Gynecology

Professional Gynecologic Care

Gynecology is the branch of medicine that deals with diseases and routine physical care of the reproductive system of women. Our physicians at Grace OB/GYN are pioneers and leaders in the advancement of gynecologic surgery and care for the patients of Western North Carolina. Please stop by our office in Asheville, NC, or call 828-252-1050 to schedule an appointment.

The Care and Services We Offer Include:

  • Complete Gynecologic Evaluations
  • Hysterectomy
  • Urogynecology
  • Pelvic Disease Treatment
  • Advanced Laparoscopic & Laser Surgery
  • Cancer Screening
  • Minimally Invasive Pelvic Reconstructive Surgery
  • Treatment of Severe Endometriosis
  • Treatment of abnormal uterine bleeding - surgical and non-surgical approaches
  • Treatment of Menopause & Menopausal Symptoms - hormonal and alternative therapies

Hysterectomy

A hysterectomy is a surgery to remove the uterus. If you and your gynecologist have decided that a hysterectomy is the best choice, then the next most important decision you need to make is how the surgery should be performed. 

There are three different approaches. At Grace OB/GYN Physicians, we highly recommend the vaginal approach. We feel strongly that you should understand why we make that recommendation and be fully informed about the benefits and risks of each method as you consider this important decision.

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Abdominal Hysterectomy (TAH)

The conditions that usually necessitate an abdominal hysterectomy are cancer, overwhelming infection, extremely large fibroid tumors, and advanced endometriosis. An abdominal hysterectomy requires both a vaginal incision and a four to six inch incision in the lower abdomen. The uterus is removed, and in most cases the cervix is removed as well. The fallopian tubes and ovaries can be removed if patient and doctor agree to this prior to surgery. The hospital stay is generally 2-3 nights, and the recovery time is 6-8 weeks. Due to the large incision, unfortunately there is often considerable postoperative pain. The recuperative process will be a long one, and the scar will be permanent.

There are risks to any surgery, but the risks of the abdominal hysterectomy are greater than the risks of the vaginal hysterectomy or the laparoscopic hysterectomy. General anesthesia, which is required for the abdominal hysterectomy and the risks of infection, bleeding, blood clotting, or possible damage to other organs are also greater. Women who are overweight, who smoke or have other medical problems will be at greater risk during any kind of surgery. 


Approximately 800 hysterectomies are performed in the Asheville area annually. Of these, about 75% are done using abdominal wall incisions. Only 25% are done trans-vaginally. In contrast, Grace OB/GYN's vaginal hysterectomy rate approaches 75%. In other words, we do 75% of our hysterectomies vaginally; compared to only 25% vaginally in the rest of the community as a whole.  Up to 75% of patients who need hysterectomies are good candidates for a vaginal hysterectomy, but they may be being denied the many benefits of the vaginal approach. Chances are, if you need a hysterectomy, the vaginal approach is a possibility for you.

Laparoscopic Assisted Vaginal Hysterectomy (LAVH)

The laparoscopic hysterectomy is very similar to the vaginal hysterectomy — the difference being that a laparoscope is used to assist in the removal of the uterus. Laparoscopy was pioneered by gynecologists in the early 1960s, and has been widely used in a range of procedures; including tubal ligation, the removal of ovaries and fibroid tumors, and the treatment of tubal pregnancies. 


The technique of laparoscopic hysterectomy was developed in 1989, when several laparoscopic hysterectomies were performed with very successful results. With this procedure, a laparoscope (a tiny telescope) is inserted through a small incision in the navel. Thus, the surgeon can view a magnified image of the patient's internal organs on a video monitor. This procedure enables the surgeon to perform the hysterectomy, as well as to diagnose and treat related conditions at the same time. Often, one or two additional small (1/4") incisions are made elsewhere in the lower abdomen, in order to allow the use of other tiny surgical instruments. These tiny incisions are closed with sutures or surgical tape. Within a few months, the incisions are barely visible.

Benefits of a Laparoscopic Hysterectomy Over an Abdominal Hysterectomy:

  • Increased safety
  • No visible scars
  • Much less pain
  • Faster recovery
  • Lower cost

In a laparoscopic hysterectomy, the vascular pedicles are secured, and the uterus is freed from the ligamentous attachments. The fallopian tubes and ovaries can be removed in this way as well if clinically indicated. The uterus can then be removed through a vaginal incision, much like a vaginal hysterectomy. The patient is under general anesthesia throughout the procedure. Many patients who would otherwise have an abdominal hysterectomy may benefit from choosing a laparoscopic approach.

