Tuesday, December 16, 2008
It is sponsored by the Spirit of Women's health series. The fee for whole morning, including two other talks, on boosting immunity and dietary supplements, is $5.
Follow the link here for more info and directions:
Call (602) 230-CARE to register, or call the Spirit office for more information at (480) 512-6205.
Monday, December 15, 2008
Friday, December 12, 2008
Friday, November 14, 2008
Here is the link to my recent article:
Monday, November 10, 2008
Often, constipation, diarrhea, IBS can lead to infections. High bacterial counts in constipated women, or constant soiling of the perineum by diarrhea can increase the risk for vaginal contamination by fecal flora. Constant wiping leads to broken skin and local skin infections can occur that lead to chapped and red vaginal skin/labila skin that resembles baby rash. The vagina will burn, become red and warm and very uncomfortable. Urine contact on this type of skin only makes the burning worse. Women will say "it hurts to pee", but what they really mean is the that stream doesn't burn (dysuria), but that the urine contract on the vaginal skin burns them. This can also be true for women who have urinary incontinence where the the constast wetness of the labia from leaking urine leads to baby rash.
Good hygiene seems obvious but maybe hard to control. Frequently sweating, from working out or hot climates can increase the local bacterial counts. Urinating before and after sex and bathing after sex is always a good idea if infections are noted to occur 1-2 days after sex. Use of sexual instruments or anal sex followed by vaginal sex seems an obvious culprit. Using lubrication during vaginal sex helps to prevent small cuts/brakes in the vaginal skin allowing bacteria to enter.
Tampons keep blood and bacteria in the vagina. Switching to pads sometimes does the trick.
Certain foods and medications can raise the pH of the urine or vagina. Acidification of the vagina or urine can be done by avoiding over-douching, or taking urinary acidifiers that can be found OTC.
Vaginal estrogen is a common medication in post-menopausal women, not only to help rejuvinate the vaginal tissue for sex and lubrication, but also preventing UTIs.
These are just some of the tricks that can be tried. There are many other reasons recurrent infections can occur.
Tuesday, October 21, 2008
It contains a host of information on a variety of different urological conditions, both male and female. In addition, my article from MD News magazine can be found under my profile.
Monday, September 29, 2008
Please read this article on physician blogging and privacy:
Our new updated website is nearing finalization and will have some more information on it.
Nevertheless, my office is located at:
Center for Urological Services, P.C.
4545 E. Chandler Blvd, Suite 300
Phoenix (ahwatukee), AZ 85048
Sunday, August 17, 2008
Read it here:
Thursday, August 7, 2008
Symptoms of UTIs commonly include:
dysuria (burning w/ urination)
pressure suprapubically or bladder ache
bad urine odor or color
blood in the urine
low grade temperature
Some of the frequent "fake outs" mimicking UTIs are:
Bladder or Kidney stone
Resolved UTI with persistent symptoms
Pelvic Inflammatory Disease
Enlarged uterus with fibroids pushing on the bladder
Sometimes, when women complain of recurrent UTIs, it may be that the originial UTI was undertreated with antibiotics (not long enough), or the antibiotic was not strong enough, or perhaps there are other underlying issues predisposing to UTIs (neurogenic bladder, incomplete bladder emptying, pelvic floor dysfunction, kidney stones, kidney or bladder anomalies).
What are common reasons women develop UTIs?
First sexual intercourse
Sexual intercourse in general
Decreased hormone status (post-menopausal, post-hysterectomy)
Incomplete Bladder Emptying
High urine pH
Up Next: What do you do about it.
Tuesday, July 29, 2008
Pelvic Organ Prolapse
Cost: $5. It is free for Spirit of Women members. It will take place from 9am to 12pm. Refreshements will be served and it is sponsored by many industry supporters. It is a phyisican-organized (not industry) event.
Banner Desert Medical Center is located in Mesa at Southern Ave and Dobson Rd. Take the Southern Ave exit from the 101 highway and go east 1 mile.
Call ahead for seating reservations: 602-230-2273
See you there!
Saturday, July 12, 2008
Because it is painful, injections are performed under anesthesia. No incisions are made. A cystoscope is placed into the urethra and thorugh a long but ver small needle, the material is injected under the urthral lining.
