Women’s Urology

Conditions treated by Dr Basto

Pelvic organ prolapse occurs when the pelvic organs such as the bladder, uterus or rectum, descend into the vaginal canal due to weakened pelvic floor muscles. Common types include cystocoele (bladder), rectocoele (rectum), enterocoele (small bowel) and procidentia (complete uterine prolapse).

Treatment options include nonsurgical techniques such as pelvic floor therapy or pessary inserts.  Where conservative approaches aren’t enough, surgical procedures to elevate the pelvic organs can be performed through the vagina or abdomen. 

Vaginal procedures include anterior colporrhaphy (cystocoele), posterior colporrhaphy (rectocoele), sacrospinous ligament fixation (apical prolapse) or colpocleisis (closure of the vaginal canal in non-sexually active women).   Abdominal procedures may include (but are not limited to) sacral colpopexy and uterosacral ligament suspension (USLS) which can be performed with minimally invasive techniques such as robotic surgery.

Genitourinary syndrome of menopause (GSM) refers to a range of urological symptoms that occur due to decreased estrogen levels during menopause. These symptoms may include vaginal dryness, urgency, urinary incontinence and frequent urinary tract infections. Treatment options can include vaginal oestrogen, vaginal moisturisers and pelvic floor exercises to alleviate discomfort and restore vaginal and urinary health.

A urethral caruncle is a benign, fleshy growth at the opening of the urethra, most commonly seen in post-menopausal women due to oestrogen deficiency. It may present as a small, red, tender mass causing discomfort, pain or mild bleeding. While often asymptomatic, symptomatic caruncles can be managed with topical oestrogen or surgical excision if necessary.

Urethral prolapse occurs when the inner lining of the urethra protrudes through the external opening circumferentially. This condition is more common in postmenopausal women and less commonly pre-pubertal girls. Symptoms may include visible tissue protrusion, irritation, pain, bleeding or urinary difficulties.  Occasionally thrombosis can occur where a blood clot forms within the prolapsed lining causing more intense pain.

Management typically involves conservative treatments like oestrogen creams and warm sitz baths. In severe or persistent cases, surgical correction may be required. Both conditions are benign but should be evaluated by a specialist to ensure appropriate care and exclude alternative pathologies.

A fistula is an abnormal connection between two organs. Vesico-vaginal fistulas (VVF) form between the bladder and the vagina, while uretero-vaginal fistulas (UVF) involve the ureter and vagina. These conditions typically cause urine leakage and may result from childbirth, surgery or injury.

Surgical repair is required to close the fistula and restore normal function. Minimally invasive techniques such as robotic surgery can be used to repair fistulae.

Mesh implants are sometimes used in the treatment of pelvic organ prolapse or incontinence. However, complications such as erosion, infection, discomfort and bladder dysfunction can arise.

If mesh complications occur, further treatment or surgical revision may be necessary. Patients with mesh concerns should seek evaluation and discuss options with a urological specialist.