Female Pelvic Medicine and Reconstructive Surgery (Urogynecology): Services

Evaluation and Diagnosis

A patient's first visit to UF Health Female Pelvic Medicine and Reconstructive Surgery – Jacksonville is often preceded by completion of a voiding (emptying the bladder of urine) diary and questionnaire that documents symptoms, activities, fluid intake, voiding patterns and leakage. A consultation and a physical exam are performed. Urine is collected for analysis, a pelvic exam is performed and a small tube inserted into the bladder during a procedure called catheterization to measure post-void residual (sometimes referred to as PVR) urine volume. The PVR is the amount of urine left in the bladder after normal urination. Based upon initial findings, additional testing may be required to complete the workup. This may include:

• Bladder instillation - A solution of local anesthetics is put into the bladder through a catheter to evaluate and treat interstitial cystitis.

• Complex urodynamic studies - This involves a variety of voiding and filling tests that require a small catheter be inserted into the bladder to evaluate the bladder and urethra.

• Cystoscopy/urethroscopy - A small, lighted scope is inserted into the urethra and bladder to look for inflammation, stones or tumors.

• Ultrasound/CT scan - Radiologic imaging studies are sometimes required to further evaluate the bladder, ureters and kidneys for stones, tumors or other abnormalities.

Treatment Options

Treatment options are dictated by patient preference, nature and severity of the urogynecologic problem, and the medical and physical condition of the patient. Since a wide variety of conditions are treated, many surgical and non-surgical therapies are available.

Behavioral therapy

• Pelvic muscle rehabilitation - Some types of pelvic pain, pelvic organ prolapse and urinary incontinence respond to physical therapy. Kegel exercises can be instructed by the physician and easily performed by many patients. Other patients might be referred to therapists with expertise in diagnosing and treating conditions of the pelvic floor.

• Bladder retraining and behavior modification - Certain types of bladder conditions can be managed by establishing urinary voiding schedules, fluid intake changes and dietary modification.

Medications and Devices

Medications are available to treat a range of urogynecologic problems, including urgency/frequency, urge incontinence, mixed incontinence and interstitial cystitis.

Pessaries are devices designed for insertion into the vagina to correct prolapse and sometimes improve voiding or defecation. Once fitted for such a device, patients can remove and insert them on their own or follow up with routine visits for pessary maintenance with a physician.

Surgery

The gynecologic surgeons offer a variety of surgical treatment options ranging from minimally invasive to vaginal and abdominal surgery.

• Minimally invasive surgery for urinary incontinence - Suburethral slings (TVT) and periurethral collagen injections can often be performed on an outpatient basis unless combined with more invasive procedures.

• Minimally invasive surgery for urge incontinence - Sacral nerve stimulation (interstim).

• Laparoscopic surgery - Performed using a laparoscope and surgical instruments placed through small holes in the abdomen, this technique can be used to treat pelvic organ prolapse and aid in the diagnosis and treatment of certain types of pelvic pain.

• Vaginal surgery - In many patients, pelvic reconstructive surgery can be performed through the vagina, leaving virtually no visible scars. Some conditions or patient factors lend themselves to abdominal surgery.