The USC Institute of Urology has a full-service female urology program that includes behavioral, medical and surgical expertise. Owing to the entire range of treatments available at our institute, we can evaluate and care for patients from diagnosis to the completion of successful therapy at one location.
Depending on the type of dysfunction, Keck Medicine of USC urologists tailor the best treatment option to fit the individual patient’s needs. Our physicians also provide a full range of services for patients with conditions ranging from overactive bladder and pelvic pain syndrome to voiding and sexual dysfunction. We tailor a combination of pharmaceutical and surgical therapies to the specific needs and requirements of each individual patient. Our physicians discuss conservative measures such as physical therapy, behavioral therapy and pharmacologic solutions. All types of minimally invasive continence and prolapse surgeries are considered and offered, including robotic and laparoscopic methods.
Keck Medicine of USC’s Institute of Urology is the only program in Southern California that offers a full range of options for female pelvic floor disorders, including robotic surgical techniques. For most women, minimally invasive robotic surgery offers numerous potential benefits over a traditional open surgical approach. Women suffering from infertility who need surgery may also benefit from robotic surgery.
Many factors can lead to the development of urinary incontinence, such as multiple childbirths, menopause, prior pelvic surgery and neurologic disease. We understand the negative impact urinary incontinence can have on quality of life and do our best to identify the cause and provide the best treatment options. Prior to instituting therapy, a full evaluation may be required; if so, all of the latest technologies are available at USC including urodynamics, cystoscopy and various radiologic modalities. With proper treatment, the effects of incontinence can usually be significantly reduced or even eliminated. There are various types of incontinence with the two most common types in women being stress urinary incontinence and urge incontinence secondary to overactive bladder. Stress urinary incontinence is associated with leakage of urine with cough, sneeze or laugh and is also associated with loss of urine during activities such as exercise or lifting heavy objects. Overactive bladder is leakage of urine associated with an overbearing urge to void and not being able to get to the toilet before incontinence occurs.
Treatment options for stress urinary incontinence include non-surgical options such as Kegel exercises and pelvic floor behavioral therapy. If surgical therapy is required, we offer a variety of minimally invasive surgical options which usually do not require an overnight stay in hospital. The treatment of overactive bladder usually begins with a variety of medications, pelvic floor behavioral therapy or a combination of both. For patients with overactive bladder refractory to standard initial therapy, there are other options available at USC. This includes sacral neuromodulation and botulinum toxin A (Botox) injections into the bladder. The use of bladder Botox for this treatment has recently been approved by the FDA, and investigators at USC have been among the country’s leaders in evaluating this novel treatment. For those patients still requiring further therapy, lower urinary tract reconstruction is always an option, and USC has been a pioneer in this field for both men and women for many years. The Institute offers a multidisciplinary approach to incontinence, bringing together urologists, gynecologists, colorectal surgeons, gerontologists and rehabilitation physicians. A commitment to innovation and excellence combined with ongoing research and teaching, keeps our surgeons and physicians at the forefront of their field.
Pelvic Floor Prolapse
A special expertise at USC is minimally invasive surgical treatment for all types of pelvic floor prolapse. This includes prolapse of the bladder, rectum and female organs. Scar-free, minimally invasive surgical techniques, such as transvaginal and robotic surgery, are offered routinely to our patients. When needed, we are able to offer a multidisciplinary approach to this problem, often teaming up with gynecologists and/or colorectal surgeons as needed.
Patients with neurological diseases can experience problems with the lower urinary tract, leading to a condition called neurogenic bladder. Symptoms can include inability to urinate, urinary incontinence, frequency and/or urgency of urination, urinary tract stones and frequent urinary tract infections. Keck Medicine of USC urologists also spend time at Rancho Los Amigos National Rehabilitation Center, which is an internationally recognized physical rehabilitation facility, and are thus very comfortable treating patients with neurogenic bladder. This includes patients with bladder dysfunction related to a variety of neurologic diseases such as spinal cord injury, multiple sclerosis, stroke, spina bifida, transverse myelitis and Parkinson’s. All treatment options are available at the institute to minimize the impact bladder symptoms can have on patients with neurogenic bladder.
Urethral diverticulum is a protrusion of the urethra into the anterior vaginal wall. A fistula is an abnormal connection between two organs. The most common type of fistula leading to urinary incontinence is a vesicovaginal fistula, which is most often seen after hysterectomy. Our physicians are experts in treating these condition, and patients are referred to Keck Medicine of USC from all over the country for our services.
Interstitial cystitis is a challenging problem that can lead to symptoms of urinary frequency and urgency as well as bladder and pelvic pain. Keck Medicine urologists work to relieve these symptoms through various treatment options such as bladder distention, bladder instillation, medication and diet.
Female Sexual Dysfunction
Many women suffer from various degrees of sexual dysfunction. This condition is divided into four categories: sexual desire disorders, sexual arousal disorder, orgasmic disorder and sexual pain disorders. Depending on the type of dysfunction, Keck Medicine urologists are available to tailor the best treatment option to fit the individual patient’s needs.
More than 120,000 cases of uterine and vaginal vault prolapse are surgically treated each year in the United States. Prolapse (or falling) of any pelvic floor organ (vagina, uterus, bladder or rectum) occurs when the connective tissues or muscles within the body cavity are weak and unable to hold the pelvis in its natural orientation.
The weakening of connective tissues accelerates with age, after child birth, with weight gain and strenuous physical labor. Women experiencing pelvic organ prolapse typically have problems with urinary incontinence, vaginal ulceration, sexual dysfunction and/or having a bowel movement.
Sacrocolpopexy is a procedure to surgically correct vaginal vault prolapse. Mesh is used to hold the vagina in the correct anatomical position. This procedure traditionally has been performed as an open, invasive surgery with a long horizontal incision being made in the lower abdomen to manually access the inter-abdominal organs, including the uterus.
Keck Medicine of USC’s Institute of Urology is the only program in Southern California that offers a full range of options for female pelvic floor disorders including robotic surgical techniques to treat vaginal vault prolapse. For most women, robotic sacrocolpopexy offers numerous potential benefits over a traditional open surgical approach.
Robotic Surgery for Infertility
For many people who want to start a family, the dream of having a child is not easily realized. Infertility is often defined as not being able to get pregnant after trying for one year. The Centers for Disease Control reports that in any given year approximately 8 percent of women of reproductive age at some point have an infertility-related medical visit.
Women suffering from infertility who need surgery to correct the major causes – such as fibroids, endometriosis and congenital abnormalities – are seeing the benefits of robotic surgery.
Surgeons at the USC Institute of Urology use minimally invasive robotic surgery to correct the following conditions which affect female fertility:
• Blocked fallopian tubes
• Tubal ligation reversal (anastomosis)
• Uterine fibroids