UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

PELVIC FLOOR DISORDERS

Sercan Kantarcı

University of Health Sciences, Tepecik Training and Research Hospital, Department of Gynecology and Obstetrics, İzmir, Türkiye

Kantarcı S. Pelvic Floor Disorders. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.29-40.

ABSTRACT

Pelvic organ prolapse (POP) and urinary incontinence represent some of the most prevalent pelvic floor disorders in women, significantly impairing quality of life and social functioning. These conditions develop as a result of multifactorial influences including advanced age, history of vaginal delivery, obesity, postmenopausal estrogen deficiency, connective tissue fragility, prior pelvic surgeries, and chronic increases in intra-abdominal pressure. POP is staged using the standardized Pelvic Organ Prolapse Quantification (POP-Q) system, which ensures objective clinical assessment and reproducibility across studies. POP frequently coexists with lower urinary tract symptoms such as stress urinary incontinence (SUI), urgency urinary incontinence (UUI), and mixed urinary incontinence (MUI), leading to both physical and psychological burdens. Patients often report urine leakage, sensations of vaginal bulging, sexual dysfunction, decreased body image, social withdrawal, and emotional distress.

Diagnosis requires a comprehensive history and clinical examination supported by additional tests when indicated. Patient-reported outcome measures, including validated questionnaires such as the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), and sexual function tools (FSFI, PISQ12), provide valuable insights into symptom severity and quality of life. Routine urinalysis, pad testing, bladder diaries, and in selected cases, urodynamic studies, further support diagnostic accuracy.

Management must be individualized and multidisciplinary. For patients with mild or tolerable symptoms, conservative measures such as lifestyle modification, weight control, smoking cessation, bowel regulation, bladder training, and pelvic floor muscle training (PFMT) are recommended as first-line therapy. PFMT has been shown to improve symptoms of incontinence and POP while also exerting positive effects on sexual function. Vaginal pessaries provide mechanical support and are widely accepted by patients across different prolapse stages, with high continuation rates when proper fitting and follow-up are ensured. Surgical treatment is considered for symptomatic, advanced cases, and includes both obliterative procedures such as colpocleisis and reconstructive options such as native tissue repair or sacrocolpopexy.

Sexual dysfunction is an integral part of urogynecological disorders. Women with POP or incontinence frequently experience coital incontinence, dyspareunia, or diminished sexual desire, which negatively impact intimate relationships and overall well-being. PFMT, particularly when combined with biofeedback and electrotherapy, has demonstrated additional benefits in sexual function. Surgical interventions may improve or impair sexual health, depending on the technique, highlighting the need for preoperative counseling and postoperative monitoring. In conclusion, pelvic floor disorders should be approached holistically, with equal attention to anatomical, functional, psychological, and sexual health domains to ensure optimal, patient-centered outcomes.

Keywords: Pelvic floor disorders; Urogynecological evaluation; Urinary incontinence

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