Urogynecology and Female Pelvic Medicine

Our expert team addresses gynecological issues typically associated with bladder problems or pelvic organ prolapse. Many of the natural processes in a woman's lifetime, including childbirth, menopause and aging, contribute to pelvic floor changes that can cause a woman to experience a bladder or pelvic problem. Sometimes other diseases and medications can also create these problems. Unfortunately, they restrict one's social life, cause pain and discomfort, reduce sexual function and can result in depression and isolation. We strive to improve quality of life for women suffering from these disorders. We focus on gynecological issues typically associated with pelvic organ prolapse, urinary or fecal incontinence and painful bladder syndrome.

We use leading-edge, minimally invasive techniques whenever possible. Our overall goal is to return women quickly and comfortably to their active daily lives without the hindrance of bladder or pelvic problems.

Urodynamics

Your physician may recommend urodynamic testing to assess the function of the bladder and the urethra. This test is performed by measuring pressure changes inside the bladder and urethra with two small catheters. Observing these pressure changes while filling and emptying the bladder help to diagnose voiding dysfunction. Observing these pressure changes during an incontinence episode provides diagnostic information that guides the physician's surgical and medical management. The response of the pelvic floor muscles during the study is recorded by using painless EMG measurements. This identifies if the pelvic floor muscles are working synchronously to contract and relax properly when voiding.

The procedure is done in the office and does not require anesthesia. The test typically takes an hour. Because it does not require any anesthesia, you would not need special transportation to and from the appointment.

Office cystoscopy

Your physician may recommend a cystoscopy to visually inspect the inside of the bladder and the urethra. Looking directly at these structures can help your physician diagnose problems that are not always detectable with an ultrasound. These findings include structural/anatomical changes and inflammatory disorders. They also confirm the absence of a neoplastic or cancerous process.

An office cystoscopy is performed after numbing the urethra with a topical anesthetic gel. In the same way that a catheter would be inserted, a flexible scope containing a camera lens is gently inserted through the urethra and into the bladder while visually inspecting these organs.

In the office setting, you can watch the procedure on a large screen as the physician explains to you what he/she sees. This procedure does not require sedation, so you will be able to drive yourself to and back from the appointment at our office.

Voiding trial

A voiding trial is a test performed to assess the ability of the bladder to empty. If the bladder is full (the patient confirms a sensation of fullness in the bladder), they are asked to void. A noninvasive ultrasound of the bladder is then performed in the office to measure the amount of urine that remains in the bladder. If the bladder is not full, then it can be filled with the help of a catheter and the patient is asked to urinate and this amount gets measured.

The amounts voided and retained in the bladder are calculated to allow your physician to identify problems with bladder emptying (urinary retention), suggesting a disorder of bladder and urethral function.

Voiding diary

A voiding diary is a measurement of how your body manages the fluids you take in. It is important that your physician has an accurate idea of what occurs in a "normal" day for you. Occasionally drinking and voiding habits may be contributing to the cause of the problem and can be easily modified to avoid the need for medical or surgical intervention. Less commonly, the voiding habits seen in a voiding diary suggest an underlying medical disease that is contributing to incontinence.