Urinary dysfunction and complaints are so integral to pelvic care that I have focused here intentionally to be able to offer the best care available.
Procedures to repair cystocele (dropped bladder) have gone through many transformations over the last 20 years, and I have tried many. I have finally settled on a most impressive technology involving vaginal suspension to ligaments deep in the pelvis with further secure attachments to the anterior pelvic floor. Use of some sort of biologic graft material is often helpful to assure a long-lasting result. Vaginal mesh is seldom (but sometimes) indicated for pelvic reconstruction, depending on the degree of pathology.
There are two main types of urinary incontinence (leakage of urine) in women – stress incontinence (leakage with cough or sneeze) and urge incontinence (overactive bladder.) Both are potentially debilitating to patients, and both can be successfully treated. The correct diagnosis is essential to finding the appropriate treatment. Urodynamics is a test that we often perform in the office to help us sort out bladder dysfunction.
I help my patients in the diagnosis and treatment of interstitial cystitis and overactive bladder. I have been trained in the use of Interstim or Axonics implant testing and placement for urinary symptoms unresponsive to medical therapies. Many women with intractable symptoms of frequency, urgency, incomplete emptying and incontinence have found incredible relief with this procedure. We have also started offering another innovative and effective treatment modality – Posterior Tibial Nerve Stimulation. This therapy for overactive bladder consists of a series of thirty-minute pain free sessions in the office.
I have been treating stress incontinence since residency. I first learned the world’s gold standard incontinence procedure, developed by a Nashville gynecologist, Dr. John Burch. This abdominal procedure has now been virtually replaced by low-pain, quick-recovery outpatient surgical procedures (a sling procedure) which are just as likely to be curative. Preoperative urodynamic testing is generally advisable and performed in the office.