Surgical Specialists of Colorado

Urogynecology

A urogynecologist is a physician with special training in urology, gynecology and obstetrics who focuses on the specialized evaluation and treatment of gynecologic conditions concerning the female pelvic organs and their supporting muscles and tissues. They are experts in all gynecologic surgery procedures and pelvic reconstructive (restorative) surgery. The subspecialty of urogynecology, now officially known as female pelvic medicine & reconstructive surgery, has been around since the 1970s. Urogynecologists complete medical school and do a four-year residency in obstetrics and gynecology. They then go on to do specialized training in urogynecology for three additional years, gaining experience in advanced diagnostic testing and treatment for pelvic floor disorders and urinary incontinence, along with training in advanced, complex and minimally invasive gynecologic surgeries. Women who in the past had to see multiple specialists for urinary, reproductive and bowel problems can now see one provider, a urogynecologist.

Urogynecologists are experts in treating uterine, vaginal, and bladder prolapse (drop), urinary incontinence, and pelvic floor disorders – all are issues that commonly affect women. These problems can occur at all stages of a woman’s life, but often start after childbirth and around menopause. The most common conditions include urinary incontinence and pelvic organ and vaginal prolapse, which often occur together. It is estimated that 50% of women with children lose pelvic floor support resulting in prolapse. Yet, only 10-20% of women seek care for their symptoms. The prevalence of urinary incontinence in the 15- to 64-year-old age group is 10-25% and up to 50% in women over the age of 60 years. The lifetime “risk” of needing surgery for urinary incontinence and pelvic organ prolapse is around 11%. Advanced training gives urogynecologists many options to treat your symptoms and so treatments are individualized to each patient.

The Surgical Specialists of Colorado Urogynecology Team is located in a state-of-the-art facility at Red Rocks Medical Center. Our specialized physicians and staff work closely with our patients to determine the exact nature of bladder control problems, pelvic relaxation issues, or other gynecologic problems. 

Conditions We Treat

  • Urinary Leakage – Incontinence
  • Frequent Urination – Urinary Urgency – Overactive Bladder
  • Pelvic Organ Prolapse, Vaginal Prolapse, Bladder Drop
  • Urinating Difficulties and Disorders
  • Recurrent Urinary Tract Infections
  • Bladder Pain Syndrome – Interstitial Cystitis
  • No-Incision Hysterectomy & Gynecology Surgery
  • Vaginal and Vulvar Pain syndromes
  • Vaginal Mesh Complications – Pain
  • Bladder and Rectovaginal Fistulas
  • Urethral Diverticulum
  • Hematuria (blood in urine)
  • Heavy Periods, Uterine Bleeding, Uterine Fibroids (aka, “fireballs”)
  • Menopausal Hormone Management
  • Vaginal Dryness – Atrophic Vaginitis – Vaginal Atrophy
  • Sexual Dysfunction – Pelvic Pain
  • Stool Leakage – Fecal Incontinence – BM Difficulties – Stool “Trapping”
  • Reproductive Birth Defects – Uterine and Vaginal Agenesis – Vaginal Septum

Symptoms of These Conditions

Many women with these conditions initially have mild symptoms and may only have symptoms with sexual intercourse. If, however, they start to develop some of the symptoms listed here, the patient should not be embarrassed to tell their health care provider about them; these are all very common!

Symptoms of pelvic floor disorders can include the following:

  • A bulge or something visibly coming out of the vagina
  • Heaviness, fullness, pulling, or aching in the vagina that is worse at the end of the day or during a bowel movement
  • Having a hard time peeing or emptying your bladder completely
  • Leaking pee when you cough, laugh, or exercise
  • Feeling an urgent or frequent need to pee
  • Having frequent urinary tract infections

Surgical Expertise

Our urogynecologists are specialists in minimally invasive laparoscopic or robotic surgical procedures to reconstruct or repair prolapse and pelvic floor conditions and there are several procedures that can provide effective relief for patients:

  • Minimally invasive surgery
  • Laparoscopic or Robotic Sacral Colpopexy
  • Uterosacral or Sacrospinous Colpopexy
  • Paravaginal Repair of Cystocele
  • Vaginal Cystocele Repair
  • Vaginal Rectocele Repair
  • No-incision, Laparoscopic or Robotic Hysterectomy
  • Minimally Invasive Suburethral, Mid-Urethral, Pubovaginal Slings
  • Laparoscopic Burch Retropubic Urethropexy

The links below contain more information about the urogynecology offerings at SSOC.

