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At Magee, Advanced Urogynecology Procedures Are Transforming Women's Lives . . . New Effective Treatments for Pelvic Floor Disorders

By Nancy Kennedy

Shepherd......Bonidie
Jon Shepherd • Dr. Michael Bonidie


Magee-Womens Hospital of UPMC has great news for the women of the tri-state region: the hospital recently opened an outpatient center in Mount Lebanon for Women’s Specialty Services, offering complex obstetric and gynecological specialty care in urogynecology, midlife health, infertility, gynecologic oncology, maternal fetal medicine and gynecologic specialties.
Among the outstanding clinical services offered at Women’s Specialty Services is The Women’s Center for Bladder and Pelvic Health. The Center is a program of Magee’s nationally renowned urogynecology division, which provides comprehensive medical and surgical care to women of all ages who are experiencing the common problems of urinary incontinence, vaginal prolapse and other disorders of the “pelvic floor” – the system of muscles, ligaments and connective tissue that supports the bladder, uterus, vagina and rectum. Michael Bonidie, M.D., and Jonathan Shepherd, M.D., urogynecologists at the Mount Lebanon location, are highly skilled surgeons who perform the intricate procedures that have transformed the treatment of pelvic floor disorders.
Shepherd says that pelvic floor disorders are extremely common and can greatly compromise a woman’s quality of life. But highly effective new approaches to treatment, including minimally invasive surgical procedures, offer permanent relief. “Urinary incontinence is not an inevitable part of aging,” Shepherd says. “It’s a treatable condition and the treatment has evolved substantially; technology has enabled tremendous improvements.”
Shepherd explains that although women in the mid-life and senior years are more likely to experience pelvic floor disorders, they happen at any age. There are multiple contributing factors: multiple pregnancies; obesity; smoking; the effects of menopause and other medical conditions. As many as one-third of women over 50 will experience some degree of urinary incontinence, but many avoid seeking treatment because of shame or embarrassment. Their lives can become restricted, as they avoid activities for fear of having an accident. That can lead to social isolation and depression.
“You don’t have to live with the discomfort and embarrassment of leaking,” says Shepherd. “We’re here to help. We understand that this is a very private health concern, but then so is breast cancer. There’s no reason to be silent about this – it’s as common as breast cancer, and we’re able to talk openly about that.”
There are two main types of urinary incontinence in women: stress and urge incontinence. Stress incontinence occurs when you laugh or sneeze, and urge incontinence refers to bladder spasms that create the urge to empty the bladder frequently, even with a small volume of urine. Some women have a combination of the two. Medications such as Detrol may alleviate urge incontinence, but are not always effective. In that case, there are surgical options: minimally invasive, outpatient surgical procedures that involve a tiny incision, little pain and a rapid recovery.
Another common pelvic floor condition, vaginal prolapse, occurs when the pelvic muscles weaken and allow the internal organs to “fall” into the vagina. Shepherd specializes in a procedure known as a sacral colpopexy, in which the bladder is supported by mesh. Shepherd’s method greatly reduces the risk of bacterial infection that sometimes results when mesh is inserted through the vagina.
The surgical procedures that repair incontinence and prolapse used to require a large abdominal incision, long admission and considerable discomfort. Now, they are performed laparoscopically and robotically, using high-tech, state-of-the-art systems. While Dr. Shepherd prefers laparoscopy, Dr. Bonidie, Magee’s Director of Robotic Gynecology, likes to use the daVinci Robotic system. “The robotic apparatus gives us a three-dimensional image rather than the two-dimensional of standard laparoscopy; it gives the surgeon ‘wristability’ – meaning that he has tremendous dexterity and precision, with natural movement,” Bonidie explains. “With the daVinci, I can control three surgical instruments at once.”
Both robotic surgery and laparoscopy are easily tolerated by patients and facilitates a rapid recovery with less pain, blood loss, scarring and risk of infection.
Magee was among the first hospitals in the Pittsburgh region to perform urogynecological surgical procedures using these cutting-edge approaches and has become a leading center in the specialty. “Magee is unquestionably one of the top urogynecology programs in the nation, from many perspectives,” says Bonidie. “We have the largest academic group in the U.S.; in general, there are just one or two urogynecologists in an entire state – but here at Magee we have seven. We offer every procedure and are nationally known for the quality of our program.”
Bonidie and Shepherd are investigators in a multicenter National Institutes of Health study that is exploring the use of Botox and sacral neuromodulation, or bladder “pacemakers” to treat incontinence. Both find it gratifying to make a difference in quality of life for women. “I loved the excitement of the Birth Center,” says Shepherd, “but this is exciting in a different way. It’s wonderful to see patients come in all smiles at the first post op visit. They are so pleased to no longer be living with pads, leaking, and a poor quality of life.”
Magee’s Womens Specialty Services, on Bower Hill Road, opened about six months ago and offer woman-centered care in a convenient, comfortable setting. “We cover a wide region. Women come here from as far away as Erie, eastern Ohio and West Virginia,” says Shepherd. “At Magee we are always trying to make the care of women and the quality of their lives better.”

Women’s Specialty Services is located at 1082 Bower Hill Road, Suite 125. For more information or to make an appointment, call (412) 429-3900.

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