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Below are some of the different services offered by Dr. Schlafstein.
The urinary bladder functions to contain and store urine until there is a convenient time to void or expel this fluid waste from the body. Regular leakage of urine prior to such appropriate time is universally undesired and is referred to as urinary incontinence. Urinary incontinence is at minimum a nuisance, but quite often it can be distressing, disabling and can in some instances lead to severe infection. While the problem is costly to society as a whole, it is particularly difficult for the individual patient and her family and is a leading cause of nursing home admission in the elderly.
In the female, there are two main categories of urinary incontinence: genuine stress urinary incontinence (GSUI) and overactive bladder (OAB). GSUI is characterized by leakage of urine with laugh, cough, sneeze, running, jumping and exercise. OAB is generally distinguished by urinary urgency, leaking on the way to the bathroom; frequency, voiding more than seven times during the day; and nocturia, getting up more than two times at night to void. Along with a thorough history and a focused physical examination, a special office test called urodynamics can help distinguish between these two main causes of urinary stress incontinence. Although some women will have a combination, it is indeed important to distinguish between these two cause of incontinence because treatment will differ.
Laparoscopy is considered to be a minimally invasive surgical procedure because a large abdominal incision is avoided. Rather three or four small incisions, each about the size of a finger, are made in the lower abdomen. A laparoscope is gently inserted into the abdomen allowing visualization of the abdominal cavity, while other instruments are inserted to facilitate the surgical procedure. Most gynecological surgeries can now be done laparoscopically, including hysterectomy, myomectomy, removal of ovarian cysts, and many others.
The advantages of laparoscopy include less post operative pain, a shorter hospital stay, and a faster overall rate of recovery when compared with traditional abdominal surgery . The avoidance of a large abdominal incision also decreases the incidence of other post-operative complications related to the heart and lungs. Because of the smaller incisions laparoscopy is also more cosmetically pleasing to the patient.
Pelvic organ prolapse is another name for vaginal herniation. This common condition is the result of the loss of pelvic support that occurs when the soft connective tissue that support the pelvic organs become stretched, weakened or torn. These hernias are categorized based on their anatomical location within the vagina. Anterior vaginal hernias are called cystoceles, posterior are rectoceles and/or enteroceles. Apical defects involve prolapse or falling of the uterus and upper vagina. Symptoms of this condition include pressure, heaviness, lower back pain, painful or difficult sexual intercourse, and incontinence.
While aging is a common factor, there are many other potential contributing causes of prolapse. They include menopause and estrogen loss, multiple vaginal deliveries, uterine fibroids, family history, pelvic trauma or previous surgery, repeated heavy lifting, chronic constipation and coughing, excess body weight, and certain medical conditions such as diabetes.
Female Pelvic Reconstructive Surgery is performed to treat Pelvic organ prolapse. The surgical treatment is much like that of hernias in other locations of the body. The goal of this surgery is to restore the body to it's normal anatomical and functional status.
Bio-Identical hormones may be used to treat the menopausal woman. These hormones are molecularly or biologically identical to the hormones naturally produced during a woman's reproductive years. These compounds are plant derived, hence they are also referred to as phyto-hormones. Treatment is individualized to the patient's needs. A prescription is required and can be filled only at pharmacies which specialize in compounding (our office is happy to provide a list of these pharmacies). Therapy may be administered orally (pill form) or topically (a cream), depending on patient desires and response to therapy. Dosing may be adjusted based on the patient's symptoms or after specialized salivary testing.
While Menopause is defined as the end of menstrual periods and the end of of a woman's reproductive years, wesee menopause as a beginning! Each women will have her own individual needs at this stage of her life. While symptoms can often be inconvenient and bothersome, serious and debilitating long term heath risks can also occur due to changes associated with menopause. We evaluate our patients with this in mind and will attempt to tailor any therapy to the individual's needs.
The Urgent PC System is an effective, outpatient method for treatment of overactive bladder symptoms including: urinary urgency, urinary frequency and urge incontinence. It can be used as a primary treament, but most oten is employed after a patient fails or is unable to tolerate medical therapy. In some cases it may also be used to treat fecal incontinence.
The treatment is based on the Eastern medicinal principles of acupuncture. Electrical impulses travel through the tibial nerve to the sacral plexus, and relax the nerves responsible for overactive bladder function. This treatment consists of twelve weekly office treatments lasting thirty minutes each. Subsequent treatments are given as needed. Urgent PC is extremely well tolerated by patients, in fact most patients find the time very relaxing!
The purpose of the urodynamic testing is to evaluate bladder function in patients who leak or have difficulty holding their urine. The testing takes about 20-30 minutes and is performed in our office. The test provides important information regarding the ability to store urine, as well as being able to identify voiding difficulties, and the specific causes of urinary leakage. It is particularly important for a patient who is going to have bladder related surgery to have this testing.
Vulvar Vestibulitis is a condition characterized by pain, discomfort, irritation and redness of the vestibule, the opening of the vagina. This is a chronic inflammatory condition effecting the vestibular glands laterally and the perineal skin below. While the entire vaginal opening may be involved, often the lower area is most tender.
Vulvar vestibulitis occurs in women of all ages. It can occur in women who are sexually active and also in women who have never been sexually active. Although currently it is unknown studies are being conducted to determine the exact cause of this condition.
Some of the symptoms of vulvar vestibulitis include:
This involves the injection of a very low dose of onabotulinum toxin A into the bladder in order to relax the bladder smooth muscle, and ultimately treat symptoms of overactive bladder (OAB) and urinary urgency incontinence. This treatment is performed
on an outpatient basis under light anesthesia. Typically the procedure is repeated every six to nine months in order to achieve and maintain optimal results. Symptoms of OAB include bothersome daytime urinary frequency, the need to get up on multiple
occasions during the night in order to void, as well as urinary urgency often associated with leakage.