Urology Feminine


30% women's urinary incontinence

Female urethra shorter than male

Importance of personalized treatment

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Everything you need to know about Female Urology

In women, the appearance of urinary incontinence, prolapses and urinary infections are much more frequent for various anatomical and functional reasons:

  • The urethra is shorter than in men and that makes it more in contact with the outside. This is why urinary infections are more common.
  • Vaginal births, pregnancies and menopause are some of the causes that cause female urinary incontinence, mainly stress incontinence, which affects 30% of women throughout their lives. Weakness of the pelvic floor can cause prolapse (drooping and externalization of some pelvic and genital organs).

Among the most frequent are the urinary incontinence and prolapse.

The increase in life expectancy has led to an increase in the number of patients suffering from these types of conditions that greatly affect their quality of life (reduction in physical activity, sexual activity, social relationships and psycho-emotional stress). ). The tendency to hide this problem makes it difficult to quantify in terms of prevalence.

The recommendation of treatment requires knowledge of the causes and the results of the diagnostic tests performed. which must be individualized for each patient.

The pelvic floor is a anatomical structure that closes the abdominal cavity in its lower part providing support for the pelvic organs and actively participating in the mechanisms of urinary continence and sexual function. Therefore, its deterioration can lead to urinary incontinence, hernias of the pelvic organs that manifest themselves with the appearance of a “lump” in the genital area (prolapse) and sexual dysfunction.

These alterations occur more frequently after menopause and are related to obstetric and surgical history, hormonal status, lifestyle habits, physical exercise, obesity, etc.

Urinary Incontinence (UI) is defined as involuntary loss of urine that conditions a hygienic and/or social problem, and that can be objectively demonstrated.

What types of urinary incontinence exist?

  • Stress urinary incontinence: involuntary loss of urine associated with small, medium or large effort.
  • Urge urinary incontinence: involuntary loss of urine associated with a sudden and urgent desire to urinate.
  • Mixed urinary incontinence: combination of the previous two.

For the diagnosis, it is essential to take a correct complete clinical history in which special reference is made to the number of births and their characteristics, cesarean sections, weight of the fetus, pelvic surgeries, age, hormonal situation, lifestyle habits and physical exercise, obesity, etc. .

A physical examination is also performed, which allows the assessment of the pelvic floor and the characteristics of incontinence.

Other complementary tests are:

  • Blood and urine analysis to determine kidney function and possible urinary infection.
  • Ultrasound of the urinary system.
  • Urodynamic study that reveals whether there is a neurological alteration, which is essential to know before deciding on any therapeutic conduct, fundamentally surgical.

In mild STRESS URINARY INCONTINENCE they may benefit from pelvic floor physiotherapy, change in lifestyle habits and hormone therapy.

In the vast majority of cases it requires surgical treatment.

There are many abdominal, laparoscopic, robotic or vaginal techniques. The choice of technique must be individualized depending on each case and the preferences and good results obtained by the surgeon. Dr. Ramírez described “Colpocervicourethropexy. Simplified retropubic technique” (Actas Urol. Esp., 15-2 (149-153). 1991) with more than 80% of good results (Arch. Esp. De Urol. 50. 6 (649-654), 1997).

EMERGENCY URINARY INCONTINENCE, once other causes such as urinary infection, cystitis, etc. have been ruled out, and after carrying out a urodynamic study, can be resolved with medical treatment (anticholinergic, antimuscarinic drugs, beta-3 adrenergic agonites).

These drugs reduce or eliminate involuntary contractions of the bladder muscle, acting favorably in cases of bladder hyperactivity or mixed causes.

A prolapse is descent of the pelvic organs as a result of the weakening of the pelvic floor. In most cases it is important to treat it because it can generate a multisystem disease and cause, among other things:

  • Urinary incontinence
  • Defecatory dysfunction
  • sexual dysfunction
  • Chronic pelvic pain
  • Urethrocele (urethral prolapse)
  • Cystocele (bladder prolapse)
  • Uterine prolapse
  • Rectocele (rectal prolapse)
  • Enterocele (bowel prolapse)
  • Prolapse of the vaginal vault.

The treatment It can vary depending on the stages in which the prolapse is found. and may be based on conservative medical treatment or surgical treatment.

In most cases, the correction of CYSTOCELE and RECTOCELE is achieved with vaginal surgical techniques through the implantation of meshes designed for this purpose and in cases of severe prolapses, the fixation of the vagina to the sacrum (colposacropexy) via laparoscopic, robotic or open is the choice due to the good results it offers in the long term.

Patricia ramirez urologa2

"Female urinary incontinence, mainly stress incontinence, which affects 30% of women throughout their lives"

Dr. Patricia Ramírez

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