Female Urology

 

Urologic conditions affect both men & women, but women may experience disorders differently. Some urologic conditions, such as Urinary incontinence & urinary tract Infections are more common in women, because the urinary tract is much closer to their genital area than in men. As such, pregnancy, childbirth & sexual intercourse can also play a part in urologic conditions affecting women.

The most common issues women experience that are related to the general urinary tract are infections, incontinence and fistulas.

UTIs are caused by bacterial infections in the urinary tract causing painful or frequent urination, blood in the urine, cramps or nausea. One woman in five develops a UTI during her lifetime and women are 10 times more likely to have a UTI than men.

Urinary incontinence
Involuntary loss of large or small amounts of urine is called urinary incontinence.
There are 4 types of urinary incontinence:
.Usually, due to weakness of perineal muscles
.So, many females believe it's normal and part of aging
.It can be improved with Kegel’s exercise
.SUI is mainly treated with surgery

A) Stress Urinary Incontinence: - Urine leak while coughing, sneezing, laughing, or lifting weight is called Stress Urinary Incontinence. Usually, SUI starts due to weakness of the perineal muscles due to multiple pregnancies, vaginal deliveries, or obstructed labour.
· Many women believe it's part of ageing and a normal phenomenon.
· It can be improved with Kegel’s exercise or medical treatment with Tab Duloxetine, but the results are suboptimal.
· SUI is mainly treated with surgical treatment with either prolene mesh or autologous tissue.

B) Urge Urinary Incontinence: - Urine leaks before reaching the restroom are referred to as urge urinary incontinence (UUI). UUI can be associated with Frequency and/or Nocturia.
· UUI can be associated with frequency and/or nocturia.
· A urinary tract infection, aging, genitourinary tuberculosis, stones, or bladder carcinoma can all cause UUI.
· UUI can be treated with various medications, such as anticholinergics, B-agonists, or combinations.
· If it is not responding to medications, it requires a urodynamic study to check for bladder function.
· UUI, if non-responsive to medicines, can be treated with an intravenous injection of BOTOX.
· Severe UUI can be treated with surgery, like an augmentation cystoplasty.

C) Mixed Urinary Incontinence: - Urge Urinary Incontinence with Stress Urinary Incontinence is called Mixed Urinary Incontinence. Usually, for MUI, you must require treatment for UUI first. The patient should then be evaluated after some time, which may necessitate a urodynamic study. Then, depending on the patient, bothersome symptoms may require treatment for stress urinary incontinence.

D) Overflow Incontinence: - Urinary incontinence (continuous) with a full bladder is called overflow incontinence. Usually, in neurogenic chronic urinary retention, the patient experiences overflow incontinence. Typically, an indwelling Foley's catheterization is required for 3-4 weeks, followed by a urodynamic study to evaluate the bladder. If UDS finds an atonic bladder, the patient may require clean intermittent catheterization or an indwelling catheter.

Overactive bladder
An overactive bladder represents a collection of symptoms. These symptoms include:
Urinary urgency: a sudden, uncontrollable desire to pass urine.
The average person passes urine eight times per day. More than eight times is considered high urinary frequency.
Urge incontinence: Urine leaks with urgency.
Nocturia: It is the frequent need to urinate at night.
Overactive bladder is more common in male patients above 65 years and female patients above 45 years.
Different treatments can help fix your overactive bladder. Treatments may include changing certain behaviors, medications (anticholinergics and B agonists), Botox injections, and nerve stimulation (neuromodulation).
. For the more severe type of OAB, augmentation cystoplasty is also a treatment option.

Urinary tract infection in women
Urinary tract infections are more common in females than in males. There is an almost 30 times higher incidence rate. Most women have urinary tract infections at some point in their lives.
Urinary tract infections occur when bacteria get into the bladder. A UTI in the bladder is known as cystitis. This infection can spread into the kidneys, which are called pyelonephritis.
Women get UTIs more often because their urethra is shorter than men's. This makes it easier for bacteria to enter the bladder. The female urethral opening is also near the vagina and anus.
UTI is more common in women who are sexually active, postmenopausal, diabetic, or on catheterization.
UTI Symptoms:
Pain or burning sensation while passing urine
Urgency and frequency in urination, lower abdominal pain, and blood in the urine
If the infection spreads to the kidneys, you will experience fever and chills

Urological problems in pregnancy
Many changes occur in the body during pregnancy, including changes in the functioning and filtering of the kidneys, as well as changes in blood pressure status. Urinary tract infections are the most common problem among pregnant women.
This results in low birthweight babies, intrauterine growth retardation, or the foetus dying suddenly. If the infection spreads to the kidneys, the patient must be admitted and given antibiotics.
Another problem is kidney and ureteric stones. This may lead to acute kidney infections. These problems are treated with medications or may require stenting.
Urinary incontinence is also a major problem during pregnancy. Because of the weight of the fetus, a pregnant lady may experience urine leakage while coughing, sneezing, and laughing. This is called stress urinary incontinence and may continue in postpartum life as well. They have frequent urination and an extreme urge to

Genitourinary fistula
Genitourinary fistula is the most common complication of gynaecological and obstetric procedures. Its incidence rate is 1–3 per 1000 deliveries. It is more common in women who have an early-age pregnancy, cephalopelvic disproportion, and poor antenatal care, which results in obstructed labor.
Hysterectomy can also cause bladder injuries (2.9%), ureteric injuries (1.8%), and fistula formation. Pelvic malignancy, pelvic irradiation, trauma, and foreign body erosions are other common factors.
Vesicovaginal fistulas are more common, followed by ureterovaginal fistulas and vesicouterine fistulas.
Common urological problems in women
Women suffer the same problems as men, like:
Cancers (adrenal, kidney, bladder, and urethra)
Urinary stones
Trauma to the kidneys, ureter, bladder, or urethra
Voiding Dysfunction
Men and women are evaluated and managed in the same way.
Some common urological problems in females include:
Recurrent urinary tract infections
Urinary incontinence
Voiding dysfunction
Interstitial cystitis