Everything you need to know about Female Urology

In women, the occurrence of urinary incontinence, prolapse and urinary tract infections are much more frequent for various anatomical and functional reasons:

• The urethra is shorter than in the male and this makes it more in contact with the exterior. This is why urinary tract infections are more frequent.
• Vaginal childbirth, pregnancy and menopause are some of the causes of female urinary incontinence, mainly stress incontinence, which affects 30% of women throughout their lives. Pelvic floor weakness can cause prolapse (drooping and externalization of some pelvic and genital organs).

Among the most frequent are urinary incontinence and prolapse.

The increase in life expectancy has led to an increase in the number of patients suffering from this type of ailment, which greatly affects their quality of life (reduced physical and sexual activity, reduced social relations and psycho-emotional stress). The tendency to conceal this problem makes it difficult to quantify its 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 an anatomical structure that closes the abdominal cavity in its lower part providing support for the pelvic organs and actively participates in the mechanisms of urinary continence and sexual function. Therefore, its deterioration can lead to urinary incontinence, pelvic organ hernias manifested by the appearance of a "bulge" 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 the involuntary loss of urine that causes a hygienic and/or social problem, and that can be objectively demonstrated.

What types of urinary incontinence are there?

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

For diagnosis, it is essential to take a complete medical history, with special reference to the number of deliveries and their characteristics, cesarean sections, fetal weight, pelvic surgeries, age, hormonal status, lifestyle and physical exercise habits, obesity, etc.

A physical examination is also performed to assess the pelvic floor and evaluate the characteristics of incontinence.

Other complementary tests are:

• Blood and urine tests to determine renal function and possible urinary tract infection.
• Ultrasound of the urinary system.
• Urodynamic study to show whether there is neurological alteration, which is essential to know before deciding any therapeutic conduct, mainly surgical.

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

In the vast majority of cases, surgical treatment is required.

There are a multitude of abdominal, laparoscopic, robotic or vaginal techniques. The choice of technique must be individualized according to each case and the surgeon's preferences and the good results obtained. Dr. Ramirez described the "Colpocervicourethropexy. Simplified retropubic technique" (Actas Urol. Esp., 15-2 (149-153). 1991) with more than 80% of good results ( Arch. Esp. of Urol. 50. 6 (649-654), 1997).

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

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

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

• Urinary incontinence
• Defecatory dysfunction
• Sexual dysfunction
• Chronic pelvic pain

• Urethrocele (urethral prolapse)
• Cystocele (bladder prolapse)
• Uterine prolapse
• Rectocele (prolapse of the rectum)
• Enterocele (prolapsed bowel)
• Vaginal vault prolapse.

Treatment may vary depending on the stage of prolapse and may be based on conservative medical treatment or surgical treatment.

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