Urogynecology in Los Angeles County, CA

Aronson Rosenthal ObGyn specializes in treating pelvic floor disorders, such as urinary and fecal incontinence, pelvic organ prolapse, and other conditions that affect the female reproductive system. Our urogynecology clinics in Los Angeles County offer the full scope of diagnostic and treatment modalities to deal with these conditions. We can provide the most comprehensive, state-of-the-art care for women with pelvic floor disorders.

These conditions include:

Evaluation

History: Questions are designed to cover several important areas of pelvic floor function such as: voiding, bowel function, what activities lead to loss of urine, pelvic pain, and sexual function. Frequently a patient is asked to keep a voiding diary for 24 hours including times and amounts of voids. Other medical conditions will be reviewed in addition to prescription and over the counter medications, prior surgeries, previous deliveries and prior bladder infections.

Physical Exam: The examination is targeted at those systems which help support vagina, cervix, uterus and bladder. In particular, sensation of the surrounding external genitalia, the muscles of the pelvic floor, and the supports of the bladder, urethra and bladder neck will be evaluated regarding continence. A rectal exam is performed to evaluate tone and for the absence of blood. The amount of urine remaining inside the bladder can be measured with either a small catheter or bladder ultrasound. With the patient in a standing position or bearing down, the physician tries to determine which organs in the pelvis have lost support and how severe that loss of support is.

Urine culture: A clean catch midstream urine culture is obtained to exclude infection as a cause of urinary incontinence.

Urodynamics: Is an office based study using very small catheters, with pressure sensors, placed in the bladder, and either the vagina or rectum. The goal is to observe the behavior of the bladder and urethra as the bladder is slowly filled. If the bladder is overactive, the pressure will rise. The patient will be instructed to tell the physician when she has a first sensation to void and when she can no longer tolerated bladder filling. She will be instructed to cough and bear down to elicit any urine leakage.

Additionally, a device will pull the catheter slowly through the urethra to measure the pressure generated by the muscles in the urethra. These studies help determine if the cause of incontinence is anatomic, a sphincter deficiency, or an overactive bladder. Finally, once the bladder is full, the patient is asked to empty her bladder while the volume and rate of flow are measured. This helps determine if the bladder and urethra function normally, whether there is an obstruction, or if straining is required to pass urine.

Cystoscopy: A small telescope is introduced into the urethra to evaluate the health and integrity of the urethra and bladder and look for the presence of a foreign body (stones, tumors or sutures from prior surgery), chronic infection or diverticulum. The physician can observe the response of the urethra and bladder neck to coughing or straining.

Treatment Options

Aronson Rosenthal OBGYN has extensive knowledge and experience in providing our patients the latest treatment technology and techniques to treat pelvic floor disorders, we provide minimally invasive and reconstructive surgeries that are safe and effective. Here are some of the ways we treat pelvic floor disorders:

Medications: may be helpful in overactive bladder with 50-60% improvement, but also help about 40% on individuals with stress incontinence. Side effects are common.

Physical therapy: consists of pelvic muscle exercises such as Kegels, biofeedback, electrical stimulation, and bladder training drills. 50% of those with stress incontinence and 40% of those with overactive bladder show improvement.

Behavior modification: bladder training drills to lengthen time between voids

Continence Devices: may be small disposable devices designed to fit in the urethra temporarily to hold the urine by blocking the urethra and removed for urination.

Support Devices: Pessaries are flexible devices that are custom fit to the vagina helping support the cervix and bladder neck (improvement 30-40% of the time) Once inserted in the vagina, the pessary should be comfortable and stay in place with a variety of activities. It should be removed and cleansed on a weekly to monthly basis.

Surgical treatments

Burch Procedure: is an abdominal approach that elevates the bladder neck by lifting the surrounding vaginal tissue to the underside of the pubic bone. (successful 80-85% of the time for stress incontinence)

Sling procedure: is a minimally invasive vaginal approach whereby a mesh is placed under the urethra and acts as a bladder hammock giving dynamic support to the urethra (successful 85-90% of the time)

Periurethral injections: is an office procedure whereby collagen/permanent material is injected near the urethra to help occlude the bladder neck.(most useful in sphincter deficiency without loss of support, successful 50-60% of the time)

Sacral Nerve Stimulators: Interstim is a surgical alternative to the treatment of overactive bladder not responding to medication. It involves an implantable pacemaker that stimulates nerves in the sacral region thereby reducing the sensitivity of the bladder wall (60-80% success rate in properly selected patients, involves a test stimulation that lasts one week)

Vaginal hysterectomy: is removal of the cervix and uterus through the vaginal opening. Tubes and ovaries may or may not be removed concurrently. This is usually combined with a bladder suspension if urinary incontinence exists.

Anterior Posterior Colporrhaphy: is removal of vaginal tissue superiorly beneath the bladder and/or inferiorly over the rectum both supporting and tightening the vaginal opening.

Schedule an Appointment With One of Our Urogynecologists

If you are a woman suffering from a pelvic floor disorder, we urge you to schedule an appointment with one of our urogynecologists today. Our specialized team of medical professionals can provide you with the personalized care and attention you need to help alleviate your symptoms and improve your quality of life. Call our clinic at (310) 325-8864 to schedule an appointment.

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