WATCH: Restorative Pelvic Medicine & the Evolving Role of Urogynecology

Pelvic floor disorders are among the most common — and most underdiscussed — conditions affecting women across the lifespan. In this episode of Women in Surgery, Dr. Shlomit Schaal sits down with Dr. Danielle Antosh to explore the scope of urogynecology, the clinical burden of pelvic floor dysfunction and how multidisciplinary, minimally invasive approaches can meaningfully restore quality of life for patients.

From a clinical standpoint, this conversation underscores why pelvic floor disorders deserve earlier recognition and more deliberate referral pathways. As Dr. Antosh explains, conditions such as urinary incontinence, pelvic organ prolapse and fecal incontinence often stem from childbirth-related trauma and age-related changes, yet many patients delay seeking care due to embarrassment or lack of awareness. For practicing physicians, this represents both a challenge and an opportunity — to normalize these conversations and guide patients toward evidence-based, often non-surgical, interventions before disease progression.

The discussion also highlights how urogynecology has evolved into a highly collaborative surgical subspecialty. By integrating pelvic floor physical therapy, urology, colorectal surgery, plastic surgery and gynecology, clinicians can tailor care plans that emphasize function, durability and recovery — while avoiding unnecessary surgery when conservative management is appropriate.

Key highlights

• Childbirth and aging remain primary risk factors — but not the only ones. Vaginal delivery and advancing age significantly increase risk, but pelvic floor disorders also occur in women without prior childbirth. Modifiable contributors such as weight gain and chronic constipation should be addressed early in clinical care.

• Urogynecology bridges gynecology and urology with a reconstructive focus. As a surgical subspecialty, urogynecology emphasizes restoring pelvic anatomy and function, with the goal of reducing urinary leakage, prolapse, sexual dysfunction and bowel symptoms.

• Minimally invasive techniques have transformed recovery and outcomes. Laparoscopic, robotic and vaginal approaches now allow complex reconstructive procedures with shorter recovery times and less morbidity compared to traditional open surgery.

• Pelvic floor physical therapy is a cornerstone of conservative management. Not all patients require surgery. Pelvic floor physical therapy plays a critical role in managing incontinence, bowel dysfunction, pain syndromes and overactive bladder — particularly when pelvic floor hypertonicity is present.

• Multidisciplinary care improves decision-making for complex cases. Structured collaboration across specialties, including preoperative case review for select patients, supports more individualized treatment plans and improved outcomes.

• Leadership and systems-based thinking enhance clinical impact. Dr. Antosh describes building a system-wide urogynecology division and fellowship program, emphasizing data-driven quality improvement and coordinated care pathways to expand access to subspecialty expertise.