Female Urology Treatments
Dr. Neil Grafstein, Director of Reconstructive Urology, Female Urology and Voiding Dysfunction in Mount Sinai’s Department of Urology, is a renowned expert in the management of women’s incontinence problems. 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.
Common urologic conditions and treatment options include:
In most cases of incontinence, conservative or minimally-invasive management is our first line of recommended treatment. This may include fluid management, bladder training or pelvic floor exercises. However, for women whose symptoms are more severe and/or when conservative approaches are not sufficient, the optimal treatment option is usually surgery.
- Behavioral Modification
Women with mild to moderate stress incontinence often find simple changes like decreasing fluid intake, as well as eliminating caffeine, helps significantly. Timed voiding can be helpful, too, in preventing accidents by scheduling frequent trips to the toilet before leakage occurs.
- Pelvic Floor Muscle Training
Kegel exercises are designed to strengthen the pelvic floor and sphincter muscles to promote urinary control. These exercises consist of repeatedly contracting and relaxing the pelvic floor muscles.
- Suburethral Sling Procedures
The most common surgery for stress incontinence is the sling procedure. In this operation, a narrow strip of material is applied under the urethra to provide support and improve urethral closure. The operation is minimally invasive and patients generally recuperate very quickly.
- Bulking Agent Injections
Bulking agents can be injected to facilitate closure of the urethral opening. Unfortunately, the cure rate with this minimally invasive treatment is modest. Improved results are sometimes seen after multiple injections.
For urge incontinence there are also multiple treatment options available. Behavior modifications including drinking less fluid, avoiding caffeine, alcohol and spicy foods, not drinking at bedtime, and timed voiding. Kegel exercises can also help.
Many women find relief with medication. There are numerous bladder relaxants available that prevent the bladder from contracting involuntarily without the patient's intention.
Other alternatives can be considered in patients who fail to respond to behavior modification and/or medication. Neuromodulation is the use of a bladder pacemaker to control bladder function. This technology consists of a small electrode that is inserted in the patient's back close to the sacral nerve (responsible for controlling bladder function) in order to stimulate the bladder nerves and control bladder function.
Botulinum toxin (Botox) can be injected into the muscles of the bladder using a cystoscope to treat incontinence. Botox blocks the release of chemicals that cause bladder incontinence.
Overflow incontinence due to obstruction is generally treated with medication or surgery to remove the blockage. In cases where there is no blockage, we may instruct patients to perform self-catheterization a few times a day. By emptying the bladder regularly, the incontinence often disappears.
Pelvic Organ Prolapse
Pelvic reconstruction surgery should be performed by a surgeon with extensive experience and who is fellowship-trained in performing pelvic organ prolapse surgery. Surgery can be performed through the vagina or abdomen.
Surgery to repair a vesico-vaginal fistula can be done through the vagina or abdomen, depending on the location of the fistula and the extent of the opening between the organs.
For patients who decide to delay surgery because of no or mild symptoms, ongoing monitoring is advised. Surgical removal of the diverticulum is the treatment of choice.
We Can Help
Dr. Neil Grafstein is fellowship-trained in female and reconstructive urology and has performed hundreds of surgeries for conditions such as pelvic organ prolapse, urethral diverticula, and vesico-vaginal fistulae. For a consultation with Dr. Grafstein, please call 212-241-4812.
Department of Urology
5 East 98th Street, 6th Floor
New York, New York 10029
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New York, New York 10019