Roberta Speyer

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Roberta Speyer:  “Hello, this is Roberta Speyer,  and I’m reporting for OBGYN.net from Lausanne in Switzerland.  It’s July  2, 2001, and we’re here at the ESHRE meeting.  I have the pleasure of  interviewing the two doctors who are organizing the Controversies in  Obstetrics and Gynecology and Infertility meeting in Paris.  This is  Professor Zeev Shoham and Professor Zion Ben-Raphael, and I’d like to  get a little bit of news about what’s going into the preparations for  this Congress.  I had the pleasure of being at the one in Prague, which  was an exceptional Congress.  We had a much larger turnout than had been  expected, did we not?”
       
       Professor Zeev Shoham:  “Yes, we had approximately 1,200 people.”
       
       Roberta Speyer:  “Every time you do this Congress you end up producing a whole book, isn’t that correct?”
       
       Professor Zeev Shoham:  “Yes, it’s the Proceedings of the  Congress.  All the invited speakers will submit chapters of their talk  which will be arranged in the book and distributed to the people who  come to the Congress.”
       
       Roberta Speyer:  “We have the pleasure of having that at  OBGYN.net; we have many chapters from that book published which is an  excellent resource, thank you very much.  What’s special about this  particular meeting compared to last time?”
       
       Professor Zion Ben-Raphael: “We’re talking about state of the art  lectures on quite controversial issues, we’re talking about new details  state of the art       procedure. Basically we’re doing a whole day, two days of  discussion with only the burning, most deep questions that we are  discussing.”
       
       Roberta Speyer:  “So that’s where the controversies come in or  controversies depending on what side of the pond we’re on here, right?   Am I correct that what you’re looking at is issues where there may be  very widely divergent viewpoints in how to treat or manage individual  situations and you’re really delving into it and maybe getting a little  bit of excitement going on here about how two different opinion leaders  might look at the same issue?”
       
       Professor Zeev Shoham:  “Yes, that’s true and actually we will  have very interesting sessions.  We’re going to deal with the use of the  Internet in medicine - a controversial issue in using the Internet  versus the hard copy.”
       
       Roberta Speyer:  “Yes, I had the pleasure of being a Co-Chair with  David Bloomer from Parthenon.  I intend to wipe the floor up with him  personally; we’re going to prove that the Internet is far better than  print.  David seems to think there’s some other opinions there that he’s  going to be sharing, but forget it, we’re going to slay him.”
       
       Professor Zeev Shoham:  “We will also have a session about  evidence-based medicine, how we should approach the study we are doing,  and how this should be interpreted.  Then we will have sessions about  the controversial issue on menopause - HRT treatment.  We’ll have  sessions about infertility, how to treat the patients, and what’s the  best way to treat the patient today.  We will deal with  gynecology/oncology with the top leader in the field.”
       
       Roberta Speyer:  “Who’s that?”
       
       Professor Zeev Shoham:  “Peter Schwartz.”
       
       Roberta Speyer:  “Give us some names of some of the speakers.”
       
       Professor Zeev Shoham:  “Ian Jacobs and Whitehead.”
       
       Professor Zion Ben-Raphael:  “We’ll do laparoscopy.  The whole  program will be on the Internet so people can zip in and see it but I  would like to say something about the degree for organization.   Chair-people were invited to this Congress, and chair-people have a  special job to do.  Each session has three chair-people and they will  get the lecture beforehand.  They will have to prepare questions for the  speakers.  They know exactly what the speaker is going to say so the  chair-people are part of this debate and prepare questions for these  speakers.”
       
       Roberta Speyer:  “Will there be lots of opportunities for the participants to ask questions?”
       
       Professor Zion Ben-Raphael:  “Forty-percent of the time is dedicated for discussion.”
       
       Roberta Speyer:  “Very good.”
       
       Professor Zion Ben-Raphael:  “So sixty-percent is lecture but forty-percent is discussion.”
       
       Professor Zeev Shoham:  “We want the audience to be very active  during the time of the session, and we actually want the interaction  between the audience and the speakers.”
       
       Roberta Speyer:  “Very good, so what do we have planned for fun  over there in Paris?  All work and no play makes Roberta a dull doll.”
       
