A History of Excellence, Providing The Best Women's Health Services

Urology centers of Alabama is dedicated to providing state of the art care for our female patients. In fact we have 3 female urologist who are very experienced in seeing and treating women and are well versed in urinary incontinence, prolapse and other issues unique to women. Care is provided in a compassionate and private manner. Urology Centers of Alabama looks forward to putting women first!

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urinary incontinence

Problems

Incontinence

Incontinence

Urinary incontinence in women can be troublesome and embarrassing, but it is treatable. There are several types of incontinence, but the most common are urinary urge incontinence, stress incontinence, and mixed incontinence. Incontinence is a very common condition and the prevalence does increase as one ages. Urinary urge incontinence involves the involuntary loss of urine usually associated with a sudden urge that cannot be suppressed. Some of the causes may be related to infection, hormone status, childbirth, or previous pelvic surgeries. A thorough history and comprehensive pelvic floor exam are vital. Not only is it important that the physician know all of the medications that the patient is taking, but it is equally important to know the toilet habits and dietary habits. It can be exacerbated by certain types of foods/beverages. A urinalysis is needed to rule out an infection. Further testing either with urodynamics or cystoscopy or both may be needed.

Treatments

Treatments for Urinary Urge Incontinence

Non-Invasive-
    Symptoms that a woman may experience include:
  • Behavioral Changes- This includes weight loss, smoking cessation, and pelvic floor muscle therapy.
  • Botox- This is an In-office treatment, that uses Botox to calm that nerves that trigger the overactive bladder muscles, that cause incontinence.
  • Dietary Changes
  • Pharmacological- This involves a trial of medications that are known as anticholinergics. It is important that the patient is aware of the side effects of medications. If the medications are not helpful or cannot be taken, then other surgical modalities are investigated
  • Physical Therapy- Pelvic floor muscle therapy
    Minimally Invasive -
  • Interstim - The therapy uses a small, implanted medical device to send mild electrical pulses to a nerve located just above the tailbone. This nerve, called the sacral nerve, controls the bladder and surrounding muscles that manage urinary function. The electrical stimulation may eliminate or reduce bladder control symptoms. Interstim therapy does not treat symptoms of stress incontinence. 
  • Stress Urinary Incontinence

    Symptoms

    Stress incontinence is the involuntary loss of urine associated with physical activity such as coughing, sneezing, and exercising. It is caused by several factors some of which may be childbirth and previous pelvic surgeries. As many as 50% of all women experience symptoms of stress urinary incontinence. As with urinary urgency incontinence, a thorough history and physical exam is crucial.

    Treatments

    Treatments for Stress Incontinence

      Non-Surgical
    • Kegal Exercises
    • Dietary Modification / Times Voiding
      Surgical-
    • Sling
    • Non-mesh Option
    • Bulking Agents
    Treatments

    Small fistulas may sometimes resolve with a foley catheter drainage. However, the majority of times, surgical treatment is needed. Depending on the location of a fistula, the physician may repair the defect either vaginally or abdominally. Trained physicians can repair this robotically, which greatly minimizes post-operative discomfort.

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    Urethral Stricture Symptoms

  • Blood in the urine
  • Difficulty urinating
  • Frequent urination
  • Painful urination
  • Spraying of the urinary stream
  • Discharge from the urethra
  • Diagnosis includes a detailed history and physical including onset of symptoms and severity. Your doctor may also choose to evaluate your urethra with a variety of office tests including:

  • Post-void residual volume: determining how well you empty your bladder
  • Urinary flow rate: strength of urinary stream retrograde urethrogram: X-ray performed while instilling dye into urethra
  • Cystoscopy: looking into the urethra and bladder with a small telescope
  • Incontinence Treatments:

    Various treatment options exist, each with their own advantages and disadvantages.

  • Urethral Dilation
    : Gently stretching the stricture with sequential dilators. Usually performed in the office with local anesthesia, however recurrence rate is high.
  • Endoscopic Incision
    : The stricture is cut using a special cystoscope while under general anesthesia in the operating room. Typically performed on outpatient basis, and no formal skin incision is needed. Success rate is typically pretty good, but depends on location of the stricture and length of the stricture. Each subsequent incision carries higher recurrence rate.
  • Open Urethroplasty
    : Removing the diseased segment and replacing with healthy tissue. The technique used depends on location and length of the stricture, as well as surgeon experience. For longer strictures, a tissue graft is usually needed to bridge the gap. The tissue used for grafting can include local penile skin or even buccal mucosa from inside the cheek. Success rates are typically very good with low recurrence rates, especially with surgeons with experience in performing these procedures.
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    Kidney Stones

    Kidney Stones

    Many patients consider kidney stones as simply a very painful nuisance which has to be tolerated periodically. In fact, kidney stone disease is a complex problem with various types of stones and with many different causes. At Urology Centers of Alabama, we utilize state of the art equipment and techniques to successfully treat stones. However, careful evaluation and management options also allow us to successfully prevent recurrent stone episodes in many patients.

