Posts in Category: Incontinence

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.

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

FAQs for Mid-Urethral Slings

I often have patients ask me about Mid-Urethral Slings to treat and prevent their stress urinary incontinence. The first thing I tell patients is that the FDA has deemed Mid-Urethral Slings as safe, and I’ve personally seen this option work for many women who struggle with the loss of urine during physical activities. Here is a list of a few FAQs to review, originally published by AUGS. To see the full list, click here. Call my office to learn more about how this procedure can change your life.

What is a mid-urethral sling (MUS)?
A mid-urethral sling (MUS) is a small mesh strip used in surgery to treat stress urinary incontinence, a type of leakage that occurs during activity such as laughing, coughing, or exercise. The mid-urethral sling works to prevent or significantly reduce the loss of urine during these activities.

The surgery is done through a small incision in the vaginal wall below the urethra (the tube through which urine passes from the bladder). Through this incision a half-inch wide strip of polypropylene mesh is placed between the urethra and the vagina. The ends of the mesh are passed out incisions in the groin or above the pubic bone. Using absorbable suture, the vaginal incision is closed covering the sling.

Are mid-urethral slings safe?
The mid-urethral sling is considered safe and effective by the US Food and Drug Administration (FDA). As with any surgery, complications can occur but they are typically minor and can usually be repaired.

What sort of evidence supports the efficacy and safety of the mid-urethral sling?
The mid-urethral sling procedure is the most studied surgery to treat stress urinary incontinence and there have been over 2,000 articles published about it. Results of these studies have appeared in prestigious medical journals such as the New England Journal of Medicine. Two large government funded studies have evaluated the mid-urethral sling’s safety and efficacy – both found the procedure to have a low complication rate and a high success rate. Other large scientific studies from around the world have supported the safety and efficacy of the mid-urethral sling.

What is the difference between a mid-urethral sling and vaginal prolapse mesh?
A mid-urethral sling is used to treat stress urinary incontinence. A vaginal prolapse mesh is placed through a vaginal incision to correct a vaginal bulge (ex. cystocele, rectocele or dropped uterus). Vaginal prolapse mesh is larger and placed in a different location than the mid-urethral sling mesh.

Does a mid-urethral sling cause cancer?
There is no evidence that any women have developed cancer as a result of a mid-urethral sling.

Does a mid-urethral sling cause any other diseases?
There is no evidence that polypropylene mesh or mid-urethral sling causes other diseases.

Bladder control WITHOUT medication or surgery

I want to let you in on a little-known therapy that can really help you with your bladder control issues.  No medications to take with side effects. No surgery.   Whether you leak with urgency (that “gotta-go” type) or stress (cough, exercise), or both, this is the place to start restoring urinary control.   Even if you just have overactive bladder or get up too much at night, this therapy is great for you.  You don’t hear about it as much since it is not offered very many places and there is no drug company to spend millions advertising it.

It is called Pelvic Floor Muscle Training.   I tell patients that it is sort of like a personal trainer for your bladder.  And it really does work.  Of course, it’s not 100% effective for everyone, but most patients will get dry or almost dry with this therapy.

So, what it entails is coming in for therapy once a week or every other week for 4 – 8 sessions.  My pelvic floor specialist will help you out.  What she will do is gently place a small tampon-like probe in the vagina and a smaller one in the rectum.  She will then assess your strength by having you do Kegel’s exercises.  If you don’t know how to do them, then she will teach you.   After that phase is over, she will take out the rectal probe, and move to stage two with the vaginal probe only.

The vaginal probe provides electrical stimulation which will boost muscle growth and reset the bladder nerves so that they will calm down.  This takes about 8 – 15 minutes.   The whole thing is about 40 minutes the first time and 20 minutes on follow-up.   Throughout the session, my pelvic floor trainer will talk to you about other strategies to help you with your bladder control issues.  Once, we found out during therapy that our patient that was drinking 6 Diet Cokes per day and once she stopped it, her bladder issues resolved.

Then, there is homework.  She will write a plan for you to work on Kegel’s to get you in the habit of activating those muscles and strengthening them.  The more consistent you are with the exercises, the better you will do.

This therapy has been proven effective in multiple studies.  It is covered by most all insurance carriers and Medicare.  In fact, oftentimes, the insurance company will require that this therapy be tried before moving on to advanced therapies.  It works in two ways: strengthening the pelvic floor and resetting the bladder nerves.

Pelvic Floor Muscle Therapy is particularly good to do postpartum.  The muscles are so weak and stretched out after having a baby, that it will really help you get back to normal more quickly if you have a few sessions to strengthen the muscles again.  That will prevent a lot of trouble down the line. Insurance will cover that as well.

Then, after the therapy is over, you continue the exercises and if you are interested we can set you up with a home therapy device that you can use yourself.

It’s a great way to get the pelvic floor toned up with great bladder control!

Have a wonderful day,

Dr. Christina