       Professor Zion Ben-Raphael:  “I think some of the fun is one of  the sessions that was organized by Steve Corson.  He came up with a  special session; he got five or six of the leading companies who have  new high-tech pieces for endometrial ablation and he gave them  guidelines.”
       
       Roberta Speyer:  “Who are we probably talking about here?”
       
       Professor Zion Ben-Raphael:  “Novacept, Microsulis, Gynecare, and  laser ablation - all of them.  He gave them guidelines on how to present  their results; each one has to comply with the guidelines, and each one  has to present the results in the same way.  The audience, him, the  chairman, and everybody together will be able to judge which one has  really made the most impact in the last year or two.”
       
       Roberta Speyer:  “That sounds very interesting and very clever of  Dr. Corson because now he’s got them doing all the work and he gets to  sit out in the audience and ask questions.  I think I should have done  mine that way; I’m very envious.  So which presentation do you think is  really interesting and you’re looking forward to seeing?”
       
       Professor Zeev Shoham:  “I think most of the sessions are very important and are very interesting.”
       
       Roberta Speyer:  “Yes, but come on, you got to have one you like.”
       
       Professor Zeev Shoham:  “No, no, I tell you the main issue of this  Congress is that the whole issue of our field will be discussed within  the meeting so people who are dealing with infertility will have for the  first time the opportunity to go just to listen for one or two sessions  in oncology or perinatology to gain knowledge about what’s going on  with the fields that they are not doing or interacting in their daily  life.  So people will have the possibility to interact and to listen to  other kinds of sessions or lectures that they are not used to hearing in  their daily life…”
       
       Roberta Speyer:  “All the time.”
       
       Professor Zeev Shoham:  “All the time and that will...”
       
       Roberta Speyer:  “Broaden their horizons.”
       
       Professor Zeev Shoham:  “Right.”
       
       Roberta Speyer:  “What about the social program?”
       
       Professor Zion Ben-Raphael:  “Socially, I can tell you at least one thing and that is lunch is free.”
       
       Roberta Speyer:  “We’ll all be there - the entire viewership of  OBGYN.net will show up at least for lunch but we want to make sure you  register for this Congress because this is a great Congress.  You can  register right on OBGYN.net right under where you click to see this  interview.  Just click and go sign up because if you don’t and you miss  this  - be there or be square.  You miss an event.”
       
       Professor Zion Ben-Raphael:  “Usually they will have to wait a full year.”
       
       Roberta Speyer:  “A full year. Where is it going to be - in Washington?”
       
       Professor Zion Ben-Raphael:  “Yes, in Washington.”
       
       Roberta Speyer:  “With Professor Alan DeCherney?”
       
       Professor Zion Ben-Raphael:  “DeCherney and Lobo.”
       
       Professor Zeev Shoham:  “It will be Roger Lobo and he will be the  Chairman.  Then we will have half sessions which are Professor Alan  DeCherney and Professor Mary D’Alton.”
       
       Roberta Speyer:  “But I want to know are we going to do anything  in Paris; are we going to have any little rides on the Seine or French  fries or something?”
       
       Professor Zion Ben-Raphael:  “We’re probably going to surprise you.”
       
       Roberta Speyer:  “He wants to surprise us but there will be some good stuff, right – social events?”
       
       Professor Zeev Shoham:  “Yes.”
       
       Roberta Speyer:  “I know we had some fun in Prague.  I’m really  looking forward to this event and we’re going to be doing some  broadcasts from it afterwards but you certainly want to make sure you’re  there.  Don’t just watch it later because I go to a lot of conferences  in my job and I have to tell you the last one I went to that was in  Prague was an excellent conference.  Everyone that goes to it really  gets a lot out of it.  It’s an excellent clinical conference so please  come to the conference, we’ll see you in Paris.”
       
       Professor Zion Ben-Raphael:  “We agree on that.”
       
       Roberta Speyer:  “Thank you, doctors.”     

