It’s World Continence Week! Reach out for help

WCW-2015-Group

Yes, there is a day or a week for just about everyone and every cause these days! But this one is near and dear to my heart, because I see women every day whose lives are affected negatively by incontinence. Fortunately, I also get to see how their lives are greatly improved by our treatments. World Continence Week is an annual initiative with a primary goal of raising awareness about issues related to bladder control. You probably know that incontinence is the involuntary leakage of urine, but did you realize that bladder control problems are preventable, and they can be managed and often cured?

This is a hard topic for many people to talk about, and believe me, I completely understand. Of all the medical issues that women talk about with their friends, for some reason, they do not want to talk about this issue. Some of my patients even hide it from their husbands. Incontinence is a sensitive subject, and it affects an estimated 400 million people around the world.

Because this sometimes feels too taboo to discuss, World Continence Week has stepped in to draw attention to the problems and increase awareness about the condition. At the end of the day, this week is about giving a voice to those who suffer while boosting their confidence to seek help from a doctor and improve quality of life.

I want you to know that if you are suffering with incontinence issues, or you know someone who suffers, you can start the process today to begin changing your life for the better. Here are three easy steps that you can begin right now. I have found these to actually be curative in some cases.

  • Reduce your intake of caffeine. Think coffee, tea and sodas.
  • Make diet modifications. Spicy and acidic foods can trigger an overactive bladder.
  • Establish a bathroom schedule. Urinate before you have the urge.

There are many other options to consider in your journey to treat and cure incontinence. I have created a bladder treatment pathway to make it easy to see the various treatment options and guide you most quickly to the therapy that will work for you. We can discuss the best route for you during a visit to my office. My staff and I talk about this every day, so leave your embarrassment at the door! We are here to care for you and walk beside you as we tackle this issue.

We can discuss:

  • Pelvic Floor exercises, either at home or through our pelvic muscle toning program
  • Bladder neurostimulators that retrain the bladder nerves and is often a permanent solution
  • Bladder Botox, administered easily in the office to relax the bladder muscle
  • Medications
  • Surgery, such as a simple outpatient 15 minute procedure with 95% success rates

Take action this week! I promise it’s worth it. It can literally change your life.

Dr. P

Originally posted 2015-06-25 14:53:05.

Hope for Leaky Bladders

Are you suffering from a leaky bladder?  Is it hard for you to empty your bladder completely? Or maybe you feel like you need to go way too often.

These are common issues for many women and frequently go unaddressed. The good news is that if you do suffer from the above symptoms, I offer specialized urodynamics tests in my office that allow me to narrow down the cause of your bladder problems to properly address your symptoms and provide treatment options specific to your needs.

Urodynamics consists of several tests that provide valuable insight to how a patient’s lower urinary tract (urethra and bladder) are functioning. These tests determine how well the bladder is holding urine and evaluates the bladder’s ability to empty properly. Urodynamic testing is key to determining the cause of bladder incontinence.

It is fascinating what all the tests can tell us! Urodynamics commonly includes the following:

  • Uroflowmetry: measurement of urine volume and speed
  • Postvoid Residual Measurement: measures the amount of urine remaining in the bladder after urination
  • Cytometric Test: measures how much the bladder can hold when it communicates with the brain that it is full
  • Leak Point Pressure Measurement: determines the point at which the bladder leaks are involuntary
  • Pressure Flow Study: measures the pressure the bladder requires to urinate
  • Electromyography: evaluates for nerve or muscle damage

If you are one of the 25% to 45% of women who suffer from bladder leakage, I encourage you to give my office a call! To patients, bladder symptoms may feel like an embarrassing or uncommon problem but I promise it isn’t. Don’t let your bladder condition hold you back from the things you love, my team is here to help you get your life back again.

-Dr. P

Originally posted 2017-03-03 12:40:36.

One month!! Thankful!!

It is 8/8/14. We opened our doors 7/7/14, so that means we have one month under our belt!!  Woohoo!  We did it/are doing it!  Things are coming along very well.   We have helped almost three hundred ladies with their urological issues so far and have registered almost 400 into our system for appointments.  We’ve started doing surgery through the new practice: some bladder repairs and a few stones. And our pelvic floor program is in full swing.  We have been busy!

