UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

INTRODUCTION TO UROGYNECOLOGY

Sahra Sultan Kara

University of Health Sciences, Kartal Dr. Lütfi Kırdar City Hospital, Department of Gynecology and Obstetrics, İstanbul, Türkiye

Kara SS. Introduction to Urogynecology. In: Balsak D, Çim N, Ege S, editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.3-14.

ABSTRACT

Urogynecology is a multidisciplinary medical subspecialty positioned at the intersection of gynecology and urology, focusing on the diagnosis, treatment, and prevention of pelvic floor disorders in women. These conditions include pelvic organ prolapse (POP), urinary incontinence (UI), fecal incontinence (FI), sexual dysfunction, and chronic pelvic pain. Although gynecology and urology evolved as distinct fields, the surgical needs of women necessitated their integration, giving rise to urogynecology. In the 19th century, James Marion Sims’ surgical repairs of vesicovaginal fistulas and Howard Kelly’s anatomy-based techniques marked the first systematic applications in this field. During the ancient and medieval periods, pelvic floor disorders were managed symptomatically using pessary-like devices and herbal applications. As anatomical understanding advanced through cadaveric dissection, pelvic surgery began to evolve on a scientific foundation. Over time, simple perineorrhaphies were replaced by suspension procedures such as Tension-free Vaginal Tape (TVT), Transobturator Tape (TOT), sacrospinous fixation, and sacrouterine plication, followed by laparoscopic, robotic, and natural orifice surgical techniques. DeLancey’s pelvic support level model and Petros’ Integral Theory have guided both anatomical and functional surgical planning. Today, medical treatments offer effective alternatives to surgery, particularly in cases with mild to moderate symptoms. Topical estrogen preparations, beta-3 agonists, anticholinergic agents, serotonin-norepinephrine reuptake inhibitors, and selective estrogen receptor modulators are commonly used for symptom control. In addition, pelvic floor muscle training (Kegel exercises) is a cornerstone of conservative therapy, especially in the postpartum and postmenopausal periods. When combined with physiotherapy-based approaches such as biofeedback and electrical stimulation, these interventions improve symptom severity and enhance quality of life. Cosmetic and functional procedures, including vaginal laser applications, dermal fillers, and labioplasty, have further expanded the scope of medical management. Epidemiological studies report prevalence rates of 30-60% for UI, 25-50% for POP, 8-15% for FI, 5-25% for chronic pelvic pain, and up to 35% for sexual dysfunction worldwide. Age, obesity, history of vaginal delivery, genetic predisposition, and chronic intra-abdominal pressure (e.g., constipation, coughing, heavy lifting) are primary risk factors. In the future, bioengineering, AI guided simulations, stem cell-based regenerative therapies, and personalized treatment strategies are expected to enhance the management of pelvic floor disorders. Urogynecology now represents a comprehensive approach prioritizing not only anatomical repair but also functional, cosmetic, and quality of life outcomes.

Keywords: Pelvic floor disorders; History of medicine; Urinary incontinence; Pelvic organ prolapse; Epidemiology

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