Articles

OBGYN.net Conference CoverageFrom the ESHRE 2001 Conference - Lausanne, Switzerland

Controversies in Obstetrics, Gynecology, and Infertility

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Roberta Speyer, President of OBGYN.net interviews MH Lee, PhD, CEO of Medison, on the recent acquisition of Kretztechnik Austria by GE

Sound Off

2 1/2 Year Follow-Up of Weight Loss Surgery Video

 “Hi, this is Roberta Speyer, and I’m doing a follow-up after two and a half years of having my adjustable LAP BAND surgery in Frankfurt. In that time, I’ve had a lot of e-mails from a lot of people that have wanted to know about the surgery, especially since it’s now been approved for the United States and that happened in April of 2001. I thought it would be nice to explain. A lot of people said they’d like to know what’s it like now, two and a half years after the surgery; what am I feeling, and would I do it again so I’m going to address some of those questions.

First of all, am I glad I did it and would I do it again – yes, I’m absolutely delighted I did it and I would do it again in a New York minute. There was no way I was ever going to lose ninety pounds which is the amount of weight I’ve lost and then with no effort whatsoever keep that ninety pounds off consistently for a year and a half. That was not going to happen in my life. I know you can say I could have exercised, I could have gone on diets, and I could have done this or that. I could have done a lot of things but apparently I hadn’t done them by the time I was in my mid-forties so it didn’t look like they were going to happen anytime soon. This worked for me.

How did it change my life? Physically, a lot of aches and pains I had like backaches, ankles, and knees, all those problems disappeared - I don’t have them anymore. I have more energy, and I feel more comfortable moving around through this space that I occupy in the world. Would I like to lose more weight? I lost about 80% of the weight I wanted to lose. I wanted to go down from 270 to 160, and I sit consistently at 180 now for a year and a half. I think I could lose additional weight if I’d reduce the amount of fat intake in my diet. I tend to travel a lot for my job, and I eat in a lot of nice restaurants and of course that’s usually fatty food. Probably, I also could decrease more if I didn’t consume alcohol. I like to have cocktails so the question is do I want to lose the twenty pounds or do I want to have my cocktails and my fatty foods - and I guess at this point it’s probably the latter rather than the former. However, I’m not unhappy at this weight so for me this has been a success even if I only lost 80%. If I was willing to put in more effort I believe I could have lost the entire 100% of weight that I was looking to lose when I went into this odyssey two and a half years ago.

Do I feel it, do I feel different, and how does it affect my life? People ask me those questions sometimes. First of all, you don’t feel the device anymore than you feel, I guess, contact lenses or anything else a person might get like a new filling and they play with it with their tongue but after a while you get used to it. You don’t really feel the device there. If I eat too fast or don’t chew my food well enough, which sometimes is the case, or I eat something that’s very fibrous I might get a blockage right where the band is inserted around the pouch of the stomach that’s created and then nothing will go through. At that point, usually you end up having to throw up.

Is it nasty, terrible, or awful? It’s not like throwing up when you imagine it when you’re sick, you’ve had the flu, or you’ve got a hangover. This is more like it’s in and it’s out and it’s very quick. It really hasn’t had the opportunity to become digested with stomach acids so it’s not horrible, and at that point you really don’t have much of a choice. I’ve never had a case where I couldn’t get to a bathroom. It’s not like it comes over you like a wave; you know something is stuck and you’ve got to go get rid of it so you go to the bathroom. I put my finger down my throat, it comes up, and that’s the end of it and we move right on from there.

How often does that happen for me – that probably happens about once a week. I can go weeks without it happening or I can have it happen a couple of times in the same week but if we wanted to average it I’d say once a week.

How did it affect me emotionally? When I first started losing the weight I was just delirious, I mean, this was something that I couldn’t get over. I was buying new clothes, I bought a new car, I was getting my nails done all the time, and my hair done. It was wonderful but it did have some ramifications with my family and that is that someone who had prior to that been entirely focused on them and on the home and the house suddenly had a new toy. My new toy was myself and I wanted to focus all my energy and attention on myself - buying new clothes, doing things, and enjoying myself in ways that before this just hadn’t been physically or emotionally possible. So it did have some repercussions in my relationships; I became very selfish and self-centered for a period of about a year and it caused some problems with my relationships with my family. Now in the time that’s intervened since then I’ve come back down to earth, and I no longer am quite as excited about it. I’m used to it, it’s just who I am now, and my relationships have gone back to being pretty much what they were prior to surgery but there was that so I would say to anybody that was thinking about having this surgery to anticipate that it is a life altering thing to lose that much weight and it is going to affect you not just physically but emotionally.

