Posts By cpramudji

What is Vaginal Rejuvenation?

I am thrilled with the growth of vaginal rejuvenation treatments in my field. More and more women are starting to have the conversation with their doctors about their feminine health, and the range of non-surgical procedures to improve women’s vaginal health is expanding.

However, the language commonly used around the revolutionary treatments such as ThermiVa and MonaLisa Touch can be vague. What does the term feminine or vaginal rejuvenation mean and how does a woman know if the treatments can fix her uncomfortable symptoms?

Vaginal or feminine rejuvenation is the enhancing of the vagina’s function and cosmetic appearance.

The desire for better sex, a more youthful appearance, and convenience are the main reasons women are choosing non-surgical procedures for rejuvenation. Additional reasons include:

• Perimenopausal and menopausal women experiencing dryness, leaky bladder, or laxity
• Women suffering from dryness due to bioidentical hormones
• Women experiencing dryness from breast cancer treatments
• Women who have discomfort wearing yoga pants, a bathing suit, or riding a bike
• Women that have difficulty achieving orgasm
• Mothers that have vaginal laxity, leaky bladder, prolapse, or decreased sensitivity due to vaginal births

Lastly, I wanted to leave you with a few other notes about vaginal rejuvenation that I think are helpful to be aware of. First, the results can last up to one year and can vary from person to person. Secondly, the procedures are not typically covered by insurance.

If you are interested in vaginal rejuvenation, my team and I are available to help you determine which non-surgical treatment option is best for you. Email us today at info@houstonfemaleurology.com!

-Dr. P

Squashing Myths About In-Office Cystoscopy Tests

Many women are frightened by the idea of a cystoscopy test. When I sit down with my patients to discuss the procedure, they mainly express concern about pain and discomfort.  However, this procedure can provide great insight into a patient’s bladder health and should not be feared. Below is a list of FAQ’s to help ease your mind about your upcoming cystoscopy test.

What is an in-office cystoscopy?
A cystoscopy test is a procedure that allows me to examine the bladder lining, by inserting a scope into the bladder through the urethra. A cystoscopy test can be compared to a colonoscopy, but for the bladder.

Why would a woman need to have this procedure?
A woman would need a cystoscopy test if she has a polyp, tumor, or other abnormality. Additional reasons for a cystoscopy include blood in the urine that a physician found in a laboratory exam, bladder irritation, overactive bladder, or continuous bladder infections.

What misinformation have women heard about this procedure that’s wrong? Why should they not be nervous?
Most women think a cystoscopy test is very painful. Usually women hear this from others who have had a cystoscopy performed in the past, using a rigid scope. Now, we use a flex scope that is much smaller and less painful. The cystoscopy test only takes two to three minutes and the level of discomfort felt can be compared to a pap smear.

How should women prepare for this procedure?
It is important to come to the office with a full bladder so we can take a urine sample.  If you feel like you might have an infection, please let my office know before the procedure so we can treat the infection before performing the cystoscopy.

What does the process of having an in-office cystoscopy look like at Houston Female Urology?
First, the patient comes in for a regular appointment. We then take a urine sample to check for infection. Next, the medical assistant prepares the area and inserts a numbing jelly in the urethra. Once the area is numb, I fill the bladder with water. The scope is then inserted through the urethra into the bladder for the quick test. The results are discussed with the patient right away. Once complete, the patient will get dressed and go to the bathroom to empty the bladder. If there is any discomfort, we can provide a medication to help.

Will the patient feel much pain after they leave the office?
A patient should not feel any pain once they leave our office. There can be a slight burning but the feeling should go away after a couple of hours and is not a common side effect.

Please call my office if you have any other questions about your cystoscopy test. My team is always available to make sure you feel comfortable before coming in for your visit!

-Dr. P

Thanking God for the privilege

It has been a long time since I wrote in my blog.  The holiday season is very busy for surgeons (having met their deductible, many people try to have surgery before the end of the year), and then the time just got away from me.   I started this entry right before Thanksgiving.

As a Christian, my life is dedicated to trying to bring glory to God in any little way that I can.  Now, I often fail, but it’s a striving and a focus that informs my day to day living.  I don’t think that we have a “spiritual life” and a separate “secular life”.   I think it is all integrated.   As such, when I come into an exam room or the operating room, I am thinking “What is God doing here?  How can I join in with His work?”  Sometimes it is as simple as giving her an antibiotic, other times it is praying about a struggle in her life, or praying that the surgery and recovery go well, and using my surgical skills to help her.

