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Urogynecology Archive Questions

Below are Dr. Johnson’s answers to Urogynecology questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 42.

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Q : 1

My mother, age 87, has Alzheimer's and has been hospitalized twice due to UI. Now she defecates and urinates simultaneously and has rectocele. Her doctors said operation was not an option because of her age and mental condition. Are there any other options?

Unfortunately, a rectocele repair will not help. With severe Alzhiemer's, there are no good solutions. In general, the only way to help with the hygiene problem may be urinary and fecal diversion. It is difficult to operate at this age combined with the mental status.

Q : 2

Are there any reasons not to have bladder sling surgery and a hysterectomy at the same time?

They can be done together or as a staged procedure with the hysterectomy first. The dual scheduling of these surgeries depends on a surgeon's preferences.

Q : 3

Do you ever treat male patients?

My practice is limited to female patients.

Q : 4

I had a urethral sling inserted two years ago with mixed results. It has helped the stress incontinence, but has made the urinary urgency and leakage much worse. I have no luck with medications. Do you use Botox injections for urgency?

We use Botox or interstim for patients with OAB that is unresponsive to medications.

Q : 5

I had a rectocele prolapse repair that used mesh. I now have pain during intercourse and feel uncomfortable like something is just sitting at my vaginal opening. I have asked my doctor about the pain and he says everything is fine, but he had to keep doing a procedure in his office on one spot after the surgery. Could this mean the mesh is not placed properly? Do you deal with this type of repair?

I do manage mesh complications. You would need an exam to have an opinion. It can cause pain with intercourse.

Q : 6

Ă„bout 15 years ago, I had surgery to repair some of the areas that had been damaged due to the births of my four children. The doctor said that he would lift my bladder to take care of my incontinence, but it didn't help much. I've heard there are new surgical techniques which are more effective. How successful is it?

There are different techniques depending on your problem. You will need a complete evaluation to determine what you need. The success rate may be as high as 80 percent.

Q : 7

I had cystocele, anterior vaginal repair and hysterectomy three months ago and my bladder and vaginal wall have fallen already. If I contact the surgeon who did it, do you think he would be able to do the surgery again so soon?

You should contact him for reevaluation and possible referral to a urogynecologist specializing in prolapse.

Q : 8

Can I have tension free vaginal tape placement if I have a bladder infection?

The infection should be treated first.

Q : 9

I am scheduled to have a sling surgery to treat SUI next week and was wondering if I should wait for the recommendations from FDA panel that meets September 2011 to discuss safety and effectiveness of surgical mesh to treat SUI.

That is up to you. The slings have a very safe record. The vaginal mesh for prolapse are the ones with the higher rate of complications.

Q : 10

I have been researching information about urinary incontinence, prolapsed bladder, and pelvic floor dysfunction and I think I am suffering from all three. I did have a hysterectromy along with bladder repair about 12 years ago. There is some incontinence along with pain, with intercourse. Also there is a loss of feeling/sensation during intercourse.

You need to have a complete examination of the pelvic floor as well as your bladder to evaluate for prolapse, incontinence and pelvic floor function.

Q : 11

Is it common for a teenage girl who is a competitive athlete to have urinary leakage?

This is not that common. She should be evaluated if it is a problem.

Q : 12

I have had constant pain in the urethra and burning for 3 months. I have seen two urologists, have no urgency issues, but recently had blood in urine and was put on Cipro. I had CT scan and that was clear with no presence of stones. I am having constant pain, throbbing, and irritation.

You may consider an evaluation by a urogynecologist. If you have had a negative workup, has Urethral Syndrome been considered? An alternative therapy for this is Elavil. It may be worth a try. Other treatments include dietary changes, urethral dilatation and pelvic floor physical therapy.

Q : 13

Do you perform vaginoplasty that is needed as a result of vaginal delivery?

Yes, I repair all types of vaginal trauma.

Q : 14

What do you think about laproscopic surgery and using mesh? I was seen about 4 years ago for prolapse.

Each case has to be evaluated with regard to surgical approach and the use of mesh. They are both good in certain situations. There are alternatives to mesh depending on what needs to be corrected. A complete evaluation and discussion of advantages of different approaches with and without mesh would allow you to make the best choice.

Q : 15

What type of antibiotic regime do you follow for a Remeex sling procedures with a vaginal defect repair?

Generally, preop IV antibiotics and possibly 5 days of antibiotics depending on the patient.

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