So if you start feeling different, expect it, and also that people’s perception of you is a certain way. You behave and look a certain way and you do certain things, maybe you sometimes did some of those things to compensate for being overweight. When you lose the weight and you change, it changes a little bit the way they see you and maybe it makes them feel nervous or uncomfortable about their value or importance in your life.

So those were just some of the things I think I would bear in mind; it is a big change and it will change relationships and you have to try to understand that and not expect that not to happen. We’ve covered emotional, we’ve covered hyperemesis - that’s throwing up for those of you who don’t know, and we’ve covered how I feel about it. I didn’t have any diabetes or high blood pressure or any of those types of problems prior to surgery so I can’t really address those though I know there are other people who have had the surgery and it certainly has helped with those. I think in looking back over it the only thing I could possibly say is I wish it had been available sooner and I wish I had done it sooner. I think that anyone thinking about doing this surgery if they’re quite substantially overweight or have problems with losing or keeping weight off and if those problems tend to be more related to the amount of food they consume rather than the fact that they’re a sweets eater then I think they’re probably a good candidate and should look into this.

It’s reversible and people have asked me - when are you going to have it removed? I said they’d be tearing it out of my cold, dead hands; I’m never going to have it reversed. I don’t want to because in a year or two I would be back to 270 pounds and maybe beyond. That was my fate, and I really feel that this surgery gave me a new chance to have a new life and I am very glad I did it. I hope any of you that do it have as much success as I did. My only advice about surgeon selection is because it’s a new procedure people are getting proctored by surgeons from Europe and Latin America. It’s new in the U.S. so it’s difficult for people to go and get someone who’s had a lot of experience. It is possible to have the surgery done in Mexico, and some of those surgeons are the ones who are training the U.S. surgeons. So it’s perfectly conceivable to go down there, and if you’re paying out of pocket, it is less expensive. I had it done in Germany with an excellent surgeon, and a lot of plans do cover it now in the United States. I think this is the thing of the future for anybody who has chronic weight problems, and I wish you all a great deal of success. Thank you.”

At this time, three years post-op, Roberta is satisfied with the outcome of her surgery and hopes you have found her story helpful in your search for answers. Please direct any questions about LAP BAND surgery to your personal physician, or email the product makers directly at: 

http://www.inamed.com/contact/bio_patient.cgi

.  Due to time restraints Roberta Speyer and the OBGYN.net team cannot respond to personal emails.

2 1/2 Year Follow-Up of Weight Loss Surgery

Roberta Speyer:   “Hello, today we’re talking with Dr. Fleischman about urinary  incontinence.  This is Roberta Speyer of ObGyn.net, and I have the pleasure today to be talking to a specialist  who deals with urinary incontinence in America.  Dr. Fleischman could  you tell us a little about yourself and your practice?” 

  “Sure.  I’m  currently in private practice in New Haven, Connecticut with Gynaecology  and Infertility and I’m a Clinical Instructor of Obstetrics and  Gynaecology at the Yale University School of Medicine.”
 
 

 “What about urinary  incontinence in America?  What’s the landscape?  Why has your practice  chosen to diagnose and treat urinary incontinence?  Is this something  new or is this something that’s not new but something we are hearing  more about?” 
 
 

  “I think it’s  definitely not new. It’s something we’re certainly hearing a lot more  about these days. I think when you look back on the statistics of it;  it’s fairly poorly documented in terms of how prevalent this disorder  is. We know it’s somewhere, depending on which study you’re looking at,  it’s about 10-50% of women will report urinary incontinence. Certainly  something that increases with increasing age and when you get up to  women over 64 it can be as high as 40 to 50% of the population of the  community. When you look at nursing homes it’s even greater than that,  about 50% of women who are living in nursing homes will leak urine.” 
 
 

 “Is this more prevalent in women than in men?” 
 
 

  “It certainly is more prevalent in women than in men.  It is a problem in men but not nearly as common.” 
 
 

 “What are the contributing factors to that?” 
 
