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WHAT IS UROGYNECOLOGY?
Urogynecology is a sub-specialty of Gynecology, and is also known as Female Pelvic Medicine and Reconstructive Surgery. A urogynecologist manages clinical problems associated with dysfunction of the pelvic floor and bladder. Pelvic floor disorders affect the bladder, reproductive organs, and bowels. Common pelvic floor disorders include urinary incontinence, pelvic organ prolapse, and fecal incontinence. Additionally, Urogynecologists are also responsible for the care of women who have experienced trauma to the perineum during childbirth.
Urogynecologists manage women with urinary incontinence and pelvic floor dysfunction. The clinical conditions that a urogynecologist may see include stress incontinence, overactive bladder, voiding difficulty, bladder pain, urethral pain, vaginal or uterine prolapse, obstructed defecation, anal incontinence, and perineal injury. They may also care for women with vesico-vaginal or rectovaginal fistulae with specialist training, and in conjunction with other specialties.
COMMON CONDITIONS TREATED BY UROGYNECOLOGISTS
- Genital prolapse
- Urinary incontinence
- Painful intercourse
- Voiding difficulties
- Urinary retention
- Abdominal reconstruction
- Vaginal reconstruction
- Botulinum toxin injection
- Sacral nerve stimulation
WHY CHOSE THE GYN SURGICAL INSTITUTE FOR CERVICAL SURGERY?
The GYN Surgical institute is specialized in advanced bladder procedures.
WHAT IS A CYSTOSCOPY?
Cystoscopy is a test that allows specialists to look at the inside of the bladder and the urethra using a thin, lighted instrument called a cystoscope. The cystoscope is inserted into the urethra and slowly advanced into the bladder. This procedure allows specialists to look at areas of the bladder and urethra that usually do not show up well on X-rays. Tiny surgical instruments can be inserted through the cystoscope that allow specialists to remove samples of tissue (biopsy) or samples of urine.
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Urodynamics is a group of diagnostic test procedures to assess how the bladder and urethra are functioning with respect to storing and releasing urine. Generally speaking, urodynamic testing provides precise measurements using sophisticated instruments to assess the bladder’s ability to eliminate urine steadily and completely.
WHAT IF I NEED A URODYNAMIC STUDY?
Urodynamic testing helps physicians determine:
- any difficulty experienced in starting a urine stream
- the amount of effort put forth to maintain a urine stream
- if the stream is interrupted
- if there is residual urine left in the bladder after urination
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WHAT IS AN OVERACTIVE BLADDER?
Overactive bladder is marked by a sudden, uncontrollable urge to urinate, which can lead to the involuntary loss of urine, called urge incontinence. Approximately 40% of women have an overactive bladder, although it is not a life-threatening condition, it can be embarrassing and many women may have it for years before serious complications arise. IT also is more common with advanced age.
Overactive bladder is characterized by a group of four symptoms: urgency, urinary frequency, nocturia, and urge incontinence.
Urgency is considered the hallmark symptom of an overactive bladder, although there are no clear criteria for what constitutes urgency. Presently, urgency is currently defined as a sudden, compelling desire to pass urine that is difficult to defer.
Urinary frequency is considered abnormal if unable to urinate more than eight times in a day. This frequency is usually monitored by keeping a voiding diary with recorded urination episodes. The number of episodes varies depending on sleep, fluid intake, medications, and up to seven is considered normal if consistent with the other factors.
Urge incontinence is a form of urinary incontinence characterized by the involuntary loss of urine occurring for no apparent reason while feeling urinary urgency. Urge incontinence can also be measured with pad tests, and these are often used for research purposes. Some people with urge incontinence also have stress incontinence and this can complicate clinical studies.
Botox works by relaxing the bladder muscle. It is FDA-approved to treat urinary incontinence due to overactive bladder related to nerve damage from conditions such as multiple sclerosis and spine injury.
WHAT OTHER BLADDER TREATMENTS
For some women, symptoms of stress incontinence or overactive bladder don’t respond to conservative treatment. When urinary incontinence markedly disrupts life, surgery may be an option. During a sling procedure, the surgeon uses strips of synthetic mesh and tissue (from the patient or a donor) to create a sling or “hammock” under the urethra or bladder neck. The bladder neck is the area of thickened muscle where the bladder connects to the urethra — the tube that carries urine from the bladder. The sling supports the urethra and helps keep it closed — especially when coughing or sneezing — so urine doesn’t leak through.
Collagen implants are one method to help treat incontinence due to a weak sphincter. Collagen is a protein naturally found in the body of animals and humans. Implanting (injecting) animal collagen into the urethra may help close the sphincter and restore most or all control over urine flow. Collagen implants are usually done in the hospital on an outpatient basis. Local, regional, or general anesthesia may be applied during this procedure. The doctor inserts a cystoscope (a thin, tubelike telescope) into the urethra to better see during the procedure. A needle is inserted (either through the cystoscope or along the outside of the urethra) to the sphincter area. The doctor injects collagen through this needle into the wall of the urethra. The injections make the tissue close up, which stops urine from leaking out of the bladder. Collagen is injected around the urethra near the sphincter. The collagen “bulks” the urethral tissue, creating a seal that stops urine from leaking. During urination, the tissue separates naturally to allow urine to flow.
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WHAT IS A BLADDER LIFT?
The bladder lift procedure aims to correct urinary incontinence. Urinary incontinence in women often occurs when pressure is placed on the bladder. This can be caused by urethra that sags and inadvertently opens during everyday activities, such as coughing or sneezing. The bladder lift involves the placement of mesh tape under the urethra to keep it in its normal position – just like a sling. This will prevent urine leakage. This procedure requires anesthetics and most patients are released on the same day.
WHAT IS A BLADDER PACEMAKER?
For women whose overactive bladders have not been settled by standard therapies, a pacemaker for bladder function can alleviate urinary urgency and leakage problems, dramatically improving quality of life. The surgery itself is done on an outpatient basis, and usually occurs in two stages. In the first stage, patients are given a mild sedative while surgeons use a needle to locate a particular nerve that travels from the base of the spine to the bladder. A tiny electrode is placed near the nerve, which is then attached to a pacemaker worn on a belt outside the patient’s body. The patient wears the device for a period of about two weeks, sending mild electrical pulses to the nerve that helps control erratic bladder function. If the pacing improves the patient’s symptoms, the device is permanently installed in the upper portion of one of the patient’s buttocks, where it comfortably resides for as long as it’s needed. Installation of the device is completely reversible and can be discontinued at any time with no permanent damage to the nerves.
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WHAT IS INTERSTITIAL CYSTITIS?
Interstitial cystitis — also called painful bladder syndrome — is a chronic condition defined by bladder pressure, bladder pain and sometimes pelvic pain, ranging from mild discomfort to severe pain. The bladder expands until it’s full and then signals the brain that it’s time to urinate, communicating through the pelvic nerves. This creates the urge to urinate for most people. With interstitial cystitis, these signals get mixed up — the need to urinate is felt more often and with smaller volumes of urine than typical.
- Pelvic exam — During a pelvic exam, our doctors examine the external genitals, vagina and cervix and feels the abdomen to assess internal pelvic organs.
- Urine test — A sample of urine will be analyzed for evidence of a urinary tract infection.
- Potassium sensitivity test — In this test, our doctors place two solutions — water and potassium chloride — into the bladder, one at a time. The doctor then asks the woman to rate on a scale of 0 to 5 the pain and urgency that is felt after each solution is instilled. If more pain or urgency is noticeably felt with the potassium solution than with the water, our doctors may diagnose interstitial cystitis. People with normal bladders can’t tell the difference between the two solutions.
- Cystoscopy — With cystoscopy, our doctors insert a thin tube with a tiny camera (cystoscope) through the urethra, which allows our doctors to see the lining of the bladder. Along with cystoscopy, our doctors may inject liquid into the bladder to measure bladder capacity. Our doctors may perform this procedure, known as hydrodistention, after applying a local, regional, or general anesthetic to ensure comfort.
- Biopsy — During cystoscopy under anesthesia, our doctors may remove a sample of tissue (biopsy) from the bladder and the urethra for examination under a microscope. This is to check for bladder cancer and other rare causes of bladder pain.
SURGICAL PROCEDURES FOR THE TREATMENT OF INTERSTITIAL CYSTITIS INCLUDE:
- Fulguration — This minimally invasive method involves insertion of instruments through the urethra to burn off ulcers that may be present with interstitial cystitis.
- Resection — This is another minimally invasive method that involves insertion of instruments through the urethra to cut around any ulcers.
- Bladder augmentation — In this procedure, surgeons remove the damaged portion of the bladder and replace it with a piece of the colon, but the pain still remains and some people need to empty their bladders with a catheter many times a day.
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