Bladder control problems are common in women. If you have stopped enjoying activities like running or skiing because of urinary leakage or poor bladder control you are not alone. Urinary incontinence affects over 23 million people in the United States, with the majority being women. Problems with urinary leakage can cause anxiety, social embarrassment and may limit social and daily activities. The most common types of urinary incontinence are:

  • Stress Incontinence – Leaking of urine that occurs with laughing, coughing, sneezing or during exercise, movement or other activities.
  • Urge Incontinence - Also referred to as overactive bladder, is the sudden uncontrollable urge to urinate, sometimes resulting in urine loss on the way to the restroom.
  • Mixed Incontinence – A combination of both stress and urge-incontinence.

Stress Incontinence

Stress urinary incontinence (SUI) is the most common form of incontinence, especially in younger women. This is when small amounts of urine are lost with coughing, sneezing, lifting, exercise, or other activities. This may be caused by loss of support of the bladder neck or a weak sphincter of the urethra (the bladder outlet), or a combination of both. Injuries to the support tissues, pelvic muscles and/or nerves can occur during childbirth, as a result of the aging process, chronic straining/coughing, or obesity. Treatment for SUI can be non-surgical or surgical. One simple treatment involves pelvic floor muscle exercises and/or direct electrical stimulation of the pelvic floor, sometimes under the guidance of a physical therapist. These exercises work to strengthen the pelvic floor muscle which can help support the bladder neck. A pessary or incontinence ring can also be placed in the vagina to help the symptoms of stress incontinence. If these treatments aren’t helpful, there are a variety of minimally invasive surgical options that are available -- suburethral sling procedures, minimally invasive slings, Tension free Vaginal Tape (TVT) sling or the Burch procedure. Your urogynecology specialist can make specific recommendations based on your diagnosis, the severity of your symptoms and your wishes.

Overactive Bladder and Urge Urinary Incontinence

Women who go to the bathroom frequently, feel the urge to urinate often, and get up a lot during the night to empty their bladder may have a condition called overactive bladder (OAB). Also known as urge incontinence, OAB describes a condition where an individual cannot control her urine on the way to the bathroom, which results in dribbling on the way to the bathroom or loss of a large amount of urine at an inopportune time, often causing embarrassment, a need to stay closer to home and, in some cases, social isolation. The cause of this condition is variable and can be multifactorial. Some things that can influence bladder function include aging, low estrogen, nerve or muscle damage to the bladder, bladder stones or growths, previous bladder surgery, poor bladder emptying, or infection.

Treatment for this condition depends on severity. For mild cases, avoiding bladder irritants (caffeine being one of the most common) in the diet, minimizing intake of fluids before leaving the house or before bedtime and retraining the bladder by timed toileting (bladder training or drills) may be all that is needed. Pelvic floor muscle exercises (Kegel exercises), which may be done under the guidance of a physical therapist, can also help build better bladder control. Electrical stimulation of the nerves and muscles involved in bladder control is another option that can be done in the specialist’s office or with a physical therapist. Topical estrogen therapy--in the form of a vaginal cream, pill or vaginal ring placed directly in the vagina--can also be used as an adjunct for bladder and urethra health. There are several medicines that can also be used to help this condition, often used in conjunction with these other therapies. If these treatments are not helpful, a procedure called Interstim (or sacral nerve stimulator) has been in use in the U.S. since 1999 and is a very effective option. Interstim is a two-stage minor outpatient surgery in which an electrode is placed under the skin to stimulate and calm the nerves leading to the bladder that may be causing the overactive bladder symptoms. Another effective treatment is injection of Botox directly into the bladder; these often need to be repeated over time as the Botox wears off.

This term refers to relaxation or weakness of the structures that support the pelvic organs, such as the top of the vagina, uterus, bladder, and rectum. Generally, weakness is the result of an injury to the support structures during vaginal childbirth, but this may also occur in individuals who have not had children. Some other common risk factors include heavy lifting, obesity, genetic predisposition, smoking, coughing, constipation/straining, or prior surgeries. Pelvic organ prolapse encompasses one or more of the following conditions:

Cystocele (“Bladder Drop“) - This is a condition where there is a weakness in the ceiling of the vagina that supports the bladder. Weaknesses in the support of the bladder and vagina can occur in the middle (central cystocele), lateral vagina (paravaginal defect) or at the top (transverse defect) of the vagina.

Rectocele (“Rectal Bulge“) - This is a condition that occurs when there is a weakness in the floor of the vagina that results in the rectum bulging up into the vagina. Rectocele is not the same as a “rectal prolapse” but rectal prolapse is common in patients with pelvic organ prolapse.

Uterine prolapse (“Uterus Falling“) - This is a condition that occurs when the support of the uterus and cervix is lost, causing the descent of the uterus down the vaginal canal toward the opening of the vagina.

Enterocele - This generally occurs after a hysterectomy, when there is a weakness in the top of the vagina with small intestine pushing the top of the vagina toward the vaginal opening.

