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Urogynecology OverviewDon’t Be Sidelined by Bladder-Control Problems or Other Pelvic-Floor Disorders!Women are living longer and staying healthier these days. Increased exercise and other active pursuits are part of this new lifestyle, but unfortunately, bladder control problems slow down or sideline many of the 13 million Americans. Most of those affected are women. Sufferers often see bladder control problems and other pelvic-floor disorders as a roadblock to health, vitality, and self-esteem. Pelvic floor disorders include bladder control problems (urinary incontinence), fecal incontinence, and pelvic organ prolapse—that is, the dropping or falling of the uterus, bladder, rectum, and vagina. Any of these problems may occur separately or in some combination with each other. Women need to know that these disorders need not stand in the path to a full life. At St. Luke’s and Roosevelt Hospitals, the Urogynecology and Pelvic Reconstructive Surgery Division is made up of highly qualified, experienced specialists with advanced training. Our approach allows for comprehensive care, even for patients with the most complex conditions. We begin with state-of-the-art diagnostic procedures and evaluation, and then offer a complete treatment and education plan to each patient based her own individual needs and preferences.
We provide a broad range of management and treatment options for urinary incontinence and prolapse. Treatment types may include behavioral modification, pelvic muscle rehabilitation, biofeedback, and pharmaceuticals, with or without the latest minimally-invasive surgery. Contact us today and get on the road to an active, vital life! Minimally-Invasive Surgery for Fibroids and Other Gynecologic ConditionsIn addition to urogynecologic care—for bladder control problems and pelvic floor disorders--our specialists are also leaders in minimally-invasive surgery for other noncancerous gynecologic conditions. They are experts in vaginal hysterectomy, which is considered the method of choice in women who need a hysterectomy for noncancerous problems. A woman who has been told she is not a candidate for vaginal surgery because of a prior cesarean section, because her fibroids are too large, or because she hasn’t had children can, in fact, usually have vaginal surgery without much problem.
Contact Us at 212-523-7570 Treatments for Bladder-Control Problems and Pelvic-Organ ProlapseIn the Division of Urogynecology and Pelvic Reconstructive Surgery at Roosevelt Hospital, our expert physicians offer you the best treatments for prolapse and incontinence. These treatments range from conservative education and behavior modification to advanced, minimally-invasive surgical procedures. During the diagnostic process, our specialists will listen closely to you and explain your options. You can then choose the most effective and suitable plan for your needs and lifestyle. Below are some possible components of a comprehensive plan. Behavioral Treatment and Education Pelvic floor exercises, also known as pelvic muscle rehabilitation, can be very effective for stress incontinence and may help increase quality of life for those with prolapse. Bladder retraining is a behavior modification technique that helps correct incontinence. We offer education and support for these and other non-invasive treatments. The levator ani muscles are the set of muscles that span the pelvic floor. They are attached to the pubic bone in front and the hip bones on either side. The levator ani muscles provide support to both the vagina and the urethra, so keeping them strong will help support the pelvic organs and prevent or minimize urinary incontinence. Kegel exercises involve contracting the levator ani muscles. These are simple exercises that all women should know about and learn how to do. In order to keep the pelvic floor muscles strong, you need to exercise them as part of your daily routine, just as you would with any fitness program. First, learn to identify the muscles. It is often difficult for some women to do this. Many times women are instructed to try to stop the flow while urinating. This is a good tool for identifying the pelvic floor muscle. However, Kegels should not be practiced this way on a routine basis, as it can lead to urinary retention and dysfunctional voiding. If you continue having trouble identifying your pelvic floor muscles (and you will not be alone), a consultation with your gynecologist can help. There are also physical therapists who specialize in pelvic floor dysfunction, and can be an invaluable resource in teaching patients to get the most out of their Kegel exercises. Once you can identify the muscles, get in the habit of doing Kegels twice each day. I usually instruct patients to do a set of 10 contractions at a time, holding each contraction for 10 seconds. The exact exercise plan isn’t as important as making sure that you do these exercises on a regular basis. Once you get the muscle strong, it is important to put them to work. Before and during coughing, laughing and sneezing, when you have problems with urinary leakage, make sure that you contract your pelvic floor. You may be surprised how much you can cut down on the leakage of urine. Remember, squeeze before you sneeze…or cough…or laugh…or lift a heavy object. Pessaries are Effective and Noninvasive A pessary is a device made of silicone that is placed in the vagina to relieve symptoms of prolapse or stress incontinence. They can actually prevent prolapse from getting worse. After being fitted, most women don’t notice that they are wearing a pessary. Medications are used for both forms of incontinence, and can be very effective for urge incontinence, which does not respond to other treatments. Minimally-Invasive Surgery for Bladder Control and Pelvic Organ Support Many women find relief from prolapse or stress incontinence without surgery. However, to truly and permanently correct these problems, pelvic reconstructive surgery is the only option. The choice is yours. If you decide it is right for you, a typical surgical treatment is minimally invasive, performed through the vagina and without a major incision. The division’s physicians are accomplished and flexible surgeons who will customize the procedure to your problem. At your request, they will employ surgical treatments that conserve the uterus. Minimally-Invasive Incontinence Surgery. To correct bladder control problems, we typically use the tension-free transvaginal tape (TVT sling) procedure. Over a million of these minimally-invasive procedures have been performed worldwide over the past 10 years, with excellent success rates and low rates of complications. Our urogynecologists perform a high volume of TVT sling procedures, with excellent results and minimal complications. The procedure is performed through the vagina, takes only 20 minutes, does not require an overnight stay, and if desired by the patient, can be done under local anesthesia. Other operators have made various attempts to modify the transvaginal tape procedure. However, a huge body of data, and our own excellent results, have led us to conclude that the original TVT is still the best. For incontinence, we also perform the transobtuator tape slings, which are also minimally-invasive and more appropriate for some patients. Minimally-Invasive Prolapse Surgery. We repair the dropping of the vagina and uterus through the vagina, supporting these organs with the patient’s own tissue. This is the least-invasive approach, with the quickest recovery time and the fewest complications because mesh is not usually required. In addition, we are skilled at correcting vaginal-vault prolapse via the vaginal route in women who have had a prior hysterectomy, a procedure many gynecological surgeons avoid. We have had good success rates with these approaches and still see many of our patients many years after their surgeries for their gynecologic care. Minimally-Invasive Surgery for Other Gynecologic ProblemsDr. Dabney and Dr. Hardart are experts at treating many additional gynecologic problems without a major incision, through the vagina or laparoscopically. Surgery by the Vaginal Route for Hysterectomy, Fibroid Removal, or Ovarian CystsVaginal surgery is the least invasive approach for many procedures because the patient ends up with no incisions on her abdomen. The only incision is made through the vagina. In addition to this, the surgeries are often shorter and require less anesthesia than the abdominal route. Patients also recover more quickly. Our specialists do many hysterectomies through the vagina that other New York City surgeons would only perform abdominally. Vaginal hysterectomy has been found to be the route of choice by recent scholarly publications. Vaginal ovarian cystectomy and vaginal myomectomy, respectively allow ovarian cysts and fibroids to be safely removed through the vagina. Laparoscopic Hysterectomy or Fibroid RemovalThese procedures are much less invasive than conventional, "open" abdominal surgeries, and utilize a camera and instruments inserted through minor incisions to remove the uterus or fibroids.
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