USC Urology has a full-service pelvic medicine and reconstructive surgery program, with expert and board-certified surgeons to treat benign conditions of the pelvis, including but not limited to pelvic organ prolapse; voiding dysfunction; neurogenic bladder; urinary incontinence; prostate enlargement; male bladder symptoms; urinary and rectal fistulas; diverticulum, involving the bladder or urethra; and urinary retention.
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 provide all aspects of care, including behavioral, medical and surgical therapies, in a multidisciplinary setting. Owing to the entire range of treatments available at our many locations, we can evaluate and care for patients, from diagnosis to the completion of successful therapy. We tailor a combination of conservative measures, such as physical therapy, behavioral therapy and pharmacologic solutions, to each patient. Minimally invasive surgery techniques, including robotic and laparoscopic methods, are available to treat incontinence, prolapse and other symptoms and disease states.
Keck Medicine’s Catherine and Joseph Aresty Department of Urology is one of the few programs in Southern California that offer a full range of options for pelvic disorders, including robotic surgical techniques.
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 a variety of 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 nonsurgical options, such as Kegel exercises and pelvic floor behavioral therapy. If surgical therapy is required, we offer a variety of minimally invasive surgical options that usually do not require an overnight stay in hospital. The treatment of overactive bladder usually begins with pelvic floor behavioral therapy, medication or a combination of both. For patients with overactive bladder resistant to standard initial therapy, there are other options available at USC. These include sacral neuromodulation, posterior tibial nerve stimulation and botulinum toxin (Botox®) injections into the bladder.
Investigators at USC have been among the country’s leaders in evaluating the novel use of Botox® injections to treat the bladder for both overactive and neurogenic bladder. For those patients still requiring further therapy, lower urinary tract reconstruction is 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, pelvic floor physical therapists, 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 this field.
Pelvic Floor Prolapse
Minimally invasive surgical treatment for all types of pelvic organ prolapse is a special expertise at USC Urology. This includes prolapse of the bladder, rectum and female organs. Scar-free, minimally invasive surgical techniques, such as transvaginal and robotic surgery, are routinely offered to our patients. When necessary, we 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 rehabilitation facility, and are 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 disease. All treatment options are available at Keck Medicine, 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 conditions, and patients are referred to Keck Medicine 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 behavioral and physical therapy, dietary modification, oral medications, bladder instillations and surgical intervention.
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 childbirth, with weight gain and strenuous physical labor. Women experiencing pelvic organ prolapse may have problems with urinary incontinence, vaginal ulceration, a sensation of a vaginal mass or bulge, sexual dysfunction and/or bowel symptoms.
Keck Medicine’s Department of Urology is one of the few programs in Southern California that offers a full range of treatments for female pelvic floor disorders. Surgical options include a variety of transvaginal techniques, which allow for both a minimally invasive and open approach as well as robotic procedures, as needed.