Urogynecology (Female Pelvic Medicine and Reconstructive Surgery) - is a sub-specialty of obstetrics and gynecology dedicated to the treatment of pelvic floor disorders, such as, problems with tissue relaxation (prolapse), urinary, bowel and sexual dysfunction. These diseases include the inability to control your bladder, pelvic organ prolapse, urinary incontinence, fecal incontinence, constipation, sexual dysfunction and pelvic pain. These problems can significantly affect quality of life and can be treated with the help of a board certified and experienced urogynecologist.
Urogynecology involves the diagnosis and treatment of the following conditions:
Pelvic Organ Prolapse
Incomplete Bladder Emptying
Recurrent Urinary Tract Infection
Vaginal Mesh Complications
Painful Bladder Syndrome
Catheterization: Use of a very small sized catheter to drain urine from the bladder. This may be done to determine if you empty your bladder appropriately, or to collect urine specimens to send to the lab.
Cystoscopy: a procedure that involves placing a tiny camera though the urethra into the bladder to visualize the inner surface of the bladder.
Urodynamic Testing: a bladder function test involving the use of a tiny catheter in the bladder and one in the vagina or rectum. The bladder is filled with sterile water to assess the function of the bladder and urethra as well as function of muscles and nerves. This test can help determine the reason for leakage of urine, urgency and/or the reason for inability to empty the bladder well.
Conservative Treatment Options:
Dietary and lifestyle changes: A modifications in a diet to try to avoid products known to be bladder irritants. Water and drinks management is very important as well as physical activity and weight loss.
Bladder Training: Training your bladder to hold urine longer by doing pelvic floor exercises when you have an urge to urinate and allowing that urge to pass prior to urinating. The amount of time holding your urine increases incrementally over time.
Pelvic Floor Physical Therapy (PFPT): Meeting with a pelvic floor physical therapist to better understand the exercises involved in strengthening the pelvic floor muscles. PFPT treats many issues including vaginal prolapse, urinary incontinence, fecal incontinence, pelvic muscle weakness and pelvic pain.
Pessary: A device that is placed in the vagina to support a vaginal prolapse and/or treat leakage of urine. A pessary fitting is done to determine which pessary type and size may be right for you. Sometimes you may need to try a few pessaries until you find the right pessary for you
Surgical Treatment Options:
Female pelvic reconstructive surgery: surgeries that restore normal anatomy of female pelvic organs. Minimally invasive approach is usually utilized (laparoscopic or robotic surgery). These surgery may or may not involve hysterectomy. Use of synthetic or graft materials may be sometimes offered to patients as well to achieve best results.
Types of Reconstructive surgeries: Sacrocolpopexy, Uterosacral ligament suspension, Sacrospinous ligament suspension, Anterior and Posterior Colporrhaphy, Perineorrhaphy.
Periurethral bulking injections: during cystoscopy a tiny needle is used to inject a substance into the urethra to bulk up the urethra to reduce urinary incontinence that occurs with activity.
Sling: A surgical procedure in which a small, thin ribbon of mesh is placed through a vaginal incision under the urethra to reduce urinary incontinence that occurs with coughing, laughing or activity.
Burch procedure: procedure was introduced in 1950s. Still being used as effective anti-incontinence surgery and involves placing sutures on both sides of urethra to create necessary support and treat stress incontinence. Can be done via open or minimally invasive approach.
Sacral neuromodulation: A procedure that involves placing a small lead into tail bone and a stimulating device in the area of where your hip pocket would be. This device works as a pacemaker to the bladder nerves to treat urge related urinary incontinence, frequent urination, incomplete bladder emptying, bladder retention and fecal incontinence.
Percutaneous tibial nerve stimulation (PTNS): An office procedure involving the placement of a very small, acupuncture needle in the ankle and attaching the needle to a small device to stimulate the nerves that go to the bladder. This procedure gives off a signal to the bladder nerves to treat urge related urinary incontinence, urgency and frequent urination. Each session lasts 30min. It is repeated weekly for 12 weeks, and then monthly as needed.
Bladder Botox injections: Injection of botox in the bladder wall during cystoscopy to relax the muscles of the bladder. This treatment temporarily treats urge related urinary incontinence and frequent urination. Effect lasts usually for 6-9 months. It can be periodically repeated to maintain efficacy.
Many treatments do not require surgery. However, when surgery is necessary, Dr. Kirakosyan offers cutting edge, minimally invasive approach.
Dr. Kirakosyan is board certified in Obstetrics and Gynecology and he is one of very few in the United States board certified specialists in Female Pelvic Medicine and Reconstructive Surgery (Urogynecology).