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U.S. News and World Report: America's Best Hospitals, Urology, 2014-2015

 

Creating Options for Incontinent Women

Pelvic floor disorders encompass a broad spectrum of problems which stem from weakening of the pelvic floor, the muscles and ligaments responsible for keeping pelvic organs in place. This loss of support for the bladder, uterus, vagina and rectum can interfere with the normal function of these organs and can seriously compromise a woman’s quality of life.

 

Pelvic floor disorders include the loss of bladder and bowel control and the prolapse, or dropping down, of female pelvic organs. Many patients find these conditions embarrassing or difficult to manage. As the population ages, the prevalence of these disorders is projected to rise.

 

Drs. Wade Bushman and Sarah McAchran discuss advanced treatment options available to patients at the UW Health Women’s Pelvic Floor Center.A recent study using population projections from the U.S. Census Bureau from 2010 to 2050 and prevalence data from the 2005 National Health and Nutrition Examination Survey estimated the age-specific prevalence for bothersome, symptomatic pelvic floor disorders in 2050. The number of American women with at least one pelvic floor disorder will increase from 28.1 million in 2010 to 43.8 million in 2050. The number of women with urinary incontinence is expected to increase 55 percent from 18.3 million to 28.4 million. The number of women with pelvic organ prolapse will increase 46 percent from 3.3 to 4.9 million.

 

With this increase in prevalence, the need for multidisciplinary, evidence-based care will become even more critical. For the first time at the UW School of Medicine and Public Health, members of the Department of Urology, Urogynecology and Colorectal Surgery are combining efforts to create a Women’s Pelvic Floor Center. The Center offers a personalized, multidisciplinary approach to help women navigate through the diagnosis and treatment of pelvic floor disorders.

 

Specialists with a common focus in female pelvic health combine their expertise by sharing information on best practices and developing new approaches to patient care. Patients reap the benefit of this collaborative approach with more advanced treatment options. Rather than asking patients to navigate through a variety of specialty clinics, the Center brings UW Health specialists to them and provides seamless, patient-centered, compassionate care.

 

Urinary incontinence is the most common pelvic floor disorder and several studies have documented the negative impact of women’s quality of life with higher depression and anxiety scores routinely noted. Non-surgical treatments for incontinence, such as physical therapy and exercise with the use of biofeedback, behavioral therapy and device use such as an incontinence pessary are often successful.

 

However, many patients have stress or urge incontinence, or a combination of the two, and their cases may be too severe for simpler therapies. One of the current strengths of the UW Health Urology Program lies in its ability to accurately diagnose the origin of the patient’s incontinence before initiating a treatment plan and then to tailor that plan to the individual patient. Using a state-of-the-art video-urodynamics suite, complex assessment of bladder storage and emptying ability can be performed. Accurate diagnosis leads to better outcomes.

 

For stress incontinence problems, UW Health urologists offer retropubic and transobturator mid-urethral slings, as well as pubovaginal or fascial slings which can address more complicated or refractory forms of incontinence. For urge incontinence, many patients have significant improvement with behavior modification or simple medical management.

 

For those who fail to respond, UW Health offers neuromodulating therapies with both sacral neuromodulation and the intravescical injection of Botox®. Botox® is FDA approved for use in patients with neurogenic detrusor overactivity. UW Health urologists currently provide all aspects of pelvic organ prolapse care. Surgery for pelvic organ prolapse is performed by urologic surgeons with specialized training in the field of female and vaginal surgery. Repair is tailored to the individual patient and can be performed both transvaginally and transabdominally.

 

The Department of Urology offers treatment via robotic surgery. Traditional open abdominal sacrocolpopexy has been shown to be a durable and successful method of repairing symptomatic prolapse while maintaining vaginal depth and length. The techniques utilized in open surgery have been adapted to robotic sacrocolpopexy. Robot-assisted sacrocolpopexy offers a minimally invasive approach with several technical advantages for the surgeon, including enhanced visualization with magnification. Because robotic sacrocolpopexy avoids the need for a large abdominal incision, women undergoing the procedure experience a less painful recovery with a faster return to normal activity than is possible with open surgery.

 

The Department of Urology has some of the most experienced surgeons in complex pelvic floor reconstruction for problems such as vesicovaginal fistula, damage due to prior radiation therapy and complications related to prior prolapse surgeries. The UW Health team has experience in handling the most complex vaginal mesh removal cases and vaginal repair of vesicovaginal fistulas. The vaginal approach offers minimal pain and shorter recovery compared to the open transabdominal approach that is traditionally used. With the vaginal approach, the majority of patients spend less than 24 hours in the hospital post-operatively.