Female Pelvic Medicine
Providing specialized care for women’s urologic issues in an empathetic environment
Women are more likely than men to experience conditions such as incontinence, overactive bladder, interstitial cystitis, pelvic prolapse, or urinary tract infection. Pregnancy and childbirth, menopause, and the structure of the female urinary tract all contribute to the women’s conditions we treat.
Services and treatments offered:
- Bladder control
- Bladder training: To condition the bladder to release at specific times.
Instilled medications: Placing medication directly into the bladder.
This treatment, wherein medication is placed directly into the bladder, may be advised for interstitial cystitis. Examples of treatments include heparinoid compounds (heparin) and DMSO (dimethyl sulfoxide), which relieves pain and inflammation.
A solution of the medication is directed into the bladder through a catheter, then held for an average of 10 to 15 minutes before the bladder is emptied. Treatment is given either every week or every other week for a period of six to eight weeks and then repeated as needed. Improvement is usually seen three to four weeks after the first six- or eight-week cycle.
Physical therapy and biofeedback: To help retrain pelvic floor muscles.
Biofeedback is a practice designed to help you better understand how your body normally behaves. In the case of urge incontinence, biofeedback can help you recognize when your bladder is overactive and help you contract the proper muscles to stop the urgency to urinate. A sensor is often used to monitor muscle activity in the vagina, rectum or on the pelvic floor.
Posterior Tibial Nerve Stimulation (PTNS): Stimulation of the posterior tibial nerve for OAB or incontinence.
PTNS is a non-invasive form of neuromodulation used to treat overactive bladder and incontinence. The nursing staff performs periodic stimulation of the posterior tibial nerve, which is near the ankle, on a weekly, outpatient basis.
In this procedure, the nurse inserts an acupuncture needle/electrode near the post-tibial nerve behind the ankle bone. A skin pad/electrode is adhered to the foot. These two electrodes are then connected to the pulse generator, which delivers an electrical signal that travels along the tibial nerve up to the sacral plexus in the pelvis.
Botox injection: Botox is injected directly into the bladder muscle.
Botox can be used to treat overactive bladder and other urinary issues. The physician injects Botox directly into the bladder muscle during a cystoscopy (a procedure that enables the doctor to view the affected area through a tiny camera).
The drug partially paralyzes the bladder, relaxing it so that it can store more urine, but leaves enough control to empty the bladder voluntarily. The treatment is not permanent – it typically lasts about nine months – and can cause side effects including urinary tract infection.
Sacral nerve stimulation (InterStim therapy): A tiny pacemaker is implanted in the bladder.
Sacral nerve stimulation is a minimally invasive procedure to treat urge incontinence, overactive bladder, urinary retention, or interstitial cystitis. A tiny pacemaker-like device is implanted near the tailbone through a small incision near the tailbone. This pacemaker sends mild electrical impulses to stimulate the sacral nerves, which controls bladder function.
Patients should note that sacral nerve stimulation involves a permanent surgical implant. For this reason, candidates for sacral nerve stimulation must first undergo a trial known as the percutaneous nerve evaluation (PNE). In this procedure, a temporary electrode is inserted into to the pelvis area and connected to an external pulse generator, which generates a signal for three to five days. If this neuromodulation delivers positive results, the option of implanting a permanent electrode is possible.
The patient will be given sedation for this procedure. The surgeon will insert an electrical pulse generator, like a pacemaker, under the skin in the upper, outer quadrant of the buttock. The generator is attached to a thin lead wire with a small electrode tip, which is anchored near the sacral nerve.
What To Expect After Surgery:
The patient should expect to go home within a few hours of surgery. The most common complaints of this procedure are pain and lead migration. In most studies, usually 5 percent to 10 percent of patients require post-operative correction to lead migration, but since leads can be anchored near the sacral nerve, subsequent operations are generally unnecessary.
The pacemaker device will continue to signal your bladder to regulate itself until the batteries run out. Batteries last from three to seven years, depending on the device and the stimulation regimen.
Tension-free vaginal tape (TVT): To support the urethra. This also sometimes called a “sling" procedure.
A TVT is a type of sling used to treat incontinence. Mesh tape is placed under the urethra like a hammock to keep it in its normal position. The tape provides support for a sagging urethra so it remains closed when you cough or move vigorously or suddenly.
The procedure is relatively simple and can be done with minimal hospitalization and recovery time.
The TVT is a fairly non-invasive procedure that may be performed under local anesthesia. The surgeon will make tiny incisions in your abdomen and vaginal wall, through which the tape is inserted.
TVT surgery takes about 30 minutes. No sutures are required to hold the tape in place.
What To Expect After Surgery:
Usually within hours of your surgery, you will be asked to urinate to test how your bladder and urethra respond to the surgery. This is usually an outpatient procedure. It may be necessary to have a catheter – a thin, flexible tube – placed into your bladder through your urethra to allow urine to drain while you recover.
TVT surgery usually causes minimal pain and discomfort. Although you may resume most normal activities within one to two weeks, you will be advised to refrain from driving for two weeks and from sexual intercourse or strenuous activities for six weeks.
Injection therapy: Injecting a “bulking agent” to improve urethral function.
Injection therapy is a treatment for incontinence that can be performed on both men and women. The physician injects collagen, body fat or synthetic compounds around the urethra to bulk up the urethra wall so it can seal up tightly and hold back urine. The procedure may also improve the function of the urethral sphincter and compress the urethra near the bladder outlet.
Pessary: Support through the use of a small medical device.
A pessary is a small plastic or silicone medical device that is inserted into the vagina for treatment of pelvic floor prolapse or stress incontinence.
The muscles of the pelvic floor and other supporting tissues hold your bladder, uterus and rectum in place. If these muscles and tissues weaken, your organs may shift out of their correct position, resulting in pelvic organ prolapse. The pessary will support and lessen the stress on your bladder and other pelvic organs.
- Pelvic floor muscle training (Kegel exercises): Exercises that strengthen the pelvic support muscles.
Robotic surgery using mesh (sacrocolpopexy): For treatment of prolapse for women who have had a hysterectomy.
This robotic surgery may be recommended for treatment of vaginal or uterine prolapse. Prolapse occurs when the connective tissues or muscles within the body cavity are weak and unable to hold the vagina in its natural orientation. The sacrocolpopexy is performed on patients who have had a prior hysterectomy, or it may be performed in conjunction with a robotic hysterectomy.
In the procedure, the surgeon connects the prolapsed vagina to the sacrum (the triangular bone just above the tailbone) using an artificial tissue material called a mesh. The Urology Group uses the da Vinci Surgical System for these procedures.
The da Vinci Surgical System combines computer and robotic technologies, making it possible to treat vaginal or uterine prolapse through a few small (1 to 2 cm) incisions, or operating ports, rather than through large incisions.
The patient will be placed under anesthetic before surgery. Small incisions are made in the lower abdomen area and then, by guiding robotic arms, the surgeon inserts a soft synthetic mesh through the operating ports into the pelvic area. This mesh pulls the vagina up to the sacrum.
The body's own tissues will grow into the mesh within three to four weeks. The mesh provides reinforcement of the weakened vaginal tissue.
What To Expect After Surgery:
The patient usually requires an overnight stay before returning home. While sacrocolpopexy has traditionally been considered the “gold standard” for prolapse surgery, it requires abdominal surgery with longer post-operative recovery time of one to four weeks, depending on the patient. Although you may resume most normal activities within one to two weeks, you will be advised to refrain from driving for two weeks and from sexual intercourse or strenuous activities for six weeks.
Abdominal surgery also raises risks of intra-abdominal injuries, or bowel injury, but these are uncommon.
Benefits to using the robotic method may include a shorter hospital stay, less pain, less risk of infection, less blood loss, fewer transfusions, less scarring, faster recovery and a quicker return to normal daily activities. None of these benefits can be guaranteed, as surgery is necessarily both patient- and procedure-specific.
- Female Incontinence
- Pelvic Floor Prolapse
- Vaginal Atrophy/Dryness
- Interstitial Cystitis
- Overactive Bladder
- Urinary Tract Infection