I used to pray with every patient before surgery and take a spiritual history on every patient, but that began to seem a little too rote and forced.  Now I follow the leading of the Spirit.  When I feel that I need to pray or ask probing questions, I do it.  It is amazing how God answers, often in ways I didn’t expect.   Just the other day, I prayed with a patient who had just found out she had rectal cancer.  I could see that she needed the comfort of knowing that God will be with her in her fight.

Patients are often surprised to have their doctor pray with and for them. Sometimes I feel a little silly praying for a what is for me a simple routine bladder lift; I mean, it’s not brain surgery or heart surgery. But then again, for the patient, there is nothing simple or routine about it.  I typically pray for the surgery to go well, for the entire OR team, for the patient to be healed and to recover well, and for her to have peace as she goes into surgery.   Most patients are very grateful for the prayer.  Occasionally I can see that someone feels uncomfortable, so I try to be sensitive to that before I pray.

I have some examples that show how God has answered prayers in my practice and in my life.  One day the robot at the hospital broke down before my case.  That was just one of many things that had happened that day.   There were odd delays and unexpected events that occurred. Everyone did great and no one was harmed by any of the issues.   But it was really stressful on me, because things weren’t going smoothly.   I just continued to lean on the Lord and pray for my patients and for our whole surgical team.   One of my patients told me that she was shocked when I prayed for her, but she told me that a sense of peace filled her heart and any nervousness that she had was gone.  Her surgical procedure was changed at the last minute due to the equipment malfunction so there was a lot of anxiety for her.  But the Lord gave her amazing peace.  She is now several weeks postop and doing great.

Another example was a stone case. I had been covering this patient in prayer for a few days prior to the surgery date due to her underlying health issues and the size of her stone.  This case went from a simple laser case to an open bladder case because the stone was bigger and harder than anticipated.    I was also concerned because I thought the bladder had partially ruptured when I was using the laser.  When I realized that I had to open her up, I called my office to let them know that I would be running late for my other patients due to the change in the plan.  I didn’t know it at the time, but my staff then all took a moment to join hands and pray for our patient.   Well, the open surgery went about 500% better than I had expected:  there was no rupture, the bladder was not as malformed as I thought it might be given her underlying disease, and the stone popped right out (it was about a 4 inch stone).  Another answered prayer!  She recovered beautifully and is doing better than ever.

Not only do I pray for my patients, but my staff does, too.   We all get to participate in what God is doing.  He cares about every part of our lives, even our urological health!

I have always been so thankful for the privilege of being a doctor and specifically a female urologist.  I hope that God is honored in my service to my patients.   I am humbled for the opportunity.

7 Things You Need to Know About ThermiVa

For the past few months, I have had the joy of offering ThermiVa treatments to my patients. Many have seen incredible results with ThermiVa and I wanted to provide all of my readers more insight on the treatment and the impact it can have on feminine well-being.

First, what is ThermiVa? The ThermiVa treatments use radiofrequency energy to gently heat tissue and rejuvenate collagen. The treatment works on the internal and external areas of the vagina to restore and revive. After going through a strenuous childbirth, multiple births, or the effects of menopause, the idea of taking back control of vaginal health is enticing to many of my patients. However, they are usually left with many questions about how ThermiVa can help return youthfulness and recover relationships.

Below are a few facts that I believe are helpful to be aware of when trying to decide if the ThermiVa treatment is right for you.

1. The benefits of this treatment include:

  • Reduced dryness
  • Reduced vaginal laxity
  • Improved confidence
  • Increased sensation

2. If you are in good health, you are most likely a good candidate for ThermiVa!
3. There are no risks to the procedure.
4. ThermiVa is performed in 3 treatments that take about 30 minutes.
5. There is no downtime. Most patients resume their normal activities right after the procedure.
6. ThermiVa requires no anesthesia and patients have described the treatment as comfortable.
7. The results vary from person to person, but most patients report immediate improvement!

I know to many of my patients, ThermiVa can either sound too good to be true or just a little scary. My team is here to help answer any additional questions you may have! Please give us a call and set up your consultation to learn more.

Stay tuned for next month’s blog on vaginal rejuvenation. I will provide more detail on what exactly vaginal rejuvenation is and how it can impact your feminine health!

Dr. P

 

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

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!

 

 

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!

 

 

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.

 

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.

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!