Atrophic vaginitis - is a medical term for inflammation and thinning of vaginal tissue (vaginitis) that occurs as a result of atrophy (thinning) of the tissue. It is a common condition in women after menopause and is often due to estrogen deficiency. Between 10 and 40 percent of postmenopausal women have symptoms of atrophic vaginitis. The earliest symptoms tend to be decreased vaginal lubrication, followed by other vaginal and urinary symptoms that may be worsened by infection. Estrogen therapy is less commonly administered by mouth these days, but is very effective when given directly (topically) to the vagina. Vaginal moisturizers and lubricants may also improve atrophic vaginitis.

Fecal incontinence - also referred to as anal or bowel incontinence, is a socially crippling disorder that refers to the accidental loss of stool or gas. Soiling problems are embarrassing situations few people can tolerate. Unfortunately, many women who suffer from this disorder do not seek treatment because of the social stigma, or because they do not know that treatment is possible.

Urogynecologists are experts in performing hysterectomies. A hysterectomy is the removal of the uterus and there are a variety of reasons that this may be necessary or be the best treatment for some individuals. Uterine prolapse is one common reason for a hysterectomy along with pelvic pain, fibroids, or cancer. There are several types of hysterectomies – a hysterectomy that removes the uterus only, the removal of the uterus and cervix, removal of the uterus, cervix, tubes and ovaries. There are also a variety of surgical approaches that can be used to perform a hysterectomy and your doctor will discuss the pros and cons with the goal of finding the best option for each individual patient

Surgical Specialists of Colorado offers a comprehensive approach to the diagnosis of gynecologic, urologic and bowel disorders. An evaluation begins with a consultation, review of your medical history and an exam. Patients are asked to complete a urinary questionnaire and a bladder diary to bring along to their appointment. Other tests may be necessary to diagnose and to determine the most appropriate treatment plan. There are many other types of tests available to aid in the diagnosis of pelvic floor conditions; pelvic ultrasound, anal sphincter ultrasound, Pudendal nerve testing, or a pelvic MRI. The most common tests are urodynamics (bladder testing) and cystoscopy.

Urodynamics

Urodynamics is a test that helps determine how well your bladder functions. Some (but not all) reasons this test may be needed include for the evaluation of incontinence, for people with bladder emptying problems, to look for incontinence prior to surgery for pelvic prolapse, and for patients who have a poor response to medicines for incontinence. The purpose of this test is to see how well your bladder empties, how well it holds fluid, if the bladder spasms, and how easy (if at all) leakage occurs with coughing and straining. Additionally, the test assesses how strong the urethra (outlet of bladder) is and if the bladder contracts and urethra relaxes during emptying. During the exam the patient will sit on a chair that is partially open on the base. Narrow catheters, the size of the inside cartridge of a Bic pen, measure pressure while connected to a computer that records everything that happens during the test. One catheter is placed through the urethra into the bladder to measure bladder pressure and to fill the bladder and another is placed in the vagina or rectum to measure pressure in the pelvis. Overall, urodynamics actually involves four separate tests performed sequentially: Uroflow, Cystometrogram, Urethral Pressure Profile, and Pressure Voiding (Micturition) Study.

Cystoscopy

Cystoscopy is a direct visual evaluation of the bladder and urethra. Some common reasons that your doctor may want to perform this test include: the evaluation of recurrent bladder infections, a failure to respond to medicines for overactive bladder, to look for possible bladder stones and evaluation of blood in your urine. It is performed by placing a lighted telescope (cystoscope) through the urethra to examine the bladder. The lighted cystoscope is connected to a camera, with the image of the inside of your bladder projected to a TV monitor. Your doctor can examine the bladder and urethra thoroughly to make sure there are no growths, bladder stones, or other abnormalities that can be treated. Your doctor will also look to see that the ureters (the tubes that carry urine from the kidney to the bladder) empty urine correctly into the bladder. During the test, the urethra is also examined for any abnormalities, such as a diverticulum (out-pouching) or fistula (abnormal communication). Sometimes a small instrument is used to take a small pinch of tissue through the telescope, in order to sample an area that may look abnormal. This is called a biopsy, and generally does not hurt as your doctor will numb the area first with an anesthetic.

Gynecologists - A gynecologist treats women’s health issues—pregnancy, period issues, fertility problems, menopause, and others.

Urologist - A doctor specially trained to treat problems of the urinary system. Urologists may treat UTIs, incontinence, cancer, and male infertility problems, among other conditions.

Urogynecologist - A urogynecologist has been trained in both specialties and is specially trained with additional surgical expertise to treat gynecologic, urologic and urogynecologic conditions affecting women and the female urogenital (urinary and reproductive) system, such as incontinence and pelvic relaxation problems. They have particular expertise in the conditions listed above and focus on symptoms related to urinary incontinence, prolapse, and pelvic floor disorders.

Our Urogynecology Surgeon