I truly feel blessed.   This is the realization of a dream that I have had for many years: to have a urology clinic for women and to have my own practice.  It is so fulfilling.  Everything is the way that I have envisioned it:  a beautiful, calm, clean office where patients can feel assured that they will be treated gently and professionally.  My staff is amazing.  They have put their heart and soul into this start-up and they truly see this as a mission to help women and not just another job.   I am so proud of them.  And, we have a lot of fun together!

There are of course, moments of doubt.  These are brief moments, but a frustration will occur and I will think, “what have I done?!?”  Gulp.  But in those times, I stop and think, “Christi, remember who is in ultimately in control here.   Who has orchestrated everything to make this happen?  Who has paved the way, given you the desire to be a doctor since you were three years old, opened up and closed the right doors along the way?  God has got you, and He has your practice, too.  The whole thing is squarely in His strong hands.  Rest.  Don’t worry.  This is His practice.”  He gives me a strong peace and courage to continue forward.  It’s all going to be good.

So, I am incredibly blessed and thankful and peaceful about this adventure.  Life is too short not to make big moves and walk by faith!  If I weren’t a Christian, I would be a wreck, I think.   But knowing that God has already paved the way and having His peace, I can relax.  I can just lean on Him and go step by step.   He has placed me here at this time, and my job is to trust Him and share the love of Christ through urology!

 

 

Originally posted 2014-08-08 17:16:09.

Bladder lifts 101

As I await my surgery this morning, which is a biological graft bladder lift, I thought I would take the opportunity to discuss bladder lifts.  What they are and the various options.

As we age, and especially if we have had vaginal deliveries, the bladder can start to fall.  The ligaments that surround the bladder get stretched out and the vaginal wall isn’t strong enough alone to support the bladder anymore.  This is called a cystocele.  It is sort of like a hernia in the vagina.

The symptoms may be a bulging in the vagina, a feeling that you are sitting on a ball, difficulty emptying your bladder, recurrent urinary tract infections, and some women even have to push their bladder up to be able to empty it.  We fix it when it the bulging becomes too great a bother, the bladder cannot empty well at all, or there are a lot of bladder infections.

The first thing we’ll try is a pessary.   This is like a donut that we can insert in the office that will literally push the bladder up where it belongs.  When fitted properly, it will stay in place but you won’t be able to feel it.  This can be a long-term solution or a temporary measure until surgery.   The maintenance on it is to come in to the office every 8 weeks to have it cleaned and to check the vaginal walls.

Surgically, there are four main options:

  1. Traditional tissue plication.  This is the old-fashioned lift where we simply stitch the walls of the vagina tighter to make a shelf for the bladder.  It works for a lot of people, but the failure rate is reported in some studies as high as 40%, so that’s why we started looking for other alternatives.   You may know someone who has had numerous bladder lifts.  It is still an option, however, and is done quite frequently.
  2. Biological graft placement.  This procedure uses tissue that has been processed to make a supportive sheet about 3X4 inches in size.  The two main ones that I use are Xenform, which is made from calf skin and looks like a sheet of pure collagen, and Repliform which is made from human cadaveric skin.  The cells are taken out of the graft to make it just a sheet of collagen and to prevent spread of any disease at all.  These grafts supplement your natural tissues which have been proven to be weak.  I put these in with a vaginal procedure.
  3. Mesh graft placement.   Mesh??   “The mesh from those lawyer commercials?”  Yes, the mesh from the commercials. It is still a good option.   There have been no recalls of mesh at all.   It does have to be done properly, and I reserve it for the patients who have failed other techniques.   Having done hundreds of mesh implants, I can tell you that it works very well and patients do well.  It’s not perfect, but, then again, no surgery is.
  4. Robotic bladder lift.   This procedure is approached from above with scopes through the abdomen, in contrast to the other three methods which are all done through the vaginal wall.  This method is usually done in conjunction with the gynecologist doing a hysterectomy.  The robot helps me sew the mesh onto the vagina more efficiently and precisely.

