SURGERIES

Hysteroscopy with endometrial biopsy – The hysteroscopy procedure is the placement of a very thin tube into the uterine cavity to visualize the inside of the uterus with a small telescope. This is a more thorough evaluation of the endometrial cavity followed most of the time with an endometrial biopsy to take tissue samples of the lining.. When the hysteroscopy is being performed, the patient is welcome to look at the TV monitor to see what the doctor is seeing. Many patients appreciate seeing what is wrong which helps them understand their condition much better. Some patients prefer not to watch. This procedure is done with many of the endometrial biopsies especially if a pelvic ultrasound indicates there is something abnormal inside the uterine cavity. This procedure is generally done for postmenopausal bleeding or abnormal bleeding. The risks of this procedure are minimal and will be discussed prior to the procedure.

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Urodynamics – This is a set of procedures done in the office to more thoroughly evaluate a bladder problem such as urinary incontinence or leakage of urine as well as urinary frequency. It takes about 45 minutes and is done by an RN in our office, Christine. She will initially have you urinate on a special chair that records your urination pattern on a computer. She then places a tiny catheter in your bladder to see if you have empties your bladder normally. She then places a catheter into your vagina and tapes both catheters to your thigh. You then stand up and she begins filling your bladder with sterile normal saline solution to see when you get the urges to urinate and how much you can hold in your bladder. The next step is to empty your bladder again on the special voiding chair. The last part of the test is to check the pressure inside the urethra or tube that you use to let out the urine. The pressure in this little tube is very important when it comes to options for surgery if it is necessary. The patients are given oral antibiotics for two doses in an attempt to avoid getting a bladder infection. The patient then returns in approx 2 weeks to discuss the results with their doctor or nurse practitioner.

Colposcopy – This procedure is done to evaluate the patient who has an abnormal pap smear. Not all patients with an abnormal pap smear need this evaluation initially. You may be asked to just repeat the pap in 3-6 months. For those patients that have been recommended to have a colposcopy. A colposcope is a special microscope used to look at your cervix, vagina and vulva looking for any abnormal areas that might be responsible for giving you an abnormal pap smear. If any abnormal areas are seen, a biopsy is taken which feels like a “quick pinch” and is generally tolerable by most patients. Local anesthesia is given if a biopsy needs to be taken from the vulva (outside lips). Sometimes more than one biopsy is necessary. Pt’s are asked not to use anything in the vagina for 5-7 days if any biopsies are taken. There may be some light bleeding or spotting for 5-7 days. The results of the biopsies are generally available in a few days and the patient will be called with the results. Depending on the results, the patient may be advised to just repeat her pap smear in 6 months or have treatment. The treatments include LEEP, laser of the cervix, cryosurgery, cervix cone biopsy and rarely, hysterectomy.

LEEP – The LEEP is a common procedure used by Dr. Rodriguez when treatment of abnormal cells of the cervix is necessary. It stands for Loop Electrosurgical Excision Procedure. It involves looking at your cervix again with the colposcope. Numbing medicine is given to the cervix and the abnormal areas are removed with a small thin loop of wire. The area is cauterized with a ball cautery to stop any bleeding and the procedure is done. There is generally no pain during the procedure due to the local anesthesia. The patient is asked to refrain from placing anything in the vagina for 3 weeks including tampons, douches or intercourse. The next pap smear is done in 4 months after the cervix has completely healed. Dr. Rodriguez recommends once you start having intercourse again in 3 weeks, that your partner use condoms for the first 3 months while your cervix is healing. You may need to have more frequent pap smears in the first year following the LEEP treatment. The risks of the procedure are minimal and will be discussed with you by Dr. Rodriguez.. She generally prefers this procedure over the Cryosurgery

Cryosurgery – This procedure is another option to treat abnormal cells of the cervix. This procedure has been around for over 30 years and is still used in some patients. A flat or cone shaped steel instrument is applied to the cervix and the top layer of cells that come in contact with the probe are frozen. This freezing kills the abnormal cells and this tissue sloughs off over the next few weeks. There may be some cramping during the procedure, therefore the patient us usually advised to take 600 mg Ibuprofen or 2 Aleve one hour prior to the procedure. If the patient is unable to take either of these, 2 Extra Strength Tylenols are recommended. The risks of this procedure are minimal. Dr. Rodriguez generally prefers the LEEP procedure over Crysurgery as she feels there is less scarring with the LEEP procedure.

Cervix Cone Biopsy – This is another option for abnormal cells of the cervix. This procedure can sometimes be done in the office using the LEEP method and sometimes it has to be done at the hospital as an outpatient where you go home in an hour after the procedure. This procedure removes a larger area of the cervix shaped like a cone. It removes the areas around the opening of the cervix that contain the abnormal cells. This procedure is generally done when the abnormal cells are much more advanced or very close to cancer. In certain cases, patients may also be given the option of hysterectomy.

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Cervical Polyp Removal – On occasion, patient will be found to have a polyp at the cervical opening. This is not uncommon when patients are seen for a routine pap smear. A polyp is a growth of extra tissue that generally comes from the opening of the cervix. It is generally recommended that a polyp be removed as there is a small chance these polyps can become malignant over time. It is a simple procedure to remove these polyps with a biopsy instrument. The polyp(s) are sent to the lab to be evaluated. Most of the polyps removed are benign (normal). You may develop another polyp in the future. If the polyp is very large, Dr. Rodriguez may want to remove the polyp with a different technique.

Excision of Vulva or Vaginal Growths – There are many types of growths that can occur on the vaginal lips or vulva and inside the vaginal wall. Many patients note these as new “bumps” they feel when taking a bath or shower. Most of these are benign or normal but in some cases, they become easily irritated or begin to grow. These types of growths are generally easy to remove in the office after some local anesthesia is given. These areas can take 7-14 days to heal depending on the location and size of the growth. Some of the growths are sent to the lab to be evaluated. Some are the usual skin tags and may not be sent to the lab if they appear to be normal tissue.

Gardasil vaccine – This vaccine is recommended for young women between the ages of 9 & 26. It is to prevent infection with the HPV or Human Papilloma Virus which could ultimately lead to the development of cancer of the cervix. This virus is very common among young people and is generally sexually transmitted. The vaccine consists of 3 injections over a 6 month period. This vaccine has been widely tested and appears to be safe. There has been much controversy regarding this vaccine, however, the benefits outweigh the risks. At this time, insurance is only covering the vaccinations for young women between the ages of 9 & 26. Any woman over 26 can ask for the vaccinations, however it will be an out of pocket expense. Since there is such a high rate of divorce in our country, it is not unreasonable for a women over 26 who finds herself in this situation and dating again to consider getting the vaccinations. The cost for all 3 vaccinationa are around $500.