Urogynecology, and Female Pelvic Medicine and Reconstructive Surgery

Division of Urogynecology & FPMRS
The Urogynecology Service is a combined service consisting of Female Pelvic Medicine & Reconstructive Surgery (FPMRS) & Pelvic Floor Physical Therapy (PFPT). We provide comprehensive, cutting-edge care for women with diagnoses such as vaginal prolapse, stress and urge urinary incontinence, constipation and fecal incontinence, vaginal fistula, urethral abnormalities (diverticulum), vaginal pain due to muscle spasm, etc.

Common Diagnoses:
Vaginal Prolapse
Uterine prolapse

Urinary Incontinence
     Stress Incontinence
     Overactive bladder/urge incontinence

Fecal Incontinence
     Accidental bowel leakage

Bowel evacuation problems

Voiding difficulties

Recurrent urinary tract infections

     Vesico-vaginal fistula
     Recto-vaginal fistula

Urethral Problems
     Urethral diverticulum
     Vaginal/urethral cysts
     Urethral obstruction

All of our surgeons are specially trained in minimally invasive techniques to include laparoscopic, vaginal, abdominal, robotic, and combination surgery techniques. Most of our procedures are performed in minimally invasive fashion, such as laparoscopic, vaginal, or combined laparoscopic/vaginal approaches, or robotic.
Hysterectomy – vaginal, laparoscopic/robotic, or abdominal

Stress incontinence:
     Suburethral sling
     Urethral bulking injection

Urge incontinence
    Sacral nerve stimulation
    Bladder "Botox" injection

Prolapse surgery-laparoscopic, vaginal or abdominal
    Laparoscopic/Robotic or abdominal sacral colpopexy
    Laparoscopic uterosacral ligament suspension 

Vaginal surgeries:
    Sacrospinous ligament vaginal vault fixation
    Uterosacral ligament suspension
    Posterior colporrhaphy (rectocele repair)
    Anterior colporrhaphy (cystocele repair)
    Urethral cyst/diverticulum

Office Based Services
    Urodynamic testing
    Cystoscopy (Botox & Bulking Procedures)
    Pessary fittings
    Posterior tibial nerve stimulation
    Trigger point injections

Pelvic Floor Physical Therapy
The Pelvic Floor Physical Therapy clinic provides examination and treatment of pelvic floor muscle dysfunction related to urinary and bowel incontinence and associated symptoms, pelvic organ prolapse, constipation, and pelvic pain symptoms. We examine and treat symptoms from a neuromusculoskeletal perspective, working closely with physicians from various services such as Urogynecology, Gynecology, Urology, Gastroenterology, Colorectal and Internal Medicine to provide comprehensive treatment. Our pelvic floor physical therapists have advanced training of pelvic floor dysfunction at the post-graduate level and are board certified women’s health clinical specialists.

*Please note that Pelvic Floor Physical Therapy services are available to both female and male patients

Common Diagnoses:
  • Stress Urinary Incontinence
  • Urge Urinary Incontinence
  • Urinary retention (of muscular cause)
  • Constipation (of muscular cause)
  • Fecal incontinence
  • Pelvic organ prolapse
  • Pelvic Pain
  • Pain with sexual activity and/or sexual dysfunction
  • Pregnancy and Post-partum related pelvic girdle pain: pubic symphasis and sacroiliac joint dysfunction
  • Diastasis Rectus Abdominis
  • Post-surgical/oncology rehabilitation of the genitourinary system, including but not exclusive to pelvic reconstructive surgeries and pelvic radiation
Treatments offered:
  • Instruction in correct form and frequency of pelvic floor exercises (Kegels)
  • Biofeedback training
  • Education on bowel and bladder irritants
  • Bladder training to help regain normal function and habits
  • Therapeutic exercise for improved core and pelvic girdle stability
  • Body mechanics training
  • Manual techniques to improve tissue and joint mobility
  • Scar massage
  • Relaxation training of the pelvic floor
  • Electrical stimulation: Transcutaneous nerve stimulation (TENS) and neuromuscular e-stim (NMES)
  • Pain modalities: Ultrasound, cold, and heat

Weekly academics and monthly journal clubs ensure the highest quality education in our rapidly evolving field. The Urogynecology division also provides supervision and training to the Tri-Service residency in Obstetrics and Gynecology, as well as medical students from the Uniformed Services University of the Health Sciences. We work closely with the Washington Hospital Center FPMRS fellowship, doing cadaver labs and joint journal clubs on a recurring basis.

Tri-Service Fellowship in Urogynecology
The Urogynecology division at Walter Reed has the only DOD fellowship in Urogynecology/FPMRS. This is a three year military fellowship and we accept one fellow per year; all services are eligible. The fellows rotate between Walter Reed National Military Medical Center and Inova Fairfax Hospital providing an exceptional academic program and a very expansive surgical volume for our fellows. Fellows graduate at >90% for surgical volume of all FPMRS fellowships. We have excellent simulation centers at Walter Reed and the Uniformed Services University campus is home to the only DOD state of the art training facility in Robotic surgery. USU is also one of only a few institutions with a state-of-the art ACS accredited clinical simulation center.

The FPMRS staff, fellows and residents are actively engaged in cutting edge basic science and clinical research projects at both the Uniformed Services University and Walter Reed. The research program publishes several scientific articles and videos annually, in addition we present at multiple specialty meetings and societies.


Col Daniel Gruber, M.D., FACOG, FPMRS
Chief & Fellowship Program Director, Urogynecology