Female Urology at Mount Sinai
Under the leadership of Dr. Neil Grafstein, Director of Reconstructive Urology, Female Urology and Voiding Disorders, Mount Sinai’s Department of Urology’s world-class incontinence and reconstructive urology program provides specialized care for a broad spectrum of female neurologic and non-neurologic voiding dysfunction disorders. Dr. Grafstein is a renowned expert in the management of women’s incontinence problems and board certified in Female Pelvic Medicine and Reconstructive Surgery. He is the only urologist at Mount Sinai Hospital to have this certification in Mount Sinai Hospital. Using minimally invasive procedures whenever possible, Dr. Grafstein has been highly successful in helping women with incontinence, pelvic organ prolapse, and other urogynecologic disorders resume a full and active lifestyle.
Urinary incontinence (the inability to control urination) affects 25 to 45 percent of women. It is not only older women who suffer from urinary incontinence, although the incidence of the condition does increase with age. That said, incontinence is not a normal part of aging and treatment should be sought to restore quality of life.
The primary types of incontinence are:
- Urge incontinence (overactive bladder) is the sudden need to urinate due to bladder spasms or contractions (a sensation that urine will be lost if you do not reach the bathroom in time
- Stress incontinence occurs during physical activity or motion, such as when you laugh, sneeze, cough, or run, or perform other activities that exert pressure on your bladder.
- Mixed incontinence is the combination of stress and urge incontinence.
- Overflow incontinence is the inability to empty your bladder fully accompanied by urine leakage or dribbling.
Pelvic Organ Prolapse
The supporting structures of the pelvic floor may weaken due to a variety of reasons, including childbirth, obesity, connective tissue disorders, and surgical procedures , such as a hysterectomy. Consequently, bladder, rectal, or uterine tissue may bulge into the vagina, causing incontinence, bowel and/or sexual problems. There are several different types of prolapse based upon the organs affected:
- Cystocele occurs when the bladder protrudes into the front wall of the vagina
- Urethrocele occurs when the urethra presses into the front vaginal wall
- Rectocele occurs when the rectum is pushed against the back wall of the vagina
- Uterine prolapse occurs when the uterus drops down into the vagina
A vesico-vaginal fistula (VVF), also called bladder fistula, is an abnormal connection between the bladder and the vagina. Risk factors for vesico-vaginal fistulas include pelvic inflammatory disease and diabetes. Fistulas also may be caused by trauma during childbirth, radiation therapy or vaginal malignancies. Consistent leakage of urine is the main symptom of VVF.
Urethral diverticulum (UD) is a condition in which a bulge or pouch forms next to the urethra. Because it most often connects to the urethra, this pouch repeatedly gets filled with urine during the act of urination thus causing a variety of symptoms, including dysuria (painful urination), leakage, dyspareunia (painful intercourse), and urinary tract infections. Some diverticula are asymptomatic and found incidentally -during routine pelvic exams or during radiographic procedures.
Since many of the symptoms associated with UD are identical to other conditions, patients with UD are often misdiagnosed. A combination of a thorough medical history, physical examination, urine studies, endoscopic examination of the bladder, and specialized urethra and radiologic imaging are essential for accurate diagnosis and determination of treatment options.
Complications of UD include infection, stone formation, and malignancy.
Convenient and Confidential Treatment
The Department of Urology’s state-of-the-art, self-contained Continence Center provides the convenience of on-site diagnostic procedures and treatments. All patients who come to the Mount Sinai Continence Center are given a thorough evaluation, including a detailed medical history so the appropriate treatment can be determined. The professionals on the Continence Center team, led by Dr. Grafstein, understand the highly sensitive nature of female urinary incontinence and are committed to your physical and emotional comfort.
We Can Help
If you or a loved one is experiencing incontinence, please call us for an appointment at 212-241-7580.
Tel: 800-MD-Sinai (800-637-4624)
To make an appointment: