Female problems of the urinary and gynecological systems are often times very complex and intimately related. Therefore, these problems are not adequately addressed independently by a urologist or a gynecologist so patients are “bounced” between two specialists. Our Florida urogynecology specialists offer expertise in both female urology and gynecology to address all aspects of your problem.
There are many ways to address urogynecological problems – both surgical and non surgical. These issues, such as urinary incontinence, have a tremendous impact on your quality of life and are commonly accepted as a “natural part of growing older”.That is simply not true. Our goal is to do a thorough evaluation of your problem and provide the information for you to have a better understanding of your problem. By working together we will tailor a plan specific to your needs. Your insight allows you to take control of the situation and make informed decisions.
Pelvic rehabilitation is a systematic approach to improving the strength and function of the pelvic floor muscles which support the bladder, urethra, vagina, uterus and rectum. This group of muscles stretches from the pubic bone to the tail bone creating the “floor” of the pelvis. The urethra, vagina and anus pass through small openings in this muscle group. These muscles hold the bladder, uterus and rectum in the proper position and also help these organs to maintain proper function. Damage and loss of muscle strength can occur from aging, childbirth, surgery and other conditions. When this occurs, bladder dysfunction, bowel dysfunction and even chronic pelvic pain can result.
Pelvic floor rehabilitation provides a structured program for muscle retraining to treat these conditions.
Your therapy will be tailored to meet your needs and is provided by your nurse, who is specially trained in treating conditions related to pelvic floor dysfunction. This is a three-step approach using: 1) a program of pelvic floor exercises designed to improve your particular condition, 2) electrical stimulation of your pelvic muscles, and 3) dietary and behavioral modification information on bladder irritants, dietary fiber, urge control, and techniques for proper evacuation of the bladder and bowel. Medical research has shown this approach to be highly effective with improvements that persist over time.
This therapy is non-invasive and painless. It is conducted in privacy with one-on-one personal attention and instruction. It is safe and has virtually no side effects. The time required for each session is approximately 45 minutes. You will also be given a prescription for home exercises to continue your improvement.
Conditions treated by pelvic rehabilitation are:
A pessary is a medical device used to relieve symptoms associated with cystocele, rectocele, uterine or bladder prolapse and/or stress urinary incontinence.
Pessaries come in many shapes and sizes and are specifically designed to address a patients’ individual problem. They are usually made of pliable silicone.
Pessaries may be a temporary alternative to surgical intervention, until such time as a more permanent corrective surgery can be completed.
Pessaries are inserted in the vagina and act as support. After an initial fitting, you will be asked to return for an assessment of the effectiveness and comfort. You may be asked to remove, clean and reinsert your pessary at regular intervals.
Urodynamics is a test of the function of your bladder.
This test provides objective data regarding your bladder’s capacity, compliance (elasticity) sensations, ability to store and also ability to empty. It also provides information regarding the condition of the urethral sphincter. This valuable information is interpreted by your physician to help determine the best treatment options for your specific condition. The test is performed in the office, taking approximately one hour.
Upon arrival into the urodynamic suite, a study of your bladder’s ability to empty will be performed. You will be asked to sit on a special chair. This chair has a sensor under it to measure important information. After you have voided in privacy, the specially trained urodynamics nurse or technician will come in to make an assessment of your bladder’s ability to empty.
The next part of the study is referred to as the “filling phase”. A small catheter is placed into the bladder and another into either in the vagina or rectum. These tiny catheters contain sensors to record information. The bladder is then filled with sterile fluid through the catheter. This is the portion of the study that records your bladder’s capacity, compliance and sensations. It also will tell your doctor if your bladder has signs of being “overactive”. You will be asked to cough and bear down during this portion of the study. The data will be interpreted by your doctor to determine your bladder’s ability to “store” and will give information regarding the cause of any incontinence. Measurements of the strength/tone of the urethra sphincter are also obtained.
The last portion of the study is referred to as the “emptying phase”. This allows your doctor to determine the mechanism and ability to empty your bladder. The information from your urodynamic study and cystourethroscopy along with findings from your physical examination will be analyzed by your doctor to determine the best treatment course.
The SUBURETHRAL SLING is a vaginal procedure used to correct (stress urinary incontinence) loss of urine during physical activity – running, jumping, coughing, sneezing, lifting etc.
Through a small vaginal incision a (sling) permanent mesh-like material (Prolene) is placed underneath the mid portion of the urethra. The mesh-like material remains as a permanent sling under the urethra. The Sling causes the urethra to close when the patient puts pressure on the bladder (strains, laughs, coughs, etc.). As a result, episodes of stress incontinence are prevented or improved.
Bladder SLING – brand names include Monarch (American medical Systems).
MINI–SLINGS – brand names The Mini-Arch (American Medical Systems).
Do Your Homework!
Not all slings are the same.
Not all doctors have the same degree of experience.
Your best chance to successfully treat STRESS URINARY INCONTINENCE with a sling is with your FIRST procedure.
Overactive bladder (OAB) is characterized by frequent sudden urges to urinate. For many people with OAB, the urge to urinate is so strong and sudden that there is not enough warning time to make it to the bathroom and an incontinence episode occurs. OAB is often successfully treated with pelvic floor exercises and medication. However, sometimes these do not work or are not an option. If bladder control issues are affecting your lifestyle, we can help you regain control and improve your quality of life.
InterStim Therapy is a small pacemaker like device that works on the principle of neuromodulation. The device is used to send mild electrical pulses to a nerve located in the lower back (just above the tailbone). This nerve, called the sacral nerve, influences the bladder and surrounding muscles that regulate urinary and bowel function. The electrical stimulation may reduce or eliminate OAB symptoms. Additionally, it may also be used to treat people who have difficulty emptying their bladder (non- obstructive urinary retention).
InterStim Therapy does not treat symptoms of stress incontinence. People with stress incontinence lose urine when they exercise or move in a certain way. If you have stress incontinence, you may leak urine when you sneeze, cough, or laugh, or when you get up from a chair.
Dr. Thompson specializes in performing a 45-minute, incision free, in office procedure to determine if a patient will respond to the InterStim Therapy. A small, thin wire is placed under the skin, by the tailbone, to control bladder and/or bowel activity. Next, the wire is connected to a small stimulator which you’ll wear on a belt during a 3 to 7 day trial. If during the trial period, you experience a significant improvement in your bladder control issues then you may choose to proceed with InterStim placement. The final placement procedure is performed as a 1-hour outpatient procedure. It involves placement of a new thin wire and a small InterStim battery under the skin. The InterStim battery may last from 5 to 7 years after which it may be replaced. The entire procedure is completely reversible and may be removed at any time. Like many surgical implants- if you have an INTERSTIM you will not be able to have an MRI until the device is removed.
For more detailed information on bladder control treatments please visit the following InterStim web site:
Vaginal prolapse is a lack of support for the pelvic structures (Uterus, intestines, bladder and/or rectum) that results in a hernia or bulging of these organs into the vagina. Women with this problem often have the sensation of pressure in the pelvis or “something falling out of me.” In more extreme cases the prolapse is outside the vagina and will block the flow of urine and or bowel movements. The condition is usually painless but can cause “discomfort”. The symptoms tend to worsen as the day progresses and you are up on your feet. This condition has various degrees of progression. It is a quality of life condition. No one knows exactly why it occurs. It is associated with childbirth, obesity, chronic straining (constipation, heavy lifting), and smoking. It can also occur for no reason at all.
There are both surgical and non-surgical ways to treat prolapse. Traditionally, surgery has had a high failure rate with prolapse coming back almost 50% of the time. The key to proper management of your prolapse is a detailed evaluation.
Evaluation of prolapse:
There are multiple portions of the vagina that can be involved in prolapse. It is important to determine which portion(s) of the vagina and what underlying organs (bladder, rectum, uterus, intestines and to what degree) are involved in your prolapse. All of these types of prolapse may occur together or separately and to varying degrees. In some cases prolapse does not cause any symptoms.
Traditionally, surgery was performed either through the abdomen or through the vagina and can involve a hysterectomy. Vaginal procedures were most commonly performed. Vaginal repairs traditionally incorporated various plication procedures using the patient’s native tissues. These techniques relied upon the hope that the scarring from the surgical repair would be adequate to hold the prolapsed segment(s) of the vagina in place. Unfortunately the failure rate was high. Advances in the surgical management of prolapse have incorporated the use of biological and or synthetic grafts to augment the patient’s deficient tissues. Many new surgical devices have facilitated the use of graft augmentation. Prolapse surgery may be performed either through the abdomen or the vagina. There are many factors we consider to determine with approach or combination of approaches is right for you.
The pessary is the mainstay of non- surgical management of prolapse. A Pessary is a silicone vaginal insert that holds prolapse in place. Pessaries are available in many sizes and shapes. It is typically inserted and removed by the patient. With a properly fitted pessary you won’t even know it’s there.
PELVIC FLOOR REHAB/EXERCISES
These exercises help to strengthen the pelvic floor musculature. These exercises will not reverse prolapse but may prevent or at least slow down the progression of prolapse. Please see more in the Pelvic Floor Rehab section of our website.
When a women has been diagnosed with a Cystocele, (the bladder sags or drops down) sometimes she will develop symptoms such as difficulty urinating, involuntary release of urine and pain intercourse. That is when she will most often seek medical attention and possible surgical options. Unless other Medical conditions prevent or necessitate the procedure to be done abdominally the bladder and urethra are usually repaired through an incision in the vaginal wall by pulling the prolapsed or loose tissue in the area of the prolapse in the bladder and/or urethra.
Laparoscopic Sacral Colpopexy is a minimally invasive surgical technique used to suspend the vaginal apex for the treatment of pelvic organ prolapse.
About the procedure:
Limitations – Not all patients are candidates for a Laparoscopic Sacral Colpopexy,
Your physician will discuss appropriate surgical options specific to you and your preferences.
ThermiVa has been an incredible treatment for the following complications; atrophic vaginitis,
levator spasms, and even those with introital pain from lichen schlerosis and hyperplastic dystrophy.
I would not treat a patient with a vulvar lesion that has not been diagnosed or biopsied.
You never want to treat a patient with VAIN/VIN/Precancer of the vulvar or vagina. To be perfectly
safe, treat only those with a completely normal visual vulva/vagina.
The average age treated is 18 + to infinity, depending on complaint and issue. This is a procedure
for both the pre and postmenopausal women.
It is suggested to have a recent physical and or pap smear (when applicable) within the last 2
years (since women without a cervix do not have a pap smear). I believe that ThermiVa treatments
are best for those with normal paps. However, I believe it is also acceptable to treat women
with low risk HPV subtypes. Those with high risk HPV should be managed and treated before
proceeding with ThermiVa treatments. Once you have a normal pap, Thermiva treatments are
Follow this link to learn more about ThermiVa: http://abc13.com/1337760/
Urethral bulking is used for a condition called urinary incontinence. Millions of women worry about bladder leakage–a frustrating and often embarrassing condition that can affect a woman’s lifestyle, relationship, and emotional well-being. Urethral bulking agents may be used to treat Stress Urinary Incontinence (SUI), specifically when the cause is Intrinsic Sphincter Deficiency (ISD).Treatment with a bulking agent involves injecting a material into the tissues surrounding the urethra to help increase the thickness of the urethra. Urethral bulking does not close urethra totally; the urethra can still open normally to allow urination.
The procedure is done by Dr. Thompson in the office. You will be prescribed an oral medication to take 2 hours prior to the procedure. A local anesthetic is used. The procedure takes 5-15 minutes. There is no down time or recovery time. Resume normal activity the next day.
Botox injection in bladder is used for Over Active Bladder (OAB). This is for those patients that could not tolerate the side effects of medications or still experience urgency, frequency, or urine loss. The procedure is done by Dr. Thompson in the office under IV sedation or in the hospital. The procedure takes 15-20 minutes.
Botox injection in the pelvic floor is used for anal spam (pain). The procedure is done by Dr. Thompson in the office. The procedure can be done with local anesthetic or with IV sedation. The procedure takes 5-10 minutes.