Saturday, June 7, 2008
InterStim is appropriate and indicated for those patients that have failed medications for OAB or cannot tolerate them, in addition to urinary retention not due to obstruction (such as after hysterectomy that leads to a weakened bladder).
Test stimulation is done in hte office and takes about 30 minutes.
Assessment of the device takes 1 week. If patients noted a >50% improvement in urinary frequency, urgency or urge incontinence, then the patient can qualify for permanent implantation.
The permanent implant device is a small, round, smooth battery that resembles a pacemaker, about the size of a half dollar. It is placed under sedation and local anesthesia as an outpatient procedure, and takes less than an hour. It is placed under the skin in the right upper buttock.
Monday, May 5, 2008
Below is an image of a cystocele seen from the front. It appears to be a grade II.
Grade I: Mild bulge with straining only
Grade II: Bulge noticable at rest but not protruding out
Grade III: Bulge is at the vaginal opening
Grade IV: Bulge protruding past the opening.
Urinary incontinence can occur simply on its own as Stress Incontinence (urine lost with excerise or any other activity), or Urge Incontinence (urine lost with uncontrollable urge, Overactive Bladder). Your bladder may be in the normal anatomic position and you may still experience incontinence. This is a totally separate issue, "the leaky faucet" problem, that itself can be treated: see blogs posted below.
"Cystocele" is the term used when the bladder drops from its normal anatomic position. It can occur with incontinence, or on its own. Essentially, the support structures under and next to the bladder become weakened and allow the bladder to push down into the vagina. This leads to a bulge a woman can feel or even see. Many women say they feel they're "sitting on ball", or see something protruding from the vagina. This is more pronounced at the end of the day. If it's uncomfortable, some women will try to push it back in.
Higher grade cystoceles that cause pain, discomfort, or bulge outward and protrude past the vaginal opening should be surgically corrected. Often, many cystoceles are mild and only occur with straining and may not warrant any treatment at all.
Sometimes cystoceles can mask stress incontinence if the urine becomes trapped in the vagina by a kinked urethra, or even have trouble evacuating the bladder leading to a constant sense of urgency and incomplete emptying. Infrequently, this can lead to UTIs.
The most often sited reasons for cystocele formation are: menopause, childbirth, chronic cough conditions (asthma, smoking), and genetic. Sometimes cystoceles occur by themsleves or inconjunction with other organs that protrude from the female pelvis: rectocele (rectum protruding), vaginal vault prolapse, procidentia (uterine prolpase).
Next topic: How do we treat cystoceles?
Saturday, April 19, 2008
Hence the use of urodynamics pre-operatively. Urodynamics is like a "stress-test" for the bladder. Instead of getting on a treadmill and running to check your heart, during urodynamics, the patient sits on a commode and the voiding cycle is tested. It usually takes about 20 minutes.
A pediatric catheter is placed into the bladder and another one the same size is placed in the rectum (yes!, but not very far). Also, some patch electrodes are placed on the groin. The bladder catheter serves to fill the bladder and detect bladder pressure during urination, and the rectal catheter assists with the calculation. The patch electrodes help discern if during urination there is adequate sphincter opening or not.
During the test, the patient is asked to cough or strain to provoke a leak to test the "leak pressure".
During bladder filling, the capactiy and compliance of the bladder are gauged.
All in all, its an excellent road map for the urologist trying to determine pre-op parameters in order to help predict outcomes after surgery, or even if surgery should not be done in the first place.
I find it to very useful, and reliable since we have seasoned techs (female) who perform the tests daily.
Getting back to post-op retention. . . As long as the patient has an adequate bladder contraction and voids reflexively (the "normal way") without straining to get the urine out, then post-op retention is unlikely. Factors that can contribute to it include:
Poor bladder functionality/contraction
Strain pattern void
Post op pain
Other simultaneous procedures performed: cystocele repair, vault prolapse repair, hysterectomy
Overtightening the sling
Age > 70 (in my practice)- this doesn't mean these women can't void- but they may need a urinary catheter for a few days to a week or perform self-cath for about he same time until the bladder "wakes up"
Long-term urinary retention after a sling is very uncommon these days. Current mid-urethral slings are placed "tension free"- (hence the acronym TVT= tension free tape) have very low long term retention rates. It also greatly depends on who's doing the sling surgery- to make it "just right"- not too tight or not too loose. Since modern day slings are not stitched or anchored to fascia or bone, retention is uncommon.