All of these surgeries typically involve one night in the hospital and low levels of pain.  You do have to avoid heavy lifting or heavy exercise for about six weeks afterwards while you heal.

And there you have it.  I use all of these options regularly.  It just depends on the patient: how bad the cystocele is, her age, prior surgeries, the health of the vaginal wall.  That’s where I spend time getting to know you, evaluating you and what you need.

Please call our office if you would like a consultation about your bladder:  281-717-4003.   This is what we do!

 

 

Originally posted 2014-07-30 08:30:29.

Exhausted, but worth it: Week One of New Practice

Well, we’ve almost completed our first week of the new practice!  Oh, boy!  I am pretty exhausted.   And I feel like I have ADD.  One minute I’m discussing surgery with a patient, the next fine-tuning the process of ordering tests, next hanging a scope sterilization caddy on the wall, next minute learning about Google Adwords.

It’s like when you are trying to clean your house and you move the blanket to your bedroom, only to see a cup that needs to go to the kitchen, and in the kitchen is your child’s backpack that needs to go to their room.  Like that.  But it’s every day, all day. 7a-7p. I am not really stopping for meals, just working and grazing.

It’s all-consuming.  I can’t stop thinking about the new practice and trying to get every little thing just the way that I think it should be.  I know that the day is coming when I will again mostly be spending my time practicing medicine, my first love, and spending less time on the business part, which I like, but it wears me out.  It doesn’t feed my soul the same way.

I do love it, though.  Building something.  Creating a business and a place of healing.  Helping people with their bladder problems. Yes, I’m a doctor who hasn’t lost the drive and satisfaction to help people.  That is what keeps me from burn-out.  Keeps me going no matter what frustration comes along.  It is just the best feeling to have a patient smiling and hugging you, because she doesn’t need to wear pads anymore.

I love that I’m also able to employ some great women and (hopefully) help them realize the life that they dream of.  And I couldn’t do any of this without their dedication.  I truly get so much more from them than I give to them.  We have a great team, and everyone has the vision to fulfill the mission of our practice.  And we have a lot of silly fun as seen on the Facebook page.

Some of the challenges and frustrations that we’ve encountered:  Well, day one, the Comcast internet wasn’t working.  In fact it has gone down a couple more times since then.  We have a new modem now, so hopefully that will help.  And hey, Comcast sent me a $20 credit today!  Internet is essential because our medical records are cloud-based.  Thank goodness that Methodist has a free guest wifi.  Otherwise, I’d have to pay for a backup internet service.

Challenge two:  As much as we tried to learn the new Kareo electronic health records (EHR) ahead of time, there is just no way to know all the ins and outs until you go live.  Day 4 now, it is getting much easier.  We have figured out some good shortcuts.

Challenge three:  Today we started using our Phreesia pads.  I was hoping they would be ready Monday, but they weren’t.  Another lesson in letting go of the desire for perfection!  These are like ipads that patients use to check in and pay their co-pay.  Very cool.  At first, they didn’t work too well, but by the end of the day we were starting to see the light.  Patients seem to like them.  Decreasing paper waste!

We started out the week with one patient per hour so that we would have plenty of time to figure everything out and that was key.  I’m still going to limit the number of patients for a while until we really start to feel like we are getting efficient.  The patients have been so wonderful and patient with us.  Sweet ladies.

I say we’re off to a good start!  I think we are all tired and longing for the smooth-running machine that we all know we are capable of.  It will take some time, but each day gets a little easier.  It’s like the beginning of a run when you are sucking wind and just want to slow down or stop. BUT, if you can get past mile 3, the breathing gets easier, you reach your stride, and then you are cruising for the long run.

 

Originally posted 2014-07-10 22:23:07.

Looking Back at 2015

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As 2015 draws to a close, I can’t help but look back on this year and think about how far Houston Female Urology has come since we first opened in July 2014. This year we celebrated our one-year anniversary. That’s one year in the books as the only urology practice in Texas that exclusively serves women. This is something that makes my team so proud. It’s an honor to help our patients get their lives back and say goodbye to urological issues every day.

