Urogynecology Specialist

Urogynecology is a subspecialty within Obstetrics and Gynecology that focuses on disorders of the female pelvic floor such as pelvic organ prolapse (bulging out of the uterus and/or vagina), urinary incontinence, recurrent urinary tract infections, fecal incontinence and constipation.

Dr. Anghel has treated these often complex conditions in high volume. As a result, he is experienced in conducting comprehensive evaluations using the latest technology and offering his patients a wide range of the latest treatment options to help them lead more comfortable, functional, and productive lives. Treatment options range from physical therapy/muscle training to medicine to injections to surgery. If surgery is ultimately the best option, Dr. Anghel’s advanced surgical background enables him to offer the most minimally invasive and high tech options available, including both robotic and non-robotic techniques. At no time during this process, is the patient left to make their treatment decision without the expert guidance and care of Dr. Anghel.

Common urogynecology conditions that Dr. Anghel has successfully treated include:

Vaginal Reconstruction: A surgical procedure performed to restore function and appearance to the vagina, which can help a patient enjoy a healthier and fuller life. Reconstructive procedures may be necessary as a result of a patient having a birth defect, vaginal wall prolapse, accident, trauma or cancer treatments such as surgery or radiation. 

Rectocele Repair: A rectocele is the bulging/pushing of the rectum into the vagina as a result of the supporting rectum and vaginal tissues being weakened or torn. Rectocele repair surgery can strengthen and repair the damaged tissue and restore the rectum to its normal position – alleviating symptoms like pain and discomfort in the vagina, difficult bowel movements, inability to control bowel movements and more.

Labiaplasty: A procedure that repairs/reduces enlarged, excessively long or asymmetrical labia minora (inner vaginal lips). Often times childbirth, weight fluctuations, or the natural aging process can increase symptoms due to a lengthened labia resulting in pain during exercise or intercourse, itching, irritation and self-consciousness.

Vaginal Septum: A condition from birth, a vaginal septum is when a woman’s uterus and vagina does not develop properly creating a wall of tissue within the vagina. Depending on the complications and severity, corrective surgery can be performed to remove the wall of tissue.

Vaginal Fistula: A condition in which a hole has opened up from the vaginal wall and connects with another organ in the body, such as the bladder, rectum, colon or small intestine – sometimes allowing stool to pass through the vagina. The condition is usually caused after tissue damage from childbirth or chronic illness such as crohn’s disease. Surgery can restore the vagina to its normal function.

Pelvic Organ Prolapse: Pelvic organ prolapse is essentially a downward descent of female pelvic organs, including the uterus, bladder and rectum. These slip and create a bulge in the vagina after the muscles, tissues and ligaments supporting those organs weaken.

Pelvic organ prolapse can be attributed to several factors including, vaginal childbirth, advancing age, obesity, hysterectomy, menopause, heavy lifting, chronic coughing, constipation, previous pelvic surgery, and neurological conditions or injuries such as muscular dystrophy, multiple sclerosis and spinal cord injuries.

Treatment can include pelvic floor physical therapy, vaginal support devices and minimally invasive reconstructive surgery.

Urinary Incontinence

Urinary Incontinence — the loss of bladder control — is a common problem among women. The severity ranges from occasional, mild leakage to uncontrollable urine loss. There are difference types of urinary incontinence, which include:

• Urge Incontinence: Occurs when the bladder contracts involuntarily. Symptoms include the sudden, uncontrollable need to urinate, which can also be especially strong at night and may lead to accidental leakage while sleeping.

• Stress Incontinence: The muscles around the urethra become too weak to prevent the urine in your bladder from escaping when the bladder pressure rises with increased abdominal pressure. Even a small amount of stress created by coughing, sneezing, laughing, exercising or lifting can result in a bit of leaking.

Causes for these conditions can include aging, obesity, surgery involving the bladder, childbirth, medications, diabetes and neurological conditions or injuries such as muscular dystrophy, multiple sclerosis and spinal cord injuries.

Tests for diagnosing urinary incontinence might include:

• Urodynamic Testing: A catheter is inserted into you urethra and bladder to fill your bladder with water while a pressure monitor measures and records the pressure within your bladder. This test helps measure your bladder strength and urinary tract health.
• Cystoscopy: A thin tube with a tiny lens is inserted into your urethra and checks for abnormalities in your urinary tract.
• Cystogram: A catheter is inserted into your urethra and bladder and a special dye is injected. As you urinate and expel this fluid,  X-ray images of your bladder help reveal problems with your urinary tract.
• Pelvic ultrasound: Checks your urinary tract or genitals for abnormalities.

