Urogynecology


 

Urogynecology

uro·gy·ne·col·o·gy

Urogynecology is a sub-specialty of Gynecology, and in some countries 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.

Please click here to read the Pelvic Floor Dialogues.


The Secret You Share


With an estimated 20 to 25 million other women in the U.S. You are not alone.

You might be like Jennifer, a 47 year old North State dental hygienist, who vividly remembers the morning that her routine Pilates work-out with her friends was cut short unexpectedly by a familiar problem.

You may recognize Jennifer’s problem as urinary incontinence (UI), which may be caused by many different but related conditions. What you may not know is just how common UI really is, especially in women over age 40. Uncontrolled leaking of urine is one of the top five most common chronic medical condition affecting women of all ages. Americans spend at least 2 billion dollars a year on protective garments such as pads and diapers. Many women (and unfortunately, some healthcare providers) have been taught to think that leakage of urine after having children or as a woman ages is normal. UI is common, but that does not mean it is normal.


Leaking is Never Normal

If you are like Jennifer, it may be a relief to know that yours is a secret we understand all about. But even more importantly, you need to know that you can find lasting help at Asuriti. We care for many women just like you who have experienced the embarrassment, inconvenience, and discomfort caused by urinary incontinence or other types of voiding dysfunction. You can find out about the range of effective treatments that can dramatically improve the quality of your life.

You can live a life free from worry about your bladder.

Here at Asuriti, we provide expert evaluation and treatment under the direction of the only fellowship-trained and board-certified Urogynecologist practicing in the North State, Dr. Richard Mooney.

Select Procedures at Asuriti:

Cystoscopy

When you have a urinary problem, a cystoscope may be used to see inside your bladder and urethra. The urethra is the tube that carries urine from the bladder to the outside of the body.
The cystoscope has lenses like a telescope or microscope. These lenses allow your doctor to focus on the inner surfaces of the urinary tract.

The cystoscope is as thin as a pencil and has a light at the tip. The procedure is usually not painful and lasts only a few minutes.

At Asuriti, we may perform cystoscopy to evaluate any of the following conditions:

  • Frequent urinary tract infections
  • Blood in your urine (hematuria)
  • Loss of bladder control (incontinence) or overactive bladder
  • Unusual cells found in urine sample
  • Need for a bladder catheter
  • Painful urination, chronic pelvic pain, or interstitial cystitis
  • Urinary blockage such as stricture or narrowing of the urinary tract
  • Stone in the urinary tract
  • Unusual growth, polyp, tumor or cancer
  • Preparation for surgery


Urodynamic testing

Urodynamic testing is an office procedure to test and evaluate the function and responses of your bladder. This is testing performed in order to determine the exact cause(s) of abnormal urinary symptoms.

Who will perform the testing?

At Asuriti, urodynamic testing is performed by a nurse with specialized training, in a private and sensitive environment. The results of the testing are carefully reviewed by Dr. Mooney and used to help guide treatment recommendations.

What do I need to do to prepare for the testing?

You will receive instructions regarding preparation for the test. In particular, if you are taking any
anticholinergic medication such as Detrol, Ditropan, Sanctura, or Vesicare, please stop one week prior to the test.

How is the testing performed?

A small catheter (soft tube) will be inserted into the bladder through the urethra (where the urine exits the body). This is usually painless. Another small catheter is placed into the vagina as well to record abdominal pressures. Your nurse will then fill your bladder with sterile water to see how your bladder responds to filling. She will monitor your bladder on a viewing screen and ask what sensations you experience. At some point, you will be asked to urinate. We understand that it is difficult to perform naturally under these circumstances, but we hope to observe your normal urinary patterns.

You may have some slight burning the first few urinations after the procedure. This is normal and should not be cause for alarm.

Results are usually discussed with you in detail at a follow-up appointment.

If you have any questions about the procedure or experience any symptoms you are concerned about, please call our office at 530-246-4455 to speak to one of our knowledgeable staff.

Pessary

A pessary is a rubber device that fits into the vagina to help support pelvic organs that are sagging into or out of the vagina. This includes a dropped uterus (womb), vagina, bladder (cystocele), or rectum (rectocele). The pessary provides support for the dropped organ(s), helps with discomfort from uncomfortable bulge, and may even help with stress urinary incontinence (leaking urine with cough, strain, or exercise). Wearing a pessary can also help pregnant women with incontinence. A pessary is a non-surgical option for treating pelvic floor dysfunction.

What pessary is right for me?

There are numerous types, sizes, and shapes of pessaries. The pessary that is recommended for you will determine on the type and severity of your particular condition. At Asuriti, you can be assured of expert pessary evaluation. A pessary needs to be fit precisely, and the right size can only be determined by an exam and fitting. It may take a few pessary fittings to find the right fit. Once the right size is found, you will probably need to have it checked every couple months. Sometimes the size or shape of the pessary will have to be changed.

How do I take care of my pessary?

It is important that you follow your doctor’s specific instructions about caring for your pessary. Every pessary needs to be removed periodically and cleaned for safest use. Most pessaries can be worn for many days to weeks at a time before they have to be taken out and cleaned. Pessaries can be cleaned with ordinary soap and water.

You may be able to take out, clean, and reinsert your pessary yourself. Sometimes though, your doctor may want you to come into the office so this can be done for you by a provider. Be sure to keep your check-up appointments and clean the pessary as your doctor tells you.

Does the pessary cause any side effects?

It is common that the pessary may cause more vaginal discharge than usual. Occasionally the vaginal discharge may also develop an odor. Certain vaginal gels can help with these side effects.
Vaginal irritation is another possible side effect. Women who are past menopause may need to use estrogen cream to treat and prevent the vaginal irritation.

Can the pessary get lost or fall out?

The pessary cannot go anywhere else in the body because the vagina is a closed tube. The pessary can fall out of the vagina if you strain or lift something; this usually means that your pessary is too small. Check with your doctor if your pessary keeps falling out.

What else should I know?

Be sure to tell your doctor promptly if you have any discomfort with the pessary, you have vaginal bleeding, or if you have trouble urinating or having a bowel movement.

 

Urethral Bulking Procedure

Urethral bulking is a procedure used to treat urinary incontinence by injecting material around the urethra. This may help increase the thickness of the wall of the urethra so that it can seal tightly when you are holding back urine.

How is this procedure done?

A cystoscope (instrument with a fiberoptic camera) is used to see the inside of the urethra. Usually this is done in the office under local anesthesia. A needle is guided through the cystoscope into the urethra.

The bulking material is then gently injected into the wall of the urethra in several places.

How long does the procedure take?

This procedure is performed in the office and usually takes less than 30 minutes to complete.

Would this be a good procedure for me?

The best treatment depends on the exact nature and cause of urinary incontinence. Good candidates may be:

  • Women whose urinary incontinence is due mainly to a weakness in the sphincter muscle surrounding the urethra.
  • Women who are not fit enough for surgery and anesthesia.
  • Women who haven’t completed their family yet.
  • Women for whom conventional surgery for urinary incontinence has not been successful.

At Asuriti, we will do a thorough evaluation to understand your problem fully and then recommend treatment options that are most likely to help you. Remember that the success of any surgical procedure for urinary incontinence depends on the experience and skill of the surgeon. At Asuriti, you can be confident in receiving experienced care from North State’s only board-certified Urogynecologist.

 

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