This year we also added the MonaLisa Touch laser – a leading edge treatment that resolves gynecologic health issues often caused by menopause. I offer this as an in-office procedure that is virtually painless and requires no anesthesia. I am excited to be one of the first physicians in Houston to offering this treatment to help postmenopausal women and breast cancer survivors. (We are also thrilled that the Houston Chronicle covered our story!)

I love interacting with my patients. One way I did this in 2015 was through free seminars. My team organized two amazing events where our patients (and their friends!) were able to gather and learn more about urological issues and treatment options. We had drinks, snacks, door prizes – the events were so successful that I’m already planning more free events for 2016!

Giving back is something that is really important to my practice. This year we gave new athletic clothing wear and monetary donations to Houston Area Women’s Center. We prayed that these donations would bless the women who receive them as they break free from domestic abuse and start a new life.

So as the year winds down and Christmas approaches, I pray for real joy and peace for the whole world. So much heartache has happened in 2015, and it reminds me of the poignant lyrics of the Christmas song, Oh Holy Night – “A thrill of hope, the weary world rejoices.” Take time to rest and not get caught up in the hustle and bustle of the season. This is a time for joy – God reached down to touch mankind.

Enjoy your fresh start to a new year, and come see me in 2016! I can’t wait to continue providing the same great care to my patients.

Dr. P

Originally posted 2015-12-16 11:08:15.

What IS Female Urology????

When I first signed up for a urology rotation in medical school, I thought I was going to spending the next 6 weeks seeing old men with prostate cancer.  I really was not interested in urology at that time, but I needed something to fill my fourth year schedule. What I really wanted to do was anesthesiology: putting in IVs and breathing tubes, lots of fun procedures.

But, the anesthesia rotation was already spoken for. So, now what? Well, I was planning to be a gynecologist, so I thought, well, at least if I do urology, then I’ll get more exposure to the pelvic anatomy. Get a refresher course on all the blood vessels and structures. That will be helpful, right? Even if it is just old men and their prostates.
Well, I couldn’t have been more wrong. Even then I didn’t realize just how wrong I was. Now as I sit here practicing not just urology, but 100% female urology, it is ironic that I thought that it was only prostates!
Of course, urology does encompass prostates in men. It includes everything in the urinary tract from the kidneys through the bladder and out the urethra. Urologists have medical treatments and all kinds of surgeries to treat patients. We treat patients from birth through death, men and women, boys and girls for everything from bedwetting to terrible cancers. It is a great variety surrounding that one part of the body. That’s the reason I fell in love with urology and switched from my pursuit of gynecology.
Female Urology, of course, focuses on the female urological tract. We don’t have prostates, so we don’t need to worry about that (thank God!), but we do have other issues. The most common issue that we have is overactive bladder and incontinence. God made us with short urethras (the pipe that the urine comes through) and a big opening in our pelvis muscles to allow us to have babies. If that opening gets stretched out, such as after having babies, then we start to have problems with organs dropping and having a difficult time controlling our urine. Sometimes it happens even if one has had only C-sections, or has no children.
Female urology is here to help with that! We have everything from physical therapy to medications to surgery to pacemakers, Botox and more. It is a very exciting time because we have some very effective treatments for this now, whereas ten years ago, the options were very limited. You don’t have to live with those pads your whole life!
That is not all that Female Urology entails. It also includes urinary tract infections, painful bladder conditions, kidney stones, evaluation of blood in the urine, slow urinary stream, bladder and kidney tumors, and more.
There is even now a subspecialty, in which I am certified, called Female Pelvic Medicine and Reconstructive Surgery, which focuses on certain conditions of the pelvic floor, especially prolapse (dropped organs) and incontinence. There are even more advanced surgeries that can be used to treat these conditions, including robotic surgery, which I have been doing for several years with beautiful results (beautiful from a pelvic surgeon’s perspective!).
Over the last twelve years, I have narrowed my urology practice down to females only. I couldn’t be more pleased with my choice. I get to treat some lovely women and see them get their life back: from a life of pads and worrying about where every bathroom is to urine control. And for others, it is helping them with infections, pain, stones, or reassuring them that the blood found in the urine isn’t serious for them. Female Urology is my complete career focus and my mission.