Older slings, such as "bone-anchored slings" or pubo-fascial slings" are fixed to structures and require some degree of guesswork/finesse/luck/experience to place it just right.
In terms of TVT-type slings of the modern age, if the sling is SLIGHTLY to snug, women will notice a weakened stream, intermittent stream, incomplete emptying or urgency/frequency. New onset urgency after sling is less than 10%, and the majority do resolve within 3 months. Even a weak stream does improve after 2-12 weeks as the bladder accomodates to the sling.
What if it still too tight?
If after 3 months there are still problems, this can be confirmed by repeat urodynamics, and if the bladder is "obstructed", then the sling should be cut.
Does this compromise the effect of the sling and lead to recurrent incontinence? It can happen in 20-50% of women. The sling should be cut at the 6 o'clock position and allow lateral release of the sling. There should still enough scar laterally on both sides to keep the urethra supported.
It pays to go someone who does MANY.
Coming next. . . .Cystocele (Bladder Drop)
Sunday, April 6, 2008
I councel patients to "take it easy" for 72 hours after the procedure. Most women can go back to work thereafter (as long as work is not very physically demanding usually)
I advise patients to not do any heavy exercise for 2-3 weeks (biking, aerobics, spinning, hiking) but walking is acceptable.
No sex, baths or pools for 6 weeks!
If any other vaginal prolaspe problem exists, these can be repaired at the same time. And most are outpatient as well.
It has also been sited as a reference in other publications also reviewing pelvic floor repair and mesh.
Friday, March 28, 2008
It will take place at the Morrison Building on the campus of Chandler Regional Hospital, located at the corners of S. Dobson Rd and Frye Rd in Chandler.
Tuesday, March 11, 2008
The site is http://www.azexpocenters.com/
Click on my link to watch a short video of me describing my practice and specialty.
In addition, I will also soon be featured at the Banner Health website in their Ask The Expert video speaking about Interstim and bladder neuromodulation. Update to follow.
Urologists graduate from a usualy a 5 or 6 year surgical traininf program after medical school. Usually it is 1 or 2 years of general surgery training and then 4 years of Urology. In addition, after completion of residency, 1 or 2 years of fellowship training is undertaken in the subspeciaty of Female Urology. These programs focus mainly on incontinence, treating complications, complex urodynamic evaluation, prolapse repair with an emphasis on research and publication.
Gynecologists graduate from a 4 year training program. Those that wish to subspecialize under take a urogynecology fellowship that is typically 3 years. They also focus on incontinence, complications, and prolapse.
Fellowships differ widely depending on the interest and focus of the program director, whether urology or gynecology. Certain programs incorporate some technologies or techniques that others don't. Most of us attend the same academic meetings to keep up on the lastest advances and research.
In my practice I incorporate the use of mesh or grafts in order to bolster pelvic prolapse repair such as cystocele, vault repair or rectocele. Often when not used, cystocele will fail approximately 30% by 3 years. Conversely, despite the success of mesh, it can lead to nonhealing in 6-20% depending on the mesh, the surgery and the surgeon. Some pelvic surgeons will use such grafts but many don't. Surgeon comfort level is also important, that is, can the surgeon use such a product well.
Urologists have the advantage of dealing with the bladder from early in training. Treating bladder injury, dysfunction, removal or replacement are standard things learned in training. Gynecologists operate on the vagina and perform hysterectomies. Our two subspecialties crossover somewhere in the middle. In my fellowship I operated with a urogynecologist at least once a week.
Recurrent urinary tract infections, hematuria (blood in the urine), complex voiding dysfunction (as a result of radiation, surgery, or neurological injury), and non-obstructive urinary retention are best dealt with by a urologist who can repair/reconstruct the bladder, urethra, ureters, and remove such organs if required. All things considered, incontinence and prolapse treatment is often the most fun part of Female Urology, and is very often successful if done well by the well-trained pelvic surgeon.