Urogynecology is a focus of Mount Sinai’s Department of Obstetrics and Gynecology and Reproductive Science. 

Designed to meet the needs of the estimated 20 million women in this country with disorders of the pelvic floor, urogynecology addresses benign conditions with major quality of life importance.

Areas of focus of urogynecology include urinary and fecal incontinence, pelvic organ prolapse including cystoceles, rectoceles (dropped bladder and rectum) and uterine prolapse, chronic pelvic pain, and sexual dysfunction.

Common Problems

Urinary Incontinence

One of the biggest misconceptions is that incontinence is a normal part of aging.  This is far from the truth.  The overwhelming majority of patients with incontinence symptoms can be improved and the condition is often curable.  After the establishment of a diagnosis, both non-surgical and surgical options are available.

Stress incontinence

Defined as the loss of urine with increase in abdominal pressure (e.g. cough, laugh, sneeze or exercise).  Treatments for this kind of incontinence have the highest success rates. 

Surgical treatments for stress incontinence offered by our faculty include: the traditional Burch procedure (both open and laparoscopic), retropubic slingplasties (TVT, IVS Tunneller, SPARCS), Transobturator slingplasties (TOT, TVT-O), and the more conservative periurethral injectables (collagen, Durasphere). Non surgical treatment includes biofeedback and physical therapy.  Depending on the cause of the incontinence, cure or imrovement rates may be as high as 93%.

Urge incontinence

Defined as the loss of urine associated with urge and the inability to stop a bladder contraction.  Overactive bladder (OAB) is often the cause but can also be associated with urgency and frequency of urination with leakage.  Urge associated incontinence is often much larger in volume and can be socially devastating as the most of the bladder may empty despite efforts to hold.  The mainstay of treatment of this condition is medical.  After infection is ruled out and the ability to empty the bladder normally is established, diagnostic testing will often confirm OAB as the cause.  Medicines which “relax” the bladder will usually improve and often may cure this condition.  Pelvic floor exercises and physical therapy can further improve control.  If even the higher doses of medications fail to improve the condition, a bladder “pacemaker” know as Interstim may dramatically improve a condition previously thought to be beyond help.

Pelvic Organ Prolapse (POP)

(Cystocele, Rectocele, Enterocele and Uterine Prolapse)
This is among the most poorly understood and most inadequately treated problems encountered by obstetrician gynecologists.  It is believed to result from loss of support or breakage of ligaments and connective tissues, which hold the bladder, rectum, vagina and uterus in place.  The treatment options have included pelvic floor physiotherapy, pessary (an object placed in the vagina to hold organs in place) and surgery.  The surgeries performed for prolapse have traditionally had an abysmal track record.  Surgical failures have been reported as high as 60% within 3-5 years, meaning that in most cases a dropping or bulging organ will come down even after surgical repair.  The inadequacy of surgical options has lead to a revolution in the field over the past 5-10 years, with new techniques which offer the promise of dramatically improved outcomes.  Traditional surgical options for various kinds of prolapse, as well as the cutting edge of minimally invasive vaginal techniques are employed at all three centers.

Find out more about Obstetrics/Gynecology at Mount Sinai. Visit the Faculty Practice Associates - Female Pelvic Medicine and Reconstructive Surgery.