    What Causes Kidney Stones?

    Stones may develop because of one or a combination of reasons:

    Geography – hot, humid climates, such as in our southeastern part of the country, may increase the risk of stones in susceptible persons by either excess loss of fluids or inadequate fluid intake.

    Genetics – many stone patients have a family history of stones.

    Diet – see section below on stone prevention.

    Medical problems – hyperparathyroidism, gout, chronic diarrhea and several other inflammatory GI problems including some GI surgeries, and others.

    What Symptoms Caused Kidney Stones?

    Everyone knows about the terrible flank pain associated with kidney stones. Many think that this pain is caused by a scratching of the stone as it passes through the ureter. In fact, most of the pain is caused by obstruction of the ureter, causing a backup of urine into the kidney with resultant stretching and dilation of the tissue. Nausea and vomiting are often present during acute episodes. Some patients may have an urgency to urinate or blood in the urine. Some patients may even have no symptoms at all.

    Treatment of Kidney Stones

    There are various methods and equipment used for treating kidney stones, depending on the situation.

    Kidney Stone Prevention

    Even though we have a multitude of treatment options and equipment to successfully treat kidney stones, our goal is to help patients avoid recurrent stones. To achieve this, your urologist might recommend a change in your diet or a special medication. Calcium stone formers might be advised to drink more water, avoid salt, decrease oxalate intake and avoid calcium supplements.

    Low Oxalate Diet

    The following foods and drinks should be avoided when trying to maintain a low oxalate diet:

    • Tea
    • Strawberries
    • Spinach
    • Rhubarb
    • Chocolate / Cocoa
    • Wheat bran
    • Nuts
    • Beets

    The following foods contain oxalate , but not as much as the above products:

    Beans, blackberries, celery, dark leafy greens, swiss chard, draft beer, sweet potatoes, eggplant, white corn grits, instant coffee, okra, leeks, and soy tofu.

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    Fistulas

    Fistulas

    Fistulas are an abnormal connection between 2 organs. A vesicovaginal fistula is an abnormal connection between the bladder and the vagina, that allows continuous urinary leakage (discharge) into the vagina. This problem has a profound effect on a woman’s well-being.

    The majority of vesicovaginal fistulas in developed countries are a consequence of gynecological surgery- The majority occurring after a hysterectomy

    Symptoms-
      Symptoms that a woman may experience include:
    • Uncontrolled leakage into the vagina
    • Patients that experience flank pain
    • Infections may be suspect for urethral injury
    Treatments

    Small fistulas may sometimes resolve with a foley catheter drainage. However, the majority of times, surgical treatment is needed. Depending on the location of a fistula, the physician may repair the defect either vaginally or abdominally. Trained physicians can repair this robotically, which greatly minimizes post-operative discomfort.

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    Interstitial Cystitis

    Interstitial Cystitis (IC) is a condition that causes pain or discomfort in the bladder and the surrounding pelvic region. The symptoms are different for each person and can change on a case to case basis. Pain may worsen as the bladder fills or is emptied. The pain typically can be worse for women, during menstruation, but can also affect women who have had hysterectomies.

    Due to the varying nature of symptoms and severity, most researchers in the field of study, believe that interstitial cystitis is several diseases. Scientists have recently started using the term bladder pain syndrome (BPS) or painful bladder syndrome (PBS) to describe painful urinary symptoms that do not meet all of the definitions of interstitial cystitis.

    Symptoms
    • Urgent need to urinate
    • Frequent need to urinate
    • Mild discomfort, pressure, tenderness, or intense pain in the bladder and pelvic area

    Some symptoms of interstitial cystitis appear to be those of a bacterial infection, but tests show no organisms in the urine of people that have interstitial cystitis or painful bladder syndrome. Patients that suffer from interstitial cystitis do not respond to antibiotic therapy.

