The New World of Women's Health Care
Specialists now treat a broad range of female pelvic and reproductive disorders noninvasively
In medicine’s olden days— say, 10 or 20 years ago—problems with the pelvic floor and urinary system in women were treated mostly by gynecologists. But medicine has evolved, and a new specialist—the urogynecologist— has gained prominence in treating these difficulties. This physician focuses on treating urinary incontinence and pelvic floor disorders. Working with gynecologists and obstetricians, urogynecologists have broadened the range of available health services for women.
Many such services are now provided at the Saint Peter’s Healthcare System’s CA RES Surgicenter in New Brunswick, which is fully equipped to allow doctors to treat common female problems with minimally invasive techniques. Laparoscopic procedures involve an incision in the belly button and can also be used to treat conditions occurring outside the reproductive organs. Hysteroscopy, which requires no incision at all—instruments are sent into the uterus through the vagina—can be employed to address internal issues in those same organs.
Mark L. Mokrzycki, M.D., a urogynecologist with Urogynecology Arts of New Jersey P.A. in East Brunswick, defines his role this way: “I am a specialist who is trained in women’s health and in addressing the relationship among the urinary tract, the rectum and the female reproductive organs, which can result in disorders such as urinary and fecal incontinence and uterine prolapse.” Though he is trained to provide traditional gynecologic care, his focus is on these common problems that afflict millions of women each year.
“Urine loss affects about 30 to 40 percent of the female population and prolapse 20 to 30 percent,” he says. “They are much more common than cancer.” In prolapse, literally meaning “fall out of place,” the uterus and other female pelvic organs have sagged from their normal positions into or through the vagina. Though it can strike women of all ages, prolapse is more common in older women, particularly those who have delivered large babies or had especially long labor that stretched and damaged the muscles of the pelvic floor.
Symptoms include a feeling of pressure in the pelvis and the visible protrusion of organs from the vagina, and the condition may cause urinary or bowel problems. Many older women see prolapse as an unavoidable feature of aging. Not so, says Dr. Mokrzycki. “We can treat it with minimally invasive surgical techniques in 30 to 40 minutes,” he says. These techniques involve repairing and strengthening the stretched connective tissues and strengthening muscles with sutures or biologic or synthetic mesh implants. “The surgery is done vaginally, so there are no abdominal incisions,” he continues. “The patient goes home later the same day and can return to normal activities very quickly.” He also treats stress incontinence, the most common cause of urine loss in younger women.
This treatment also involves minimally invasive surgery that he says “literally can be done in 10 minutes.” Working with just three tiny incisions, he creates a “sling,” using implants or the woman’s own tissue, to provide support and relieve stress on the bladder. “It has a success rate of well over 90 percent and offers a lifetime cure,” he says. Finally, Dr. Mokrzycki also treats urge incontinence, or “overactive bladder,” with a revolutionary, minimally invasive procedure called InterStim, in which a small nerve stimulator is placed in the lower back to help women avoid embarrassing accidents. Perhaps the newest technology is an instrument called TruClear, which has revolutionized the treatment of uterine fibroid removal. “Saint Peter’s was one of the first to acquire TruClear,” says Michael Bohrer, M.D., an OB-GYN and reproductive endocrinologist with Reproductive Medicine Associates of New Jersey in Somerset.
Fibroids are growths in the uterine lining that can cause excessive bleeding and impair fertility. Traditionally, they were removed by using an electrified wire to shave off the growth; after the wire was withdrawn, suctions were inserted to pull out the shaved tissues. TruClear combines a non-electrified rotating blade and a suction system all in one to both shave and extract the tissue. “It’s about 10 percent faster, which can make a big difference in a large fibroid,” says Dr. Bohrer.
“It’s safer for patients and easier for physicians, so it’s really a win-win for everyone.” Vincent Mileto, M.D., an OB-GYN with Somerset OB-GYN Associates in Bridgewater, agrees. “The older way of fibroid removal can be quite cumber some,” he says. “This just gobbles up the fibroid. It’s a neat little procedure.” Some fibroids are too large and too deeply embedded in the uterine wall for TruClear, but for those there is another new technology that Dr. Bohrer calls “very much on the cutting edge”: bipolar cautery. As noted, traditional fibroid removal uses an electrical current to remove tissue. “In the past, the electricity ran through the wire loop and the patient served as the ‘ground,’” Dr. Bohrer explains. “In bipolar cautery, the probes have both electrical poles, so the electricity does not run through the patient.” This reduces the small risk that the electric current might damage adjacent tissues. “It’s safer and allows us to go deeper into the uterine wall than we can with the wire loop,” he says.
As a reproductive specialist, Dr. Bohrer also appreciates the technology afforded by the CARES Surgicenter for treating women’s pregnancy issues. “Improving fertility is what I am most interested in, and here we can fix Fallopian tube diseases or damage that can adversely affect chances of pregnancy,” he says. “By removing damaged tubes, we help prepare the pelvis to optimize the success rates of pregnancy.” In other instances, ovarian cysts or endometriosis can impair fertility, and Dr. Bohrer uses laparoscopic equipment, including lasers, to remove these uterine growths. “The laparoscopic equipment at the CARES Surgicenter is excellent, and I can use laparoscopy in cases where, at other centers, I would need to perform major open surgery.”
Dr. Mileto also touts another procedure that treats excessive menstrual bleeding, also known as menorrhagia, which occurs in one in five women in the United States. Until recently, hysterectomy— removal of the uterus—was the only effective option for relieving menorrhagia, but now physicians like Dr. Mileto use a technique called hydrothermal ablation. This treatment employs water heated almost to a boil (90 degrees Celsius), which is circulated through the uterus to destroy the lining. “It spares women major surgery,” he says. Of course, some women still require hysterectomy. For them, new laparoscopic techniques used at the CARES Surgicenter make the procedure quicker, safer and easier to recover from than it was just a few years ago.
All of the procedures mentioned here require special training on the part of the entire surgical team, and the physicians at the CARES Surgicenter appreciate what the staff there brings to the table. “The nurses and anesthesiologists at CARES are very adept at patient management and postoperative care,” says Dr. Mokrzycki. “They offer personalized, one-on-one attention. The whole center is very patient-friendly.”
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