WELCOME TO OUR BLOG PAGE!

Each week, Dr. Anne Wiskind and Christine Turner, MSN, WHNP, will be contributing posts on topics that range from basic patient education to current medical trends in Urogynecology and Gynecology.

Come back and visit us weekly to keep up on the latest procedures, news and information around women’s health. Our website www.peachtreegynecology.com has even more information, and please feel free to call any time at 678.539.5980 to schedule an appointment with us.


Frustrated by Overactive Bladder (OAB)? Think Botox

Posted on: April 12th, 2015

Overactive Bladder (OAB) is a common condition in women that causes urinary urgency, frequency and urge incontinence- the feeling of always having to go the bathroom and rushing to the bathroom but starting to leak before you can make it.

It is caused by the nerves controlling your bladder function to send signals to the bladder at the wrong time, causing it to spasm or squeeze without warning.

Typical treatments include:

  • “Timed voids”: emptying the bladder on a schedule
  • Pelvic floor exercises
  • Avoiding bladder irritants such as caffeine, alcohol and spicy foods
  • Anticholinergic medications which can cause dry mouth, constipation or blurred vision

Botox (onobotulinum toxix A) is now an option for those women with OAB symptoms that do not respond to medication or who cannot tolerate the medication side effects.

  • It works on the nerves and bladder muscle cells, blocking the signals that cause OAB
  • The Botox is injected into multiple areas of the bladder (detrusor) muscle through a cystoscope in the office under local anesthesia
  • Most people feel a significant improvement in their symptoms within two weeks
  • The effects last up to 6 months, and the treatment can be repeated as necessary
  • It is covered by most insurance plans

Side effects include:

  • Urinary tract infection (18%)
  • Painful Urination (9%)
  • Urinary retention (6%)- inability to completely empty our bladder

Botox is FDA approved and included in the American Urological Association guidelines for treatment of OAB. If you are frustrated by OAB symptoms, call us for an appointment to see if you might be a candidate for Bladder Botox Injections

 


United Health Care weighs in on route of hysterectomy

Posted on: March 15th, 2015

United Healthcare, one of the nation’s largest health insurance company has recently stated that beginning April 6, 2015, it will require preauthorization on any hysterectomy not done vaginally as an outpatient.

While this has caused quite a stir in the health care industry, United Healthcare’s policy is based on sound evidence.

·      The American College of Obstetrics and Gynecology (ACOG) has recommendation that “in general, vaginal hysterectomy is associated with better outcomes and fewer complications than abdominal or laparoscopic surgery”.

·      Vaginal hysterectomy has been endorsed by all the relevant professional medical societies due to its cost effectiveness and low complication rates.

·      By promoting vaginal hysterectomies, United Healthcare is also encouraging physicians to avoid the use of power morcellators, which have been associated with a 0.3% risk of spreading an unsuspected uterine cancer and remain a topic of controversy.

 

Some areas of concern include:

·      This is a significant step towards insurance companies driving choices for medical care rather than the physician and patient, when they (the company) do not have the facts or knowledge to understand all the aspects of a particular case.

·      With the recent emphasis on robotic and minimally invasive laparoscopic surgery, many physicians – particularly younger ones recently completing training- do not have adequate skills in vaginal surgery.

·      There are many patients with endometriosis, advanced prolapse or large fibroids who are not candidates for vaginal surgery

·      While uterine fibroids can be morcellated by hand and removed through the vagina, there is no evidence that this is any safer in spreading unsuspected cancer than laparoscopic power morcellation.

 

In this era of complicated medical choices and alternatives, it is important to have a gynecologist who will take into account your individual circumstances and take the time to help you navigate through the treatment options.  It is also important to have a physician with the surgical skills and training to perform the surgery that is best for YOU.  You will find that at Peachtree Gynecology.


Uterine fibroids and Infertility

Posted on: March 15th, 2015

I had a patient come in last week to discuss her recent miscarriage and findings of 2 uterine fibroids noted on her pelvic ultrasound.   Her fibroids were in the wall of the uterine muscle and not inside or distorting the endometrial cavity. They were moderate size with one measuring 3 cm in diameter and the other measuring 4 cm. Prior to her recent pregnancy and very early miscarriage, she had regular menses with normal flow and minimal cramping. Her question was whether the fibroids were related to her miscarriage and if she should have them removed. I did not know the answer, but said I would try to find out.

Uterine fibroids

  • Are benign smooth muscle tumors of the uterus and are present in 5-10 % of patients with infertility.
  • Fibroids are the only abnormal finding in 1-3% of infertile women
  • Fibroids that are intracavitary or submucosal ( see diagram in link below) have been clearly shown to have a detrimental effect on fertility, with adverse effects on implantation of the embryo as well as increased risk of miscarriage.
  • The effect of intramural or subserosal fibroids that do not distort the endometrial cavity is less clear
  • There is some evidence that intramural fibroids can affect fertility, particularly when they are > 4 cm in diameter. More clinical trials are underway.

Uterine Fibroids Web Site

So for my patient, it is likely that removing her fibroids may improve her chances of fertility in the future, once other causes of infertility and miscarriage have been investigated. Some considerations prior to surgery include:

  • Precise location and size of the fibroids with preoperative imaging with US (including saline infusion hysterogram) or MRI is key to planning best route of surgical removal
  • Other causes of infertility should be evaluated and corrected prior to surgery
  • Surgical removal of fibroids cannot guarantee pregnancy or a live birth
  • Fibroids tend to recur following myomectomy, up to 50% in 5 years

The good news, with proper evaluation and good surgical technique, many patients have happy, healthy babies following myomectomy. At Peachtree Gynecology, we are dedicated to finding the best solution for YOU.