    Some people with severe cases may urinate up to 60 times per day, including nocturia, which is frequent nighttime urination.

    Diagnosis
    • Urinalysis and Urine Culture
    • Cystoscopy under Anesthesia with Bladder Distention Biopsy
    • Biopsy
    Treatment

    While there is no cure for interstitial cystitis, there are many treatment options designed to help relieve symptoms associated with IC

    Non Surgical
    • Dietary Changes
    • Smoking Cessation
    • Bladder Instillation
    • Oral Medications
    • Exercise
    • Bladder Training
    • Physcial Therapy
    Surgical
    • Cystoscopy with hydrodistention, +/- biopsy
    • Sacral Neuromodulation
    • More aggressive surgery may be an option as a last resort
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    Mesh Related Complications

    Unfortunately, there are many women that have had adverse effects from the use of surgical mesh to treat pelvic prolapse. Women have reported infections, chronic pelvic pain, and painful intercourse.

    Most of the time, women can experience erosion of the mesh into the vagina. This can occur in up to 10% of women having a mesh implant to treat prolapse. However, other known symptoms occur such as:

    • Nerve Damage
    • Fistulas
    • Narrowing or shortening of the vagina
    • Bleeding in the vagina

    In 2011, the FDA really took a hard look at these complications and mesh products and upgraded the mesh procedure from a low to moderate risk to a moderate to severe risk (class IV).

    Often times, it is difficult to find doctors that can fully remove mesh. Our practice has dealt with these issues and can help women navigate through these difficult problems.

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    Overactive Bladder (OAB)

    Overactive bladder is a problem with the storage function of the bladder. This problem causes a sudden urge to urinate. Often times, this urge is difficult to stop, which leads to an involuntary loss of urine, also known as incontinence.

    Women may experience frequency and nocturia (needing to frequently get up at night the void).

    The prevalence of OAB varies from 16-43%, and it affects more women than men. The prevalence of OAB increases with age.

    Some women may experience urinary urgency incontinence. This is sudden leakage that cannot be stopped. This can be very distressing for women.

    Overactive bladder can usually be diagnosed after a thorough history evaluation from the physician.

    Diagnosis
    • In-office exam for physical and history evaluation, as well as a urinalysis.
    • Post-void residuals
    treatment
    First Line:
    • Behavioral therapies (bladder training, bladder control strategies, pelvic floor training)
    • Pharmacological management
    Second Line:
    • Medications- these are several medications that a physician may try, but some of the side effects of the medications may dictate which medications may be used.
    Third Line:
    • Botox- This is an In-office treatment, that uses Botox to calm that nerves that trigger the overactive bladder muscles, that cause incontinence.
    • Percutaneous Tibial Nerve Stimulation- a needle electrode is used to send an electrical pulse to the Tibial nerve, in an attempt to stimulate the nerve, to decrease the frequency of urination.
    • Sacral Nerve Stimulation- This is a non-invasive procedure that involves sending electric pulses through externally attached electrode pads, to the sacral nerve.
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    Pelvic Pain

    Pelvic Pain

    One of the most challenging urological disease conditions for patient and doctor alike is chronic pelvic pain. If you are frustrated by this problem, you are not alone. Chronic pelvic pain includes the syndromes chronic prostatitis and interstitial cystitis/painful bladder syndrome. It can affect both men and women. Symptoms vary but usually include urinary frequency and urgency, pain and/or pressure perceived to arise from the bladder. Frequency usually involves urinating several times throughout the day and night, sometimes even several times an hour. At times, pain is associated with bladder filling and can be severe, and it may be relieved by voiding. Sometimes, a trigger can be identified. It can be a certain type of food or it can be a stressful situation. In women, it may be associated with the onset of a menstrual cycle. Patients may see several doctors before they are diagnosed. The diagnosis of this condition is usually made after excluding other identifiable causes such as a urinary tract infection, bladder cancer, prostatitis, and endometriosis. The proposed pathophysiology suggests that there may be an initial insult—possibly trauma or infection that sets up tissue injury in the bladder/prostate. This further promotes inflammation and release of cytokines and upregulation of pain fibers. Subsequently, this causes the bladder lining to be “leaky” and very sensitive to the urinary toxins and can causes over sensitivity with the pain fibers. Also of interest, many people may suffer with other chronic pain conditions such as fibromyalgia, irritable bowel syndrome, migraines and painful intercourse and pelvic floor spasm. Treatment should be based on a multidisciplinary approach. Pharmacology, behavior and lifestyle modification, and dietary changes are implemented. Of note, it is found that if patients exhibit myofascial pain or a hypertonic pelvic floor, then physical therapy is extremely beneficial. Pelvic pain syndromes require a multidisciplinary approach with realistic goals agreed on by the patient and doctor.