 

  “Well there  are several factors. One, we certainly know that childbirth can have an  impact on it.  About 50% of women who have had vaginal deliveries will  experience some form of prolapse at some point in their future.  Unfortunately we know from most of the data that’s out there that a  small portion of those women will actually seek care. There are other  issues related to estrogen levels. There’s issues related to age and  general atrophy of the vaginal mucosa. I think the other big issue, at  least in our society today, is that the largest segment of the aging  population is the over 85 group. So when you’re dealing with a largely  increasing elderly population you’re seeing this as becoming a more  prevalent disorder.” 
 
 

 “It would be  interesting I think for the woman listening to this interview, and  certainly for the clinicians, if you could explain to us a little bit  about the typical work up for urinary incontinence?  And also include in  that, I believe as a layperson, I’ve heard that there are different  types of urinary incontinence.  Urinary incontinence isn’t one specific  problem but may be urge or stress.  So if you could fill us in a little  bit on what the different types are and how you do a work up to decide  how to treat, I think that would be very helpful to our audience.”
 
 

  “Sure.  I  think the first thing to realize about urinary incontinence is yes,  there are different types.  There’s what we refer to, and I will go into  detail a little on each of these, as genuine stress incontinence, which  typically the symptoms are leaking of urine when you laugh, cough,  sneeze, you do something with heavy lifting and it’s an involuntary loss  of urine. The second type that’s fairly common is what we call urge  incontinence or what’s also known as detrusor instability or overactive  bladder. This is more related to not as much of a structural problem  where the bladder is falling or there’s a change in the angle, but with  the muscle of the bladder.” 
 
 

 “The first type would be more of a structural problem?” 
 
 

  “Correct, and  the second, the urge incontinence is more related to what we call  overactive bladder where the muscle in the bladder is actually  contracting on its own when you don’t want it to. So an involuntary  contraction of that bladder, which gives people a sense of urgency where  they feel like they have to go to the bathroom immediately.  They can’t  wait, they get to a point and they say they need to be in a bathroom  right now, and sometimes they will leak from that.” 
 
 

  “There are  various receptors on the bladder which are either stimulated to cause  the bladder to relax or stimulated to cause the bladder to contract and  we’re not sure exactly why but in certain people they develop an over  activity of that muscle where it begins to contract on its own. There  are various reasons some can be medication. A lot of women who are put  on medications for other medical problems, such as blood pressure  medication, sometimes medications for depression can actually stimulate  the bladder or relax the bladder and cause some of these urgency  symptoms. We know that women who have severe vaginitis, if you actually  have a really bad yeast infection or bacterial infection of the vagina,  that inflammation in the vagina can actually cause some irritation of  the underside of the bladder and cause women to have urgency and  frequency symptoms at that time. So, having the symptoms, per se,  doesn’t necessarily mean it is an overactive bladder there can be other  things.  That is traditionally treated with more of a medication.” 
 
 

 “I, Dr. Fleischman,  actually had that problem and that’s why I can appreciate what you’re  saying about women going with these problems for a number of years.  I  probably had that problem for four or five years and just thought that  was because I had had children and that’s the way it was and then I  actually explained it to my physician and was treated with a pill for a  three month period of time and after that, cured.  What’s happening  during that cure, is it just you are re-educating your brain?” 
 
 

  “It’s hard to  say exactly why people don’t seek help for this.  I don’t know if it’s a  generational thing. It’s the most common complaint when I speak to most  patients. I make sure in my initial work up that in the general routine  physical exam I ask them about their urinary symptoms and the most  frequent thing they respond to me is ‘Well, yes of course, but that’s  just the way it is.’ And it’s not until you really tell them that ‘Well,  it doesn’t have to be that way and those are not necessarily normal  symptoms and we can do something about it’, that women really want to do  anything.” 
 
 

 “So is that part of  when you’re doing a work up for urinary incontinence, first of all they  have to identify that indeed they have a problem?” 
 
 

  “Right, and I  would say for me in a general ObGyn practice the way I picked up most of my incontinence work ups  actually started with a routine physical exam.   Some women come in for  their routine pap smear, who, during my review of symptoms, when I ask  them what’s going on, I always make sure I talk about general symptoms,  whether it’s vaginal pressure, whether its prolapse symptoms, but  specifically I make sure I address urinary issues. Do they leak when  they laugh, cough or sneeze, do you ever feel like you have to go to the  bathroom and when you go there’s not much there, are you getting up in  the middle of the night more than three or four times to go to the  bathroom, those sorts of symptoms. In that initial review, if any of  those things are positive, then we move on to what would be more of a  clinical work up for incontinence. 
 
