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• Vulvar and Vaginal Cancer
• Urinary Incontinence and prolapse
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Urinary incontinence and prolapse

Approximately 50% of all women experience at least occasional incontinence, and 10% experience incontinence regularly. The incidence increases with increased parity (childbirth) and with advancing age, and may be related to prolapse of the vagina and bladder. As many as 20% of women over age 75 are affected.

Urinary incontinence may occur in over 30% of nursing home residents and is often a major reason for placing individuals in nursing homes. Incontinence prevents many women from fully enjoying their careers, social relationships, and sexual lives.  Incontinence is often related to prolapse of the pelvic organs including the bladder, vagina and uterus.  Even without severe prolapse, patients may suffer from vaginal discharge, painful intercourse, and vaginal discomfort related to pressure in these areas.

Diagnosis

• Clinical history
• Pelvic examination
• Urodynamic testing for bladder function

Treatment

• Medical management includes kegel exercises, prescription drug therapy, estrogen hormone replacement, and electrical simulation of the pelvic floor.
• Temporizing measures includes local injection of the bladder neck with materials such as collagen, botox and Teflon.  Patients may also be candidates for pessary placement, a device similar to the diaphragm that may be left in place for intervals of up to 3 months.

Surgery

• Surgical intervention includes procedures to raise or lift the bladder as well as the vaginal tube.  The overall goal involves elevation and support of the bladder neck to improve the pressure relationship during activities of physical stress.
• Surgical procedures for incontinence may be done from a vaginal approach, laparoscopic approach, and through an abdominal incision.  A combination of these approaches may be appropriate in selected patients.
• Successful correction of prolapse and incontinence following abdominal surgical procedures may range from range from 60 to 100%, and generally 85-90% in selected patients.

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