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    Pelvic Prolapse

    Pelvic Prolapse

    Pelvic prolapse or vaginal vault prolapse is a very common condition characterized by the herniation of pelvic organs, bladder (cystocele), rectum, (rectocele), small intestine (enterocele), uterus, or vagina. These organs herniated due to weakness of support structures in the pelvis. The supporting muscles can become torn or stretched due to a number of things, including childbirth or age. Other risk factors for pelvic prolapse include: genetics, connective tissue disorder, obesity, and frequent constipation.

    Patients may notice a bulge in the vagina, and may even have to reduce this bulge manually in order to urinate or defecate. Patients may also have urinary incontinence accompanying the prolapse. This may surprisingly may improve as the prolapse worsens. Furthermore, patients can also complain of constipation, and dyspareunia (painful intercourse), back pain and can have recurrent urinary infections.

    Diagnosis begins with a thorough history and physical exam. A urinalysis is useful to evaluate blood in the urine or infection. A post void residual is obtained to ensure the patient is emptying. other important test that may be done include a cystoscopy and urodynamics which provide comprehensive evaluation of the bladder function and pelvic floor.

    Nonsurgical Treatment Options

    Treatment options may include conservative options such as pelvic floor retraining, biofeedback, and a placement of a pessary. A vaginal pessary is a removable device that is designed to support the areas that may cause pelvic organ prolapse. Our staff is trained to place the pessaries in the office.

    Surgical Treatment Options

    Surgical treatment options include various procedures that address the pelvic floor defect. The da Vinci robot is used to repair pelvic floor defects. This procedure is called a da Vinci Sacrocolpopexy.

    The robotic procedure allows the surgeon to work deep in the pelvis to recreate the suspension. Often, a small piece of mesh is used to help with this.

    Several advantages are noted utilizing this technique. These include shorter hospitalization stay, less blood loss, and return to normal function sooner. Our physicians are trained to deal with all types of pelvic floor prolapse.

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    Vaginal Atrophy

    Vaginal atrophy is the thinning, drying, and inflammation of the vaginal walls that occurs as estrogen levels drop. It is mostly more pronounced after menopause. Vaginal atrophy can cause painful intercourse, and an increase in UTIs, as well as other urinary symptoms.

    Treatments

    Sometimes, vaginal estrogen creams are recommended. Also, the MonaLisa Touch is an excellent treatment for vaginal atrophy, as it can actually cause an increase in the collagen layer, which results in less

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    Urinary Tract Infections

    Urinary Tract Infections

    Urinary Tract Infections are one of the most common infections to affect people. Urinary tract infections (UTIs) can affect men, women, and children, but women suffer more frequently from these infections. Fortunately, UTIs can usually be treated successfully if they are diagnosed and treated early.

    A urinary tract infection occurs when bacteria gets into the urinary tract and infects the system. Occasionally, the kidneys may become infected as well, causing a serious UTI, which could result in kidney damage. Many women who have one UTI will experience others in their lifetime. It is estimated that nearly 20% of women who have an episode of urinary tract infection will have another, 30% of those will have a third infection, and approximately 80% of those with recurrent infections will experience even more.

    Bacteria can also infect a man’s urinary tract, even though this is not as common. The majority of UTIs in men are caused by an obstruction, usually an enlarged prostate gland. This type of obstruction can cause incomplete voiding and the back up of urine in the bladder. The residual urine can lead to an infection in the bladder.

    Factors that contribute to Urinary Tract Infections

    There are a number of factors that may increase a person’s risk of getting urinary tract infections. These include:

    • Certain people with diseases like diabetes or an abnormal urinary system. Also kidney stones can increase the risk of UTIs.
    • An enlargement of the prostate gland
    • Certain people who have recently undergone catheterization or a procedure that involved having a medical instrument inserted into the urethra.
    • Urinary tract infections also occur in infants and children who are born with urinary tract abnormalities, some of which need to be corrected with surgery.
    • Sexual intercourse, especially for women.
    • The use of birth control methods such as the diaphragm.
    • Pregnancy can also be associated with a higher rate of urinary tract infections because of hormonal and other changes in the anatomy of the urinary tract during pregnancy.
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    Solutions

    Botox Treatment (Incontinence)

    Botox is indicated for the treatment of overactive bladder (OAB) with symptoms of urge urinary incontinence, urgency and frequency, in adults who have an inadequate response to or are intolerant of an anticholinergic medication.

