Page 23 - Middlesex Health & Life - Fall 2012 Issue

inside
look
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 gyne-
cologists. But medicine has evolved,
and a new specialist—the urogynecolo-
gist—has gained prominence in treating
these difficulties. This physician focuses
on treating urinary incontinence and
pelvic floor disorders. Working with
gynecologists and obstetricians, urogy-
necologists have broadened the range
of available health services for women.
Many such services are now provided
at the Saint Peter’s Healthcare System’s
CARES Surgicenter in New Brunswick,
which is fully equipped to allow doctors
to treat common female problems with
minimally invasive techniques. Laparo-
scopic 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—instru-
ments 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 urogy-
necologist with Urogynecology Arts of
New Jersey P.A. in East Brunswick,
defines his role this way: “I am a special-
ist 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 pro-
lapse.” 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 pel-
vic 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 tech-
niques 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 min-
utes.” Working with just three tiny inci-
sions, 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 per-
cent and offers a lifetime cure,” he says.
Finally, Dr. Mokrzycki also treats
urge incontinence, or “overactive blad-
der,” 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 with-
drawn, suctions were inserted to pull
out the shaved tissues. TruClear com-
bines 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.” Vin-
cent Mileto, M.D., an OB-GYN with
Somerset OB-GYN Associates in
Bridgewater, agrees. “The older way of
fibroid removal can be quite cumber-
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