Experts in Urogynecology

Newton-Wellesley Hospital has experts in urogynecology, both within its independent medical staff and through its collaboration with Brigham and Women’s Hospital. NWH provides the most advanced urogynecological care to women who suffer from problems related to various pelvic floor conditions. Urogynecology involves the diagnosis and treatment of urinary incontinence and female pelvic floor disorders, which are very common among women.

Vatche Minassian, MD, MPH, Urogynecologist at Newton-Wellesley specializes in urogynecology and reconstructive pelvic surgery and the treatment of pelvic prolapse, urinary incontinence and advanced pelvic surgery. Dr. Minassian and his team help women regain their quality of life through a variety of treatment options.

“Many women are reluctant to receive help for these conditions and suffer in silence because they think it is a normal part of aging or side effect of childbirth, but that is not true,” says Dr. Minassian.

“Many women are bothered by a loss of bladder control, bowel symptoms and pelvic discomfort and are often not aware that these problems have very effective treatment options.”

The team at Newton-Wellesley specializes in the treatment of a wide range of urogynecologic conditions including:

Urinary Incontinence
Stress urinary incontinence is one of the most common types of incontinence and is characterized by urinary leakage during activity such as coughing, sneezing, exercising, lifting and laughing. Urgency urinary incontinence, often known as overactive bladder (OAB) is another type of incontinence where women have leakage of urine associated with bladder spasms and a strong desire to urinate. Some women have mixed incontinence where both stress and urgency urinary incontinence co-exist.

“As the condition progresses, it can even occur with simple acts such as bending and walking,” says Neeraj Kohli, MD, MBA, Urogynecologist at Newton-Wellesley. “This condition is due to an anatomic weakness of the bladder neck, which maintains the seal of urine during activity. Urinary incontinence can result from a variety of conditions including vaginal childbirth, aging, menopause and obesity. Women may also experience accidental bowel leakage.”

The primary treatment may involve pelvic floor exercises or minimally invasive surgery. Surgery can often be done on an outpatient basis without the need for general anesthesia.

Pelvic Prolapse
When the muscles and ligaments supporting a woman’s pelvic organs weaken, the pelvic organs can slip out of place known as prolapse. These may include a dropped bladder, rectum or uterus. Some women develop pelvic organ prolapse after childbirth, a hysterectomy or menopause.

Overactive Bladder
Overactive bladder is a bladder condition related to problems with storage of urination. The primary symptoms include frequent urination, frequent interruptions of sleep because of the need to urinate and unintentional leakage of urine associated with a strong desire to urinate. Overactive bladder can result from dietary factors (bladder stimulants such as caffeine or alcohol), increased fluid intake, drug side effects, urinary tract infections and nerve dysfunction (associated with nerve trauma, diabetes, multiple sclerosis or spinal cord injury). Primary treatments for overactive bladder include behavioral interventions and medications. Botox has recently been approved for treatment of OAB that is nonresponsive to conservative therapies.

The experts at Newton-Wellesley specialize in the most innovative surgical and non-surgical treatment options for these urogynecologic conditions including minimally invasive procedures.

“We meet with each patient to develop an individualized treatment program for her specific diagnosis,” says Dr. Kohli. “Many patients think that the diagnosis and treatment of pelvic floor conditions is uncomfortable and invasive, but we strive to put our patients at ease and make the whole process as easy as possible.”

When a patient comes to Newton-Wellesley for an initial appointment, the diagnosis starts with a complete history and physical exam, which can often determine the cause of her condition. In cases of mild incontinence, pelvic floor exercises and physical therapy may result in significant improvement.

“Newton-Wellesley also offers a comprehensive pelvic floor physical therapy program as a nonsurgical option,” says Dr. Kohli. “Specially trained physical therapists work to teach patients techniques to improve the muscles and nerves of the pelvis.”

In cases of moderate to severe incontinence, surgery is often the best option. “We review the details regarding a patient’s frequency and amount of urination as well as urinary leakage,” adds Dr. Minassian. “A voiding diary is sometimes given to the patient to record how much she drinks and voids, and to understand specifics regarding leakage episodes. The physical exam includes a detailed pelvic exam. Office-based testing can help to further determine and characterize urinary incontinence.”

One of the most common procedures currently performed involves a suburethral sling. During the procedure a small permanent tape is inserted underneath the urethra, which acts as a hammock and prevents movement during activity.

“Treatment options have improved greatly over time for pelvic floor conditions. Our team provides advanced vaginal or laparoscopic minimally invasive surgical techniques performed as outpatient procedures and our patients can go home the same day,” adds Dr. Minassian. “Woman can experience significant improvement in their symptoms with appropriate diagnosis and treatment. There are many misconceptions about these conditions and we encourage women to discuss their symptoms and concerns with their physician. We want all of our patients to enjoy everyday activities without worry, bother or impact on their quality of life.”

For more information about the programs and services offered at Newton-Wellesley Hospital, call CareFinder at 1-866-NWH-DOCS (694-3627) or visit www.nwh.org.

Neeraj Kohli, MD, MBA
Urogynecologist at Newton-Wellesley Hospital

Dr. Kohli received his medical degree from Boston University and completed his residency at Beth Israel Deaconess Medical Center. He completed his fellowship in urogynecology and reconstructive pelvic surgery at Good Samaritan Hospital, Cincinnati, Ohio. Dr. Kohli is board certified in obstetrics and gynecology. He is in private practice at Newton-Wellesley Hospital.

Vatche Minassian, MD, MPH
Urogynecologist at Newton-Wellesley Hospital

Dr. Minassian received his medical degree from American University of Beirut and completed his residency at UCLA - Olive View and University of Iowa Hospital & Clinics. He completed his fellowship in urogynecology and reconstructive pelvic surgery at the University of Toronto - Mt. Sinai Hospital. Dr. Minassian is board certified in obstetrics and gynecology, as well as in female pelvic medicine and reconstructive surgery. He is Chief of Urogynecology at Brigham and Women’s Hospital.

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