Vaginal Hysterectomy (TVH)

If you need a hysterectomy, there is a better way. It's called "Vaginal Hysterectomy." This type of surgery frees you from the large incision that is normally required for a hysterectomy. The uterus is removed at its internal source instead — the upper end of the vagina. Small retractors and special headlights are used in the surgery. The ovaries can also be removed during this surgery if clinically indicated. The vagina is not harmed or stretched in anyway. If the uterus is enlarged by tumors, these can be removed in small sections through the vagina using a technique called morcellation.

Benefits of a Vaginal Hysterectomy:

  • Increased safety
  • No visible scars
  • Much less pain
  • Faster recovery
  • Lower cost

Surgical skill, experience, and complication rates vary among gynecologists. Since the vaginal approach requires the most skill and experience, your existing gynecologist may not be comfortable offering this minimally invasive technique to you. Some gynecologists are still telling patients that the vaginal hysterectomy cannot be done if the patient has never had a baby, has had a previous cesarean section, has large tumors of the uterus (fibroids), or needs to have the ovaries removed as well. Our physicians do not consider those conditions to be necessary barriers to the vaginal approach. We believe that the vaginal hysterectomy is the safest and most pleasant approach for the majority of patients.

Comparison

At Grace OB/GYN Physicians, we recommend and offer the vaginal approach for the majority of cases. If your hysterectomy is scheduled for the laparoscopic or abdominal approach, please consider a visit with one of our physicians to see how we might be able to offer you a different option.

Urogynecology

Urinary incontinence — the involuntary loss of urine from the bladder — represents one of the most under-recognized health issues affecting women.

Up to 50% of women suffer from urinary incontinence at some point in their lives, and approximately one-third of women over age 60 leak frequently. Urinary incontinence costs Americans some $32 billion annually in loss of productivity, medications, surgery, and hygienic products. More important, however, is the impact on a woman's quality of life. Urinary incontinence often imposes significant limitations on physical activity, creates social isolation, and can even lead to emotional problems. 


Unfortunately, most women either fail to realize that urinary incontinence is a true health condition, or they are too embarrassed to mention it to their doctor. There is a common misperception that urinary incontinence is simply an unavoidable and untreatable consequence of aging. This assumption deprives many women of the enjoyment of physical exercise, social activity, and even sexual relationships. In fact, most cases of urinary incontinence are very treatable. 


Urinary incontinence usually results from involuntary bladder contractions (urge incontinence), anatomic laxity (stress incontinence), or a combination of both (mixed incontinence). Risk factors include age, childbirth, increasing weight, and diabetes. With urge incontinence, women typically feel a strong, sudden desire to void; but leak before reaching the restroom. Stress incontinence is characterized by leaking during activities like laughing, sneezing, coughing, jumping, or standing up from the seated position. Women with mixed incontinence have both urge and stress symptoms. 


Urinary incontinence may improve somewhat with decreased caffeine intake, pelvic floor exercises (Kegel exercises), and scheduled bathroom visits to prevent the bladder from getting too full. For some women, lifestyle modifications are not enough, and medications to relax an overactive bladder or surgery that restores anatomic bladder support may be necessary. However, other disease processes such as infections, inflammation, fistulas, and neurological dysfunction (diabetic neuropathy, spinal cord disease, stroke) can lead to urinary incontinence. So it's important that women who experience bladder control problems be evaluated by their doctor to make sure that a more serious condition is not the cause.

Urodynamic Testing

The evaluation of urinary incontinence includes a thorough medical history, physical examination, urinalysis. Often, the evaluation also includes urodynamics testing. Multi-channel urodynamic testing — a safe, office-based diagnostic procedure that accurately identifies the specific cause of your urinary incontinence — can help your doctor determine if surgery is right for you. Urodynamic testing involves the placement of special catheters into your vagina and bladder. These catheters measure pressure and volume as your bladder is gradually filled and as you perform provocative maneuvers, such as coughing and bearing down, to reproduce your leaking. You are then asked to empty your bladder before the catheters are removed. Usually requiring about thirty minutes to conduct, urodynamic testing provides important information that enables your doctor to prepare the best management plan for you.


If you struggle with urinary incontinence, please consider an evaluation with one of our physicians to determine the cause and develop the right management plan for you.

Please schedule an appointment with our physicians today. Call 828-252-1050.

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