device to support organs)
  • Pelvic floor physical therapy
• Surgical:
  • Vaginal or abdominal reconstructive surgery
  • Hysterectomy (in some cases)

4. Interstitial Cystitis (Bladder Pain Syndrome)

• Lifestyle and Diet Modifications
• Medications:
  • Pentosan polysulfate sodium (Elmiron)
  • Antihistamines, antidepressants, or bladder relaxants
• Bladder Instillations:
  • Direct administration of medication into the bladder
• Physical Therapy:
  • For pelvic floor dysfunction
• Advanced Options:
  • Nerve stimulation
  • Surgery (in severe, refractory cases)

5. Urethral Diverticulum

• Surgical removal (diverticulectomy) is usually required.

6. Fistulas (e.g., Vesicovaginal Fistula)

• Surgical repair is the primary treatment.
• Temporary catheterization may help small, newly formed fistulas heal.

7. Neurogenic Bladder

• Bladder management techniques:
  • Intermittent self-catheterization
• Medications:
  • Anticholinergics or muscle relaxants
• Advanced options:
  • Botox injections
  • Neuromodulation
  • Urinary diversion surgery (in complex cases)

8. Bladder Stones or Tumors

• Bladder stones:
  • Removal via cystoscopy or surgery
  • Addressing the underlying cause (e.g., incomplete bladder emptying)
• Bladder tumors:
  • Surgical removal (e.g., TURBT)
  • Further treatment depending on cancer type and stage

Management of female urologic conditions often involves a personalized, multi-faceted approach. Early diagnosis and treatment can greatly improve a patient’s quality of life. Collaboration between urologists, gynecologists, physical therapists, and primary care providers is often essential.

Innovative treatments in female urology

Recent advancements in female urology have led to more effective, less invasive treatments that improve patient outcomes and quality of life. Here are some of the most innovative treatments currently being used or researched:

1. Botox Injections for Overactive Bladder

• Botulinum toxin A (Botox) is injected into the bladder wall to relax overactive muscles and reduce urgency and frequency.
• Offers relief for patients who don’t respond to medications.

2. Sacral Neuromodulation (SNM)

• A small device implanted near the sacral nerve sends electrical impulses to control bladder function.
• Used for urge incontinence, urinary retention, and overactive bladder.
• Newer versions (e.g., Axonics, InterStim Micro) are rechargeable and MRI-compatible.

3. Percutaneous Tibial Nerve Stimulation (PTNS)

• A non-invasive nerve stimulation technique where a small electrode is placed near the ankle.
• Stimulates the tibial nerve to improve bladder control.
• Performed in a clinic once a week over several weeks.

4. Laser Therapy for Stress Urinary Incontinence and Vaginal Atrophy

• CO₂ or Er:YAG lasers are used to stimulate collagen regeneration in the vaginal and periurethral tissues.
• Minimally invasive and often used post-menopause or post-childbirth.
• Still under study, but showing promising results in improving mild incontinence and vaginal health.

5. Platelet-Rich Plasma (PRP) and Stem Cell Therapy

• PRP or autologous stem cells are injected into pelvic tissues to promote healing and tissue regeneration.
• Experimental but may benefit conditions like stress incontinence or interstitial cystitis.

6. 3D Pelvic Floor Imaging and Mapping

• High-resolution imaging techniques (e.g., MRI, 3D ultrasound) allow better diagnosis and surgical planning.
• Helps tailor treatments for pelvic organ prolapse and complex incontinence.

7. Robotic-Assisted Surgery

• Minimally invasive robotic systems improve precision in procedures like prolapse repair, fistula repair, or bladder reconstruction.
• Associated with shorter recovery times and fewer complications.

8. Vaginal Microbiome Research

• Emerging studies on the vaginal and urinary microbiome may lead to personalized therapies for recurrent UTIs and bladder pain syndromes.
• Could result in microbiome-based treatments such as probiotics or microbiota transplants in the future.

These innovative approaches reflect a shift toward personalized, less invasive, and more effective care in female urology. Many are already in clinical use, while others are being explored in trials and research settings.

Summary

Female urology is a specialized branch of medicine focused on diagnosing and treating urinary tract disorders in women. Common conditions include urinary incontinence, overactive bladder, recurrent urinary tract infections, pelvic organ prolapse, and bladder pain syndrome. These issues often result from factors such as aging, childbirth, or hormonal changes.

Treatment options vary based on the condition and severity and may include lifestyle changes, pelvic floor therapy, medications, minimally invasive procedures, or surgery. Early diagnosis and a multidisciplinary approach are key to improving symptoms and enhancing quality of life for affected women.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKIYE