Permanent Birth Control
Essure® is a office based procedure that provides permanent contraception. Unlike a tubal ligation, the Essure Procedure can be performed in a doctor’s office without general anesthesia.



How Essure® Works
With Essure®, there is no cutting into the body. Instead, an Essure-trained doctor inserts spring-like coils, called micro-inserts, through the body’s natural pathways (vagina, cervix, and uterus) and into the fallopian tubes.

The Essure® Procedure

• One to two hour before the procedure, the patient is given medication that will help keep the fallopian tubes open and reduce cramping.
• During the procedure, the doctor inserts a narrow telescope-like instrument called a hysteroscope through the vagina and cervix and into the uterus. The hysteroscope is attached to a video camera that sends pictures to a monitor. This lets the doctor see inside the uterus.
• Normal saline fluid flows through the hysteroscope and into the uterus. The fluid expands the uterus to let the doctor see the openings to the fallopian tubes clearly.
• The spring-like micro-inserts are placed into each fallopian tube using a small, flexible tube (delivery catheter) that is passed through the hysteroscope.
• The procedure takes about 10 minutes.

During the 3 months following the procedure, the body and the micro-inserts work together to form a tissue barrier. This prevents the egg from passing into the uterus, and sperm from reaching the egg. Therefore, fertilization cannot take place. Another form of contraception is needed until 3 months after the procedure when a dye test is performed to verify that both tubes are completely blocked.

Treatment For Heavy Periods
Heavy bleeding is a problem for many women at different stages of their lives, including women who have had permanent contraception (tubal ligation or Essure); women who have been prescribed hormones and have stopped taking them; or women approaching menopause.

In the outpatient surgical setting we offer Thermachoice and in the office setting Her Option, both of which are global endometrial ablation systems.

    

Pelvic Organ Prolapse
Office evaluation and treatment options can be discussed. Pessary insertion is an office based procedure that can treat this issue in the appropriate populations when surgical intervention is not desired.

Highly Effective Contraception
We offer many contraceptive options including the Mirena IUD and the Paragard IUD for long-term reliable contraception.

    

Evaluation and Treatment of Urinary Incontinence
If you have a problem with urine leakage or blocked urine flow, your provider may be able to help. One of the tools they may use to evaluate the cause of your symptoms is urodynamic testing.

The bladder, a hollow muscular organ shaped like a balloon, sits in the pelvis and is held in place by ligaments attached to other organs and to the pelvic bones. The bladder stores urine until you are ready to empty it. It swells into a round shape when it is full and gets smaller as it empties. A healthy bladder can hold up to 16 ounces (2 cups) of urine comfortably. How frequently it fills depends on how much excess water your body is trying to get rid of.

The bladder opens into the urethra, the tube that allows urine to pass outside the body. Circular muscles called sphincters close tightly to keep urine from leaking. The involuntary leakage of urine is called incontinence.

Nerves in the bladder tell you when it is time to empty your bladder. When the bladder begins to fill with urine, you may notice a feeling that you need to urinate. The sensation becomes stronger as the bladder continues to fill and reaches its limit. At that point, nerves in the bladder send a message to the brain, and your urge to urinate intensifies.

When you are ready to urinate, the brain signals the sphincter muscles to relax. At the same time, the brain signals the bladder muscles to squeeze, thus allowing urine to flow through the urethra. When these signals occur in the correct order, normal urination occurs.

Problems in the urinary system can be caused by aging, illness, or injury. The muscles in and around your bladder and urethra tend to become weaker with age. Weak bladder muscles may result in your not being able to empty your bladder completely, leaving you at a higher risk for urinary tract infections. Weak muscles of the sphincters and pelvis can lead to urinary incontinence because the sphincter muscles cannot remain tight enough to hold urine in the bladder, or the bladder does not have enough support from the pelvic muscles to stay in its proper position.

Urodynamics is a study that assesses how the bladder and urethra are performing their job of storing and releasing urine. Urodynamic tests help your doctor or nurse see how well your bladder and sphincter muscles work and can help explain symptoms such as

• incontinence
• frequent urination
• sudden, strong urges to urinate
• problems starting a urine stream
• painful urination
• problems emptying your bladder completely
• recurrent urinary tract infections

The first step in solving a urinary problem is to talk with your provider. He or she should ask you about your general medical history, including any major illnesses or surgeries. You should talk about the medicines you take, both prescription and nonprescription, because they might be part of the problem. You should talk about how much fluid you drink a day and whether you use alcohol or caffeine. Give as many details as you can about the problem and when it started. The doctor or nurse may ask you to keep a voiding diary, which is a record of fluid intake and trips to the bathroom, plus any episodes of leakage.