Urogynecology

At Our Urogynecology Center

• Urinary incontinence
• Bladder prolapse
• Uterine prolapse
• Vaginal widening and prolapse
• Diagnosis and treatment of gas and fecal incontinence and the sexual problems associated with them are carried out

Urinary Incontinence

There are two important causes of urinary incontinence. The first cause is stress urinary incontinence, which occurs due to weakening of the anatomical support of the pelvic floor and the bladder. In stress urinary incontinence, the patient involuntarily leaks urine when coughing, sneezing or straining. This condition is generally associated with multiple vaginal births, giving birth to a large baby, giving birth at home on one's own, difficult labor, interventional deliveries, or delivery assisted by untrained persons. It is also commonly seen due to age, menopause, prolonged constipation, obesity, and lung diseases such as asthma and bronchitis. Because of high fertility in our country, the majority of involuntary urinary incontinence is this type, and it is frequently encountered in young women of reproductive age. The second cause is overactive bladder syndrome, which occurs due to dysfunction of the bladder muscle of unknown cause while the bladder fills with urine. This type of incontinence typically involves a sudden urge to urinate during water-related activities and being unable to reach the toilet in time. In some patients, the first and second causes occur together. This type of urinary incontinence is called mixed urinary incontinence. Patients with urinary incontinence constantly use pads or diapers, restrict themselves to their home, and limit their social relationships due to leakage and odor. This condition sometimes leads to serious psychological problems. In our research in our country, 80% of women with urinary incontinence see this condition as a natural result of aging and childbearing and therefore do not consult a physician. Urinary incontinence is a serious health problem and must be treated. Modern medicine offers various treatment options according to the patient's condition. These are:

• Drug therapy
• Behavioral therapy (bladder training)
• Exercise (Kegel)
• Exercise with vaginal cones
• Exercise with biofeedback methods
• Functional Electrical Stimulation (FES)
• TENS
• Magnetic chair (ExMI)
• Pessaries
• Botox
• Surgery

Depending on the severity of the patient's complaints, treatment is determined after examination, clinical evaluation (bladder diary, pad test, stress test) and urodynamic studies. If the patient's complaints are not serious or there is overactive bladder syndrome, the condition can be treated with non-surgical methods and its progression can be halted. If the patient's complaints are severe, the patient uses pads, and urinary incontinence affects their social life, the treatment of choice is surgery. Today, surgeries performed under local anesthesia through a small incision that do not require hospital stay have long-term success rates above 95%. However, the surgeries of the past that have been abandoned today had long-term success rates of around 30%, and unfortunately some of our patients today are those who underwent such unsuccessful surgeries in the past.

Pelvic Organ Prolapse

The descent of the bladder, small intestine, large intestine and uterus, which are normally located within the pelvis, toward the vagina is called pelvic organ prolapse. The patient feels a mass at the vaginal opening. In some patients, the vagina also protrudes outward along with the uterus. As with urinary incontinence, childbirth plays an important role as a cause of prolapse. Patients with prolapse have difficulty urinating or leak urine, cannot completely empty the bladder, cannot have a bowel movement and experience constipation. Some patients can urinate by pushing the vagina forward with their hand and have a bowel movement by pushing it backward. In addition, due to widening and prolapse of the vagina, they frequently experience difficulty, pain, dissatisfaction and orgasm problems during sexual intercourse. Some patients with pelvic organ prolapse and/or urinary incontinence also have complaints of gas and/or fecal incontinence. For pelvic organ prolapse, new surgical methods that can be performed under local anesthesia and have high long-term success rates have been developed. In patients with severe complaints, the treatment is surgery. By evaluating all of the patient's complaints, it is possible to restore the pelvis and vagina to their former state and to correct gas incontinence and fecal incontinence with surgeries performed in the same session.

If,

• You have felt a need to urinate frequently for a long time
• You frequently get urinary tract infections
• You feel that urine flow is gradually decreasing and that the bladder is not completely emptied
• You wake up more than 2 times at night to urinate
• You feel a sudden urge to urinate or leak urine while doing water-related tasks
• You leak urine because you cannot reach the toilet in time
• You sit close to the toilet and move items on the path to the toilet
• You leak urine when laughing, coughing or sneezing
• You use pads out of fear of urinary incontinence
• You avoid visiting your spouse, friends and relatives due to concern about urinary incontinence
• You have pelvic organ prolapse (you feel a mass at the vaginal opening)
• You have difficulty urinating or can only urinate after a very long time
• You help yourself while urinating by lifting the vagina forward and upward with your hand
• You push the vagina backward with your hand while having a bowel movement
• You constantly feel constipation and a sense of fullness in the vagina and pelvis
• You have gas or fecal incontinence
• You leak urine or gas during sexual intercourse
• You feel pain during sexual intercourse
• Unlike your previous sexual relationships, you are unable to feel anything during intercourse and have orgasm problems
• Your partner, unlike in your previous relationships, cannot feel your vagina and is not satisfied with the relationship
• A disturbing sound comes from the vagina during sexual intercourse or while moving
• Independent of intercourse, you feel pain at the vaginal opening, pain while urinating and pain in the lower abdomen
• You want to protect yourself from urinary incontinence and uterine prolapse in later stages of your life.
• There is definitely a treatment method suitable for you.

Please apply to our Urogynecology Center within the Department of Obstetrics and Gynecology.

Urogynecological surgeries performed in our clinic

Urinary Incontinence

• TVT, TVT-O, TOT
• TVT Secur
• Burch colposuspension

Bladder Prolapse

• Lifting of the bladder (anterior colporrhaphy)
• Lifting of the bladder with mesh (Prolift etc.)
• Paravaginal repair (vaginal/abdominal or with mesh)

Uterine Prolapse / Prolapse of the Vaginal Apex (Vault)

• Suspension of the uterus to the sacrum (Sacrocervicopexy)
• Removal of the uterus through the abdomen and suspension of the vagina to the sacrum (Sacrocolpopexy)
• Suspension of the uterus to the sacrospinous ligament via the vaginal route (Sacrospinous cervicopexy)
• Removal of the uterus through the vagina and suspension of the vagina to the sacrospinous ligament (Sacrospinous fixation)
• Total anterior-posterior mesh application (Prolift etc.)
• Posterior intravaginal sling application (Posterior IVS)

Prolapse of the Posterior Vaginal Wall (Descent of the Large Intestine Toward the Vagina)

• Repair of the posterior vaginal wall (posterior colporrhaphy)
• Mesh repair of the posterior vaginal wall (Prolift etc.)
• Enterocele repair

Gas and Fecal Incontinence

• Sphincteroplasty

Aesthetic and Plastic Vaginal Operations

• Vaginal widening
• Deformity and asymmetry of the labia majora

All urogynecology surgeries are performed at our center, and conservative treatment methods are applied.