Treatment for urinary incontinence can include bladder training, pelvic floor exercises, electrical stimulation, medication, medical devices and injections. Ultimately, if surgery is needed, there are several surgical procedures to treat urinary incontinence, such as a sling procedure or the insertion of an InterStim® device.

Fecal Incontinence: Fecal incontinence (or bowel incontinence) is the loss of control of bowel movements, causing fecal to leak from the rectum. Causes may include muscle damage as a result of childbirth, nerve damage, chronic constipation or diarrhea, rectal damage from surgery or radiation, inflammatory bowel disease, hemorrhoid surgery, rectal prolapse or aging. After diagnostic testing, treatment can include diet changes, pelvic floor therapy, medications or ultimately surgery.

Overactive Bladder: Overactive bladder occurs when the bladder can no longer hold urine normally. If you have an overactive bladder, you may feel a sudden urge to urinate, frequent urination, waking up more than once a night to urinate and leakage of urine before getting to the bathroom. (different from urinary incontinence when you lose control of your bladder) Treatment options vary greatly and range from lifestyle changes (modification of diet and activity), pelvic floor exercises, medication, Botox injections in the bladder, to surgery. Stress urinary incontinence: Urinary incontinence is when someone unintentionally loses urine. Stress incontinence happens when physical movement or activity like coughing, sneezing, running, or lifting puts pressure (stress) on your bladder. Urinary stress incontinence is not related to psychological stress.

LEEP Procedure: If you have abnormal cervical cancer screening result, your physician may suggest that you have a loop electrosurgical excision procedure (LEEP) as part of the evaluation or for treatment. LEEP is one way to remove abnormal cells from the cervix by using a thin wire loop that acts like a scalpel. An electrical current is passed through the loop, which cuts away a thin layer of the cervix.

Sling Procedures: For patients not responding to more conservative methods of treating urinary stress incontinence or overactive bladder, a sling procedure (there are varying types which Dr. Anghel takes time to review) may be your recommended course of treatment. Essentially, strips of synthetic mesh or your own tissue (sometimes animal or donor tissue) are used to create a sling or “hammock” to support the urethra and help keep it closed — especially when you cough or sneeze — so that you don't leak urine.

Stress Urinary Incontinence: Urge incontinence occurs when your bladder tightens or contracts involuntarily. Stress incontinence occurs when urine leaks from your bladder uncontrollably when you put pressure on it. This happens when you have weak muscles surrounding your urethra. You can develop urge or stress incontinence as part of the aging process. You might have a higher risk of it if you’re obese or take certain medications. Other risk factors include having diabetes, a neurological condition, or a spinal injury. Dr. Anghel determines what’s causing urinary incontinence during your exam.

Painful Intercourse: There are many conditions that can cause painful intercourse ranging from vaginal infections and pelvic inflammatory disease to problems with the uterus and/or cervix to menopause. A host of treatment options are available to address this often common problem.

Urinary tract infection: UTIs are more common in women than men and generally occur when bacteria enters the urinary tract through the urethra. Symptoms, which range from the urge to urinate to burning to cloudy urine, can become more serious and spread to the kidneys when not properly treated. An in-office visit can easily asses the condition and also look at other risk factors (e.g., suppressed immune system, catheter use, etc.) that may make a woman more prone to UTIs.

Urinary Retention:  A condition when the bladder does not empty all the way or not at all. It’s critical a patient be checked as there are a variety of underlying factors that may lead to this condition.

Vaginal Rejuvenation

Vaginal rejuvenation can be used to boost self-confidence by improving the appearance of the vagina and labia, relieving discomfort often associated with an enlarged labia and tightening the muscles in the vagina that have loosed from childbirth or aging

MonaLisa Touch® is an FDA approved painless and minimally invasive laser treatment for vaginal rejuvenation. It is the most effective non-surgical and non-pharmacological solution for preventing and treating vaginal atrophy and its after-effects (dryness, laxity, burning, pain during sexual intercourse and mild urinary incontinence) that many women suffer from during menopause, after childbirth or post-cancer treatments.

Gentle laser energy is delivered to the vaginal wall tissue to stimulate collagen contained in the area to achieve rehydration and functional tissue restoration. The end result often leads to improved self-confidence and sexual pleasure. Additionally:

• It’s an in-office, virtually painless procedure
• A typical course of treatment is three procedures over 18 weeks.
• Requires no anesthesia
• There is no downtime
• Each treatment is done under 5 minutes
• In both European and U.S. clinical trials, women reported symptom relief after the first treatment and increased improvement with each subsequent treatment

Learn more about MonaLisa Touch®