    How does Botox work?

    In your body, certain chemicals travel from nerve cells to muscle cells to make your bladder contract so you can urinate. With OAB, these muscles contract uncontrollably and you frequently feel like you have to empty your bladder. Botox calms the nerves that trigger the OAB muscle. This results in eliminating or substantially reducing leakage episodes, reducing the strong need to urinate right away and reducing the number of times that you need to empty your bladder daily. It generally will last 6-10 months. When your symptoms return, you can talk to your doctor and have the treatment done again. Usually, similar results are seen each time, and it can be done as many times as needed.

    The Procedure

    Botox treatment is a minor procedure for women and men that is usually done in the office. A gentle numbing agent, sometimes in combination with a light sedative is given so you are relaxed and comfortable during the treatment. Most patients report very little discomfort, and you can resume normal activities later that same day. Once your bladder is numb, the Botox is administered through a cystoscope with a small needle into the bladder muscle. A cystoscope is a thin-lighted tube that provides access and visibility inside your bladder. The total time in the office from start to finish is under an hour. The treatment itself only takes about five minutes. Talk to one of the Urology Centers of Alabama physicians to see if you would be a good candidate for Botox Treatment. BOOK APPOINTMENT

    Interstim Therapy

    “InterStim Therapy (also called “sacral nerve stimulaton”) is used to treat people with two seemingly opposite problems. The first is non-obstructive urinary retention (poor emptying in the absence of blockage of the urinary tract as may occur with prostate enlargement, prior bladder surgery, etc.). Additionally, it is used to treat patients with severe symptoms of overactive bladder (urinary urge incontinence and significant symptoms of urgency-frequency) in individuals who have failed prior behavioral therapies and treatment with multiple medications.

    The therapy uses a small, implanted medical device to send mild electrical pulses to a nerve located just above the tailbone. This nerve, called the sacral nerve, controls the bladder and surrounding muscles that manage urinary function. The electrical stimulation may eliminate or reduce bladder control symptoms in some people as well as helping those unable to urinate do so. A physician's examination and evaluation can determine whether you are a candidate for InterStim Therapy.

    InterStim Therapy does not treat symptoms of stress incontinence. InterStim Therapy has not been studied in pregnant patients or children/adolescents. It cannot be used in patients with neurologic causes of their urinary issues such as multiple sclerosis, stroke or spinal cord injury. It is not intended for patients with mechanical obstructions such as benign prostatic hypertrophy, cancer or urethral strictures.”

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    Incontinence Treatments

    Slings

    This is a minimally invasive procedure that uses a small, thin mesh or “tape” to create a “hammock” effect under the urethra. This can be approached via the pubic symphysis or the obturator area. It is important to note that after careful data analysis, the FDA has stated that there is a low to modest risk with these “tape” type procedures. The mid-urethral sling has excellent long-term data and a high success rate, that is between 80-90%.

    Non-Mesh Option

    If a patient is opposed to mesh or cannot have the type of procedure for other reasons, there are other options available.

    The Burch procedure is done to support the hypermobile urethra that causes stress urinary incontinence. It can be done with a very small “bikini” incision or robotically. Sutures, not mesh, are used to support the urethra and bladder neck.

    The fascial sling procedure uses the patient’s own tissue or fascia as the “tape”. No mesh is used for this procedure. Once again, a “bikini” incision is made where the fascia is harvested. The fascia is then fastened and placed under the urethra through a separate vaginal incision.

    Both of these procedures are alternatives to the traditional mesh procedure, with good success. These procedures are slightly more invasive techniques and involve a slightly longer recovery phase.

    Bulking Agents

    Periurethral bulking agents are injected into the urethra and used to “plump up” the urethra to decrease or eradicate stress urinary incontinence. The procedure can be done under light anesthesia or even in the office. The bulking agents are effective for mild stress urinary incontinence and for women who have the diagnosis of ISD (intrinsic sphincter deficiency), where the urethra does not close completely. These are several FDA approved agents that are used and although they are effective for stress urinary incontinence, repeat procedures may be necessary.

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    da Vinci Sacrocolpopexy

    Sacrocolpopexy is a procedure performed using the da Vinci Robotic System to correct vaginal vault prolapse. The robotic procedure allows the physician to correct the prolapse and thus provide the patient with a durable repair. Unlike the open repair, the da Vinci System is minimally invasive, more precise, less pain, less blood loss, and better cosmetics. Most of the time, patients spend only 1 night in the hospital. The procedure uses mesh to hold the vagina in the correct anatomical position. Physicians can perform this procedure, to provide long term support of the vagina, with or without the uterus in place.

    The long term cure rates for this procedure range from 75-98%.

    The da Vinci Sacrocolpopexy offers a number of benefits compared to the traditional treatment option. These benefits include:

    • Less pain
    • Less blood loss
    • Lower rish of infection
    • Less scarring
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    Stress Incontinence

    Stress Urinary Incontinence

    Symptoms

    Stress incontinence is the involuntary loss of urine associated with physical activity such as coughing, sneezing, and exercising. It is caused by several factors some of which may be childbirth and previous pelvic surgeries. As many as 50% of all women experience symptoms of stress urinary incontinence. As with urinary urgency incontinence, a thorough history and physical exam is crucial.

    Treatments

    Treatments for Stress Incontinence

      Non-Surgical
    • Kegal Exercises
    • Dietary Modification / Times Voiding
      Surgical-
    • Sling
    • Non-mesh Option
    • Bulking Agents
    Treatments

    Small fistulas may sometimes resolve with a foley catheter drainage. However, the majority of times, surgical treatment is needed. Depending on the location of a fistula, the physician may repair the defect either vaginally or abdominally. Trained physicians can repair this robotically, which greatly minimizes post-operative discomfort.

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    Mesh Related Solutions

    When mesh failure occurs, it causes great distress for so many women. We approach this problem with compassion and understanding.

    After mesh failure is confirmed, the least invasive treatment is usually attempted first. The treatment options can vary greatly depending on the location and severity of the damage:

    Treatment for Mesh Erosion:
    • Estrogen cream application to promote healing and blood flow
    • Re-sewing or replacing stitches
    • Trimming exposed vaginal mesh and re-sewing remaining mesh
    • Surgical or laser removal of mesh from vagina or surrounding organs
    • Removal of scar tissue if necessary
    • Vaginal packing with absorbent materials to minimize bleeding
    • Antibiotic therapy for current or potential infection
    Treatment for Mesh Perforation:
    • Partial or complete removal of the mesh from any damaged organs
    • Surgical repair of the damaged bladder, urethra or bowel
    • Removal of scar tissue as needed
    • Drainage of pus or of other abnormal fluids
    • Antibiotic therapy for current or potential infection

    Transvaginal mesh removal surgery is a delicate and tedious procedure. Several attempts may be necessary to completely remove the mesh, as tissue and nerves tend to grow in and through it. After the eroded mesh is completely removed, our surgeons are trained to deal with potential consequences of recurrent prolapse.

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    The drop in estrogen that comes with menopause or even during breastfeeding after delivery, causes a series of problems that have a severe impact on one’s social life and personal relationships. Among the most bothersome problems is atrophic vaginitis, which is the lack of nourishment and hydration of the cells of the vaginal mucosa. This condition causes a progressive thinning of the vaginal and vulvar mucosa which then becomes more delicate, sensitive and more exposed to trauma.

    Vaginal dryness, burning and being constantly bothered are a result of atrophic vaginitis, which is often not spoken about because some consider it a natural consequence during menopause and after childbirth. Thanks to innovative laser techniques, this problem can now be prevented and resolved in a safe and painless way.

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    Ureteropelvic Obstruction/ Pyeloplasty

    Obstruction Pyeloplasty

    Urology Centers of Alabama offers robotic, laparoscopic surgery to reconstruct an obstructed ureter and renal pelvis due to a condition known as a uretero-pelvic junction (UPJ) obstruction. This operation is known as a pyeloplasty and can be done using the da Vinci robot system.ᅠ ᅠDuring this procedure, the obstructed, narrowed area at the junction of the kidney and the ureter is removed and the ureter and kidney are sewn back together over a hollow plastic tube called a ureteral stent.ᅠ This stent is completely internal and remains in place for a month. It is removed easily in the office. Pyeloplasty has a 95% success rate.

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