Originally posted 2014-07-15 18:10:05.

Welcome

Hello, I am Dr. Christina Pramudji. I am a urologist who is a female who only does female urology, and I LOVE it!  This is where I intend to blog about female urology, about the conditions that many women have, the treatments that can help them, and about my journey into solo practice.  Thank you for reading my blog!

Originally posted 2014-06-26 14:28:35.

Meet the MonaLisa Touch

 

MonaLisaTouchI am thrilled to announce that I will be introducing a new vaginal laser treatment as an outpatient procedure this fall at Houston Female Urology. As the first urologist in Houston who’s taking advantage of this groundbreaking technology, I can’t wait for my patients to reap the benefits! Meet the MonaLisa Touch.

The MonaLisa touch is a treatment aimed at combating vaginal atrophy. Vaginal atrophy may be caused by hormonal changes during menopause, and it may also occur in women who experience a decreased estrogen production due to cancer or breastfeeding. Thinning, drying and inflammation of the vaginal walls are typical characteristics, and it may cause intercourse to be painful and contribute to problems with urination.

My patients who experience these symptoms will now be able to restore youthful, trophic conditions in the vulvo-vaginal area with the MonaLisa Touch. The MonaLisa Touch is a minimally invasive laser method that is completely reliable. Its CO2 laser source emits an impulse, and the method does not trigger negative effects like some hormone-based therapies.

Often during the period of menopause, the vagina is subject to a loss of swelling and hydration of tissues, which may cause discomfort for many women. As I mentioned earlier, some of the symptoms include itchiness, dryness, burning, loosening of the vagina and pain during sexual intercourse. Not only do these symptoms cause discomfort, but they can also interfere with your quality of life.

I am excited about the MonaLisa Touch because it naturally and painlessly overcomes vaginal atrophy by triggering physiological processes that eliminate signs of aging. Most importantly, the treatment brings an improvement in physical conditions that enable women to feel like their vulvo-vaginal areas are aging in reverse.

Stay tuned as we share more information throughout the coming days and weeks about the MonaLisa Touch. I think you’re going to love it!

Dr. P

Originally posted 2015-09-21 10:17:35.

There’s blood in my urine?

It’s a scary thing to find. When a patient sees blood their urine (hematuria), there are often many unknowns that race through their mind. I always stress that patients need to seek medical attention the first time they see it. Don’t even ignore a small amount. Call our office immediately, and make an appointment.

During the appointment, we will look at the entire urinary tract, first with imaging of the kidneys by a CT scan or a renal ultrasound and follow that with a KUB. Then, we will do a scope of the bladder, called a cystoscopy. It is a quick procedure with numbing medicine. While it sounds intimidating, patients are often surprised at how easy it is. The discomfort is similar to a Pap smear.

The most common cause of hematuria is a UTI. The infection can irritate the bladder wall to the point that it often bleeds. Other things we look for are a kidney stone, kidney tumor or bladder cancer.

While it is uncommon, occasionally we find a bladder or kidney tumor as the source of bleeding. Obviously, the sooner that a tumor is found and treated, the better. Tumors in the kidney and bladder will need to be removed surgically. Fortunately, we have great, minimally invasive options to remove these tumors without a large incision.

Often we will see patients for microscopic blood in the urine detected by their primary care doctor. While not as serious, it still requires a complete panel of testing.

Your treatment options will depend on what the testing shows. A UTI will be treated with antibiotics, water and other measures of prevention. If we find a kidney stone, then the treatment could be a number of various options to eliminate the stone, including laser and shock wave therapy, which are both minimally invasive options.

Whatever the cause, it is of the utmost importance to call our office at the first sign of blood in your urine. Our caring staff is here to help you.

– Dr. P

Originally posted 2016-04-26 11:31:37.