 And when I talk about the clinical work up it’s very important to start  out with any time you’re talking about incontinence you want to get into  a history and figure out exactly what their history is. How long have  these symptoms been present? Is this something that just started this  year, is it something that has been going on for three years and it’s  gotten progressively worse, or is this something that happened last  week? I’ve had patients, elderly women, who suddenly developed urinary  incontinence out of nowhere.  It turns out that it’s just a bladder  infection but they didn’t get the typical symptoms they had when they  were 25 or 30 with their bladder infections, rather incontinence was  their presenting symptom. You treat the infection and they don’t leak  anymore. You want to make sure what brings on the incontinence, what  makes it better, is there anything that makes it better.  You want to  make sure you get into a good history of their drug medications that  they’re on, you want to get into childbirth history, and you want to get  into neurologic findings. There are women who had neurologic impairment  secondary to either things such as multiple sclerosis and diabetes  where they actually have some nerve damage which could entail abnormal  bladder function.” 
 
 

 “So tell us a little bit about something that’s fairly new and we don’t hear very much about, urodynamics.  Is this something that you could share with us?  How does that fit into your treatment decisions?  What are urodynamics?” 
 
 

  “I will tell  you what, let me step back a second just to get into this.  Before I’m  going to do any work deciding about urodynamics I really want to make  sure I do a thorough physical exam and that’s important any time anyone  is evaluating someone for urinary incontinence. You want to make sure  that there either is or is not pelvic prolapse associated with the  incontinence because if you are going to get into repairs at some point,  and we’ll talk about that a little later, you want to make sure that  you know what other issues are going on in the vaginal area. If they  have prolapse you often have to need to fix that at the same time you’re  going to fix their incontinence, if it’s something that can be  surgically repaired. We want to check a urinalysis and culture always to  make sure that there is no evidence of bladder infection and you  typically will check what’s called a post-void residual. You have the  patient empty their bladder and then you want to see whether or not they  do a good job emptying their bladder when they voided.  A lot of women  will have what’s called over-flow incontinence where they actually think  they empty their bladder and they still might have 200ccs in there, so  they clearly have a problem with the bladder actually emptying.” 
 
 

 “If you were using a measuring cup, what are 200ccs – maybe a tablespoon a teaspoon?” 
 
 

  “Oh, no, no, no, 200ccs would be more than a cupful.” 
 
 

 “Oh my goodness!  And they still have that much?” 
 
 

  “There are  some women that will have that type of symptom, but that typically, if  I’m going to see that, that tends to be in women that are significantly  older.  I rarely see that in my 40 to 50 year-old group but more like  those 70 years of age.” 
 
 

 “So what do you see in your 40 to 50 year-old group which is a large portion of the folks on the Internet that are using OBGYN.net.” 
 
 

 “I would say  in the 40-50 year-old group we’re talking primarily about overactive  bladder and genuine stress incontinence. Those are the two major  things.” 
 
 

 “So what can we do now with these two problems?” 
 
 

  “When a  patient comes in and has these things, the next thing we talk about is,  again, how do we know what the right diagnosis is? If someone comes in  to me the first time and really just has traditional urgency symptoms,  ‘I can’t make it to the bathroom, I feel like I always have to go’ and,  you know, ‘I’m constantly running there, I get up in the middle of the  night, multiple times a night’, that really tells me they have more  symptoms than overactive bladder.”
 
 

 “So it is the urge, the urge incontinence?”
 
 

  “With some  people you have to understand it’s not always urge incontinence, meaning  that they might not leak but it’s still something that impacts their  quality of life. If you have an overactive bladder but if you have a  very good functioning sphincter, ural sphincter, your bladder is  functioning well, you could have those symptoms and not actually leak  yet.  So if you leave it alone, at some point it might develop into a  leakage issue and most patients will say, ‘Well I have the urgency  frequency but it’s rare, but occasionally, maybe once every two, three  weeks, I might leak a little bit.” 
 
 

 “My feeling was the  closer you got to a toilet, the more the urge came on.  So my problem  was by the time I got there it was right at the end.”
 
