Female Pelvic Medicine and Reconstructive Surgery
Vaginal Hysterectomy
A vaginal hysterectomy is the removal of the uterus through the vagina. There is no incision in the abdomen and no need to use a laparoscope. The removal of the uterus includes the cervix and the uterus. The Fallopian tubes and ovaries are not routinely removed in a vaginal hysterectomy. A vaginal hysterectomy is the current clinical standard for the management of uterine prolapse.
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Removal of Fallopian Tubes at Time of Hysterectomy
The removal of the Fallopian tubes offer protection against ovarian cancer. The detection of premalignant cells in the epithelia of the fallopian tubes has revolutionized the theories on the genesis of ovarian cancer. Fallopian tube removal has been proposed during surgery for benign disease, for example in women in whom hysterectomy is indicated. Such “prophylactic” or “opportunistic” salpingectomy procedures could prevent carcinoma development in later years.
Cystocele Repair
A cystocele is a distention and detachment of the support of the anterior aspect of the vagina (the roof of the vagina). The most common symptoms of a cystocele is a bulge coming through the opening of the vagina. The bulge is most prominent after physical activity and in the early stages can be associated to urine loss with effort (urinary stress incontinence). As the bulges progresses and becomes larger it causes difficulty to urinate, a sensation of incomplete bladder emptying and urinary retention.
Rectocele Repair
A rectocele is a bulge through the vagina resulting form the weakness, stretching and distention for the layer of tissue separating the vagina from the rectum. A rectocele can be an isolated problem or it can be associated associated to other types of prolapse, most commonly to a cystocele in about 80% of patient s with a cystocele.
Enterocele Repair
An enterocoele is a bulge through the vagina resulting form the weakness, stretching and distention for the layer of tissue separating the vagina from the lining of the abdominopelvic cavity. An enterocele can present as an isolated type of prolapse defect or it can be associated associated to other types of prolapse, most commonly to a post hysterectomy vaginal vault prolapse.
Repair of Post-Hysterectomy Vaginal Vault Prolapse
A prolapse of the vaginal vault after a hysterectomy results from the lack of support in the uppermost position of the vagina. The main symptom is a bulge protruding through the opening of the vagina. The most common clinical symptom is a visible or palpable soft mass in the vagina following a hysterectomy. This prolapse can happen immediately after a hysterectomy or years after. Management includes watchful observation, a pessary or surgery. A pessary is a device used in general gynecologic practice. A pessary is not a cure for prolapse. Surgical management is elected based on impairment of quality of life and symptoms.
Complex Urodynamic Testing
Our urodynamic testing unit has been established for almost twenty years. It has performed over ten thousand studies with space, staff and equipment dedicated to the study of voiding abnormalities, incontinence and voiding dysfunction. The unit follows the International Continence Society standards of urodynamic testing with emphasis on establishing a retrievable medical records of the performed studies. The Laborie multichannel system allows for concurrent electromyography during multichannel studies, a feature that has proven useful in the management of voiding dysfunction. A urodynamic study is not painful.
Midurethral Slings for Urinary Stress Incontinence
A midurethral sling for the treatment of urinary stress incontinence is the most studied and researched continence surgery in history. The material used in midurethral slings is polypropylene, a suture material used in the operating room for over fifty years. The efficacy and durability of a midurethral sling has been established through studies lasting as long as 17 years with cure rates over 85%. A midurethral polypropylene sling is the current clinical standard for the surgical treatment of urinary stress incontinence. A with all implants there is a risk of revision of the implant. The rate of revision at ten years ranges from 0.7%-3%.
Revision of Implant Surgery
Revisions of implants used in prolapse and urinary incontinence are rare. As a matter of comparison the rate of revision for a polypropylene is significantly lower than the rate of revision for a dental, hip, knee or breast implant. In those rare cases in which a revision is required a systematic assessment of the risks and benefits of the revision procedure is required. Any type of revision should be performed by a surgeon with expertise not only in the anatomical site but also on the characteristics of the implants itself.
Management of Recurrent Urinary Tract Infections
A urinary tract infection is an infection of the urethra, bladder and/or kidneys. The most common urinary tract infection is known as an uncomplicated cystitis. Urinary tract infections are clinically identified by the presence of dysuria (pain on urination), urinary tenesmus (a continued bothersome desire to urinate even with an empty bladder), pain in the bladder area and occasionally blood in the urine. Utinary tract infections can be recurrent with a diafgnosis of recurrent urinary tract infections being defined as three urinary tract infections in one year or two in six months.
