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Published on September 12, 2017

Meritas Health Establishes Urogynecology Clinic

patient receiving TENS unit stimulation the posterior tibial nerve

With percutaneous tibial nerve stimulation, a
TENS unit stimulates the posterior tibial
nerve, which causes interference with the
nerves of the bladder.

When women experience urinary or fecal incontinence caused by pelvic floor disorders, they often suffer in silence, hesitant to address the topic. They are not alone. The National Institutes of Health estimates one-third of women in the U.S. have pelvic floor disorders.

Ian M. Rosbrugh, MD, FACOG, the only full-time Northland gynecologist board certified in female pelvic medicine and reconstructive surgery, now operates his urogynecology practice as the Pelvic Health and Reconstructive Surgery Clinic at the Meritas Health Pavilion for Women.

“I have been treating women with pelvic floor dysfunctions for many years, and I wanted to solely focus on their needs,” Dr. Rosbrugh said. “These issues have a huge effect on their lives. Many don’t like talking about it, so they bear it in secret. There are things we can do to deal with their issues of incontinence and sexual function that can drastically change their quality of life.”

Tailored Care

Because women are apprehensive to discuss their problems, Dr. Rosbrugh advises referring physicians to lead discussions with their patients. “I often have new patients who have been dealing with their issues for quite some time. Many have said, ‘It’s been this way for 15 years, but I didn’t know I could do something,’” he said.

Dr. Rosbrugh provides tailored care for a range of conditions, including bladder and pelvic pain, pelvic organ prolapse, overactive bladder, urinary incontinence and fecal incontinence.

Women at risk for developing pelvic floor disorders include those who have had hernias, difficulty with childbirth, connective tissue disorders and pelvic surgeries. Pregnancy and labor-intensive jobs that require lifting and straining also impact pelvic floor disorders.

Dr. Rosbrugh provides tailored care for a range of conditions, including bladder and pelvic pain, pelvic organ prolapse, overactive bladder, urinary incontinence, fecal incontinence and pain during sexual intercourse. His comprehensive services cover a variety of diagnostic and treatment options:

Nonsurgical

  • Bladder instillation
  • Cystoscopy with hydrodistention
  • Percutaneous tibial nerve stimulation
  • Physical therapy
  • Urodynamics

Surgical Treatments

  • Anterior and/or posterior repairs
  • Congenital anomaly repairs
  • DaVinci robot-assisted prolapse procedures
  • Fistula repairs
  • Mesh removal or revisions
  • Midurethral sling
  • Sacral neuromodulation
  • Sacrocolpopexy
  • Sacrospinous ligament fixation
  • Uterosacral ligament suspension

“Everything we’re dealing with significantly impacts sexual function,” Dr. Rosbrugh said. “Many women with prolapse have stopped having intercourse because they don’t feel attractive and don’t want to inadvertently hurt themselves. If we can fix their prolapse, if we can fix their incontinence and if we can deal with their pelvic pain, generally they will see drastic differences in their sexual function.”

Early Recognition

Ian M. Rosbrugh, MDIan M. Rosbrugh, MD

Dr. Rosbrugh earned his medical degree from Loma Linda University Medical Center and completed his residency in obstetrics and gynecology at the University of Kansas Medical Center. He is double board certified in obstetrics and gynecology and female pelvic medicine and reconstructive surgery.

Dr. Rosbrugh’s Meritas Health Pavilion for Women colleagues encouraged him to provide this specialized care, acknowledging that Dr. Rosbrugh’s expertise was well-suited for this patient population.

“Dr. Rosbrugh received a considerable amount of training in this area and showed a strong interest in addressing these concerns for our patients,” said James H. Morgan, DO, FACOOG, an obstetrician and gynecologist with the practice. “It was an easy decision to support Dr. Rosbrugh with encouragement to complete the certification process and allow him to practice as a urogynecologist. Our patients have certainly come to appreciate Meritas Health Pavilion for Women’s ability to offer this service within our office. The end result has been earlier recognition and treatment for women with bladder concerns, improving their quality of life for many years to come.”

Treatment

Two outpatient treatment options for patients experiencing overactive bladder symptoms of frequency, retention and/or urge incontinence are percutaneous tibial nerve stimulation and sacral neuromodulation. The latter also benefits patients with fecal incontinence.

“Patients undergoing PTNS have tried physical therapy and medications, but they are not getting any benefit,” Dr. Rosbrugh noted. A TENS unit stimulates the posterior tibial nerve, which causes interference with the nerves of the bladder. This outpatient procedure allows the patient to relax in a recliner and read, while undergoing 12 weekly, 30-minute sessions. After the initial set of treatments, patients have periodic sessions to maintain therapeutic benefit.

A 2011 study published in Female Pelvic Medicine & Reconstructive Surgery , noted that in patients who had failed anticholinergic therapy, PTNS was an effective treatment of overactive bladder, with most improving by six weeks.

Sacral neuromodulation treatment is a two-stage procedure. First, the patient undergoes a trial period of four to five days with temporary leads delivering stimulation at the sacral nerve to thwart symptoms. The minimally invasive procedure lasts about 30 minutes. If symptoms improve after one week, Dr. Rosbrugh implants an InterStim®, which delivers mild electrical impulses to the sacral nerve. The outpatient procedure is performed in about an hour.