Did you know urology isn’t just for men? While most people associate urology with male problems, very few know that urologists also treat women and that some physicians are sub-specialized in female urology. In Hong Kong, there are only two female urologists in private practice. Healthy Matters met one of them, Doctor Vera Chung 鍾楊醫生, who kindly accepted to give us the lowdown on female urology.
1 – What is female urology and why is there a common misconception that urologists only treat males?
Urinary tract diseases are indeed more common in males. In our practice, around 70% of our patients are male, most commonly kidney stones and prostate disease. Women can suffer from similar problems as their male counterparts such as kidney stones, urinary tract infection, kidney and bladder tumor etc. Apart from diseases which are common to both genders, female urology is a relatively new discipline in the Asia-Pacific region, focusing mainly on bladder and pelvic floor functions.
2 – What are the most common female urological problems of the bladder and vagina?
The most common female urology diseases include urinary incontinence, overactive bladder, recurrent urinary tract infection and pelvic organ prolapse. In my daily practice, most women come to see me because of urinary incontinence and overactive bladder syndrome. The prevalence of female urinary incontinence is estimated to be as high as 21%, which could reach 50-60% in the elderly. Urinary incontinence and bladder dysfunction have a significant impact on work, family and social situations. However, many sufferers are too embarrassed to talk about their problems.
3 – What are the causes for those urological conditions? And what are the preventive measures?
Urinary incontinence can be broadly categorized as stress urinary incontinence or urge incontinence. As a woman goes through pregnancy and childbirth, the pressure of a full uterus stretches the pelvic floor. Vaginal delivery, in particular traumatic delivery, causes further trauma to the pelvic floor and nerves. When menopause approaches, the connective tissues of the sphincter become increasingly loose as a result of estrogen deficiency. Once the weakened pelvic floor and urethral sphincter can no longer support the urethra and bladder, urine leakage is likely to occur when there is increased abdominal pressure during cough or sneeze.
Urge incontinence is another distinct disease entity with complete a different pathophysiology. It is most commonly seen in overactive bladder syndrome. The bladder becomes over-sensitive and contracts involuntarily leading to the compelling “urge” sensation and urge incontinence.
4 – When should a woman seek medical help from a urologist?
Simple urinary tract infection and mild urinary incontinence can be adequately managed by a family physician and physiotherapist. When a woman has a refractory urinary tract infection or has alarming symptoms such as blood in urine, pain during urination, abdominal pain, severe urinary incontinence, she should consider seeing a urologist to exclude more sinister conditions.
5 – What are the treatments available?
Mild urinary incontinence can be managed by lifestyle modification such as keeping a moderate fluid intake of 1.5-2L per day, limitation of drinks that may irritate the bladder such as tea, coffee, fizzy drinks and weight reduction. Bladder training and pelvic floor exercises are effective options under the instruction of a physiotherapist. Oral medications are available for overactive bladder symptoms and urge incontinence. Five to 10% of patients with an overactive bladder may require bladder Botox injection for severe urge incontinence if oral medication cannot be tolerated. For women with stress urinary incontinence that cannot be improved by pelvic floor exercise, a minimal invasive surgery (insertion of mid-urethral tape) will help to reinforce the pelvic floor and urethral sphincter. The procedure can be performed as a day procedure with a cure rate of over 90%.