Office Cystoscopy
A cystoscopy is a procedure to look at the urethra and bladder. It consist in the placement of a thin lens attached to a camera and a monitor to facilitate a visual assessment. The procedure is done at the office with the use of an anesthetic lidocaine gel. No systemic anesthesia or sedation is required and there is no downtime. The information obtained from a cystoscopy at the office is used in the management of clinical bladder and urethral symptoms. A cystoscopy is a procedure required in the evaluation of microscopic hematuria (presence of three or more red blood cells in the microscopic analysis of a properly collected specimen of urine).
Management of Chronic and Interstitial Cystitis
Chronic and interstitial cystitis are inflammatory conditions of the bladder characterized by bladder, pelvic pain and urinary symptoms in the presence of a negative urine culture. Our approach to the diagnosis and multimodal management of chronic and interstitial cystitis is done in accordance with the treatments guidelines of the American Urological Association.
Treatment of Chronic Pain of the Vulva-Vulvodynia
Vulvodynia is persistent, constant or episodic pain in the vulva, entrance to the vagina and or clitoral area. The condition may appear spontaneously or associated to chronic pelvic pain, chronic bladder pain or previous surgery. At evaluation we aimed to determine the triggering factors as well as underlying conditions. Most cases of Vulvodynia do not have a single factor causing. The treatment aims at comfort, reduction of impact in quality of life and resumption of social and sexual activities.
Management of Painful Intercourse-Dyspareunia
Painful intercourse is a common condition affecting one in four sexually active women. The clinical presentation of dyspareunia is commonly seen as progressive with those persistent cases seen at dedicated consultations. Frequently dyspareunia can present as the clinical manifestation of an underlying disease such as Genitourinary Syndrome of Menopause, post-surgical abnormal wound healing and pelvic pathology. The impact of dyspareunia in the physical and mental well being can be manifested in an avoidance of intimacy, problems with relationships and isolation. The evaluation of dyspareunia is times at establishing a differential diagnostic list, a process of elimination of clinical causes in an effort to identify a cause and design treatment.
Fistula Repair
A fistula is an abnormal communication between two organs caused by abnormal healing, lack of blood supply or tissue damage. In the pelvis the communication between the bladder and the vagina is called a vesicovaginal fistula. When the communication is between the rectum and the vagina it is called a rectovaginal fistula. The most common cause of a vesicovaginal fistula in the developed world is surgical, most commonly following a hysterectomy. Fistulous defects following a vaginal delivery are the most common cause of rectovaginal fistula. Fistulae are classified as simple or complex depending on size and site.
Repair and Revision of Painful Episiotomy
An episiotomy is an incision performed in the perineum (the area between the vagina and the anus) to facilitate the vaginal delivery of a baby. There are two types of episiotomies, midline and mediolateral. The most common episiotomy performed in the US is a midline episiotomy. Midline episiotomies in general heal well and without painful sequaleae. Mediolateral episiotomies are usually larger and require a longer period of healing with frequently seen fibrosis and pain. As in all incisions a risk of scar, deformation and persistent pain exist. The most common complaint after an abnormally healed episiotomy is painful intercourse and an aesthetically unpleasing scar.
Anorectal Physiology Testing
Anorectal physiology testing is indicated in patients with defecatory dysfunction. The study assessed the neurologic interaction of the anorectum, rectal capacity, rectal compliance and sphincteric function. Anorectal physiology testing is useful in the evaluation of obstructed defecation, constipation and neurogenic conditions leading to bowel dysfunction. The procedure is done at our pelvic floor laboratory. There is no downtime.
Patient Feedback
Sarah J.
I would highly recommend Dr. Sepulveda in Miami. He is caring, compassionate, and an excellent surgeon. Last year he performed surgery on me for a prolapse bladder and every step of the way went very well. If you are in need of surgery for the above issue schedule an appointment with Dr. Sepulveda, you will be extremely happy. Do Not Hesitate!
Jessica R.
I have been a patient of Dr. Sepulveda in Miami for the last year. He is simply the best. Most concerned doctor I’ve ever met. He’s polite, kind and knowledgeable. I am so blessed to have him as my doctor. I also had a cosmetic procedure done an O-Shot for urinary incontinence it worked wonders. I no longer wake up at night to use the restroom. I was very satisfied with all aspects of the procedure.
Ashley O.
He definitely exceeded my expectations, and I am very pleased with my results after having the designer reduction labiaplasty surgery. Definitely exceeded my expectations, and I am not ashamed of my body anymore. Dr. Sepulveda is amazing and wants the best for her patients. Today is my 9 days after surgery. I feel well and very very happy with my decision. It looks beautiful. I recommend Dr. Sepulveda in Miami one hundred percent!