 

  “The first  kind of symptoms really go along with more than overactive bladder.  If  someone comes in to me with strictly overactive bladder symptoms and  doesn’t really leak except when they are very close to the toilet I’m  going to start them out on a medication to treat overactive bladder  before I consider urodynamics. When you are talking about urodynamics,  what urodynamics are, just to define them, urodynamics are actually a  physiologic exam that looks at the functioning of your entire lower  urinary tract system. What that means is that typically there are  catheters, one that normally goes into the bladder and one that goes  into the vagina.  What you do is, you are trying to look at the function  of the bladder and the urethra during a sort of physiologic state. In  other words I’m going to fill the bladder with saline or with water,  sterile water, add a catheter that is measuring pressures in the bladder  and the urethra. At the same time I have a catheter in the vagina which  measures pressures in the abdomen because, again, when someone leaks  urine the reason that they leak is because there is an increase in  pressure in the abdominal cavity such as coughing, laughing, sneezing or  bearing down that overcomes the ability of the bladder to prevent it  from leaking. So you want to measure what your pressure in the bladder  is and what your pressure in the vagina is and this way you can figure  out what pressures make someone leak.  Going back to urge incontinence,  I’m going to put that off the table for now, because I generally, in  someone who just has urge incontinence, I will try to treat them  medically.” 
 
 

 “No, of course, if  you can treat something easily you’re going to do that but in a lot of  cases this problem is probably multifaceted and you have to really get  in there and figure out what the problem is.” 
 
 

  “So the goal  of your urodynamics is really to objectively reproduce the affects of  the bladder function so you can figure out what exactly you want to do.”
 
 

 “Am I correct,  you’re now able to look at what’s going on and get some types of  measurements so that you can maybe take apart the problem and  reconstruct it and understand what exactly the problem is?” 
 
 

  “Right.   Rather than taking a shotgun approach and just throwing out all these  different treatments to try to fix it, you try to objectively determine  where the exact problem lies and then come up with a treatment plan that  will deal with that individual problem rather than just trying to fix  everything and hope you get the right thing.”
 
 

 “Some of these fixes include surgery correct?” 
 
 

 “So you don’t want to be doing surgery that you don’t need to do or that isn’t the correct surgery.” 
 
 

 “Exactly. What  you are looking at is what we call multi-channel cystometry or  urodynamics. Really, there are several indications; I’ll briefly go  through some of them why you would do it.  I do it in patients who have a  really complicated history. Something that’s not just as  straightforward ‘I leak or I don’t leak.’ There are other medical  problems, there are other things going on. Whether the patient has  symptoms of stress incontinence and I’m thinking that surgery might be  in my decision treatment plan, I then go ahead.  Anyone who is going to  the operating room I want to make sure I have the right diagnosis before  I do the surgery and so I do urodynamics. If someone has urge  incontinence or they have detrusor instability, overactive bladder, any  one of those sort of same ideas, the urgency symptom, but I’ve been  treating them medically and they’re not getting any better, in those  patients I’m going to do urodynamics.  If they have had previous  surgery, let’s say someone had a procedure done five years ago, six  years ago, seven years ago for urinary incontinence, they were dry for a  few years and now they’re leaking again, before I go back in to repair  it I want to make sure I know why exactly they’re leaking again. So  those are the patients you would do it on.” 
 
 

 “A woman that comes  in and has this type of a work up is going to be able to then get a much  better personalised treatment plan.” 
 
 

  “Right, to be  honest, in my practice the thing I find the most beneficial on a  day-to-day basis with urodynamics is the ability to objectively show a  patient exactly what’s going on. Look, you have the pain when this shows  up on the monitor and the urodynamics set up I have in my office uses  some fiber optic cables, attaches to a unit which then attaches to a  laptop computer so I can have an actual printout of what’s going on  physiologically as we’re doing the study, it actually shows itself on  the computer screen.” 
 
 

 “If you had to sum  it up I think you’re trying to tell them don’t put up with this, this  isn’t normal.  But let me let you put it into your own words and we’ll  finish with that.” 
 
 

  “If I could  sum it up I would say the most important thing is, this is not normal.  Leaking urine, getting up in the middle of the night several times a  night, feeling like you constantly have to go to the bathroom, urgency,  frequency, all those things, they are not normal. These are not things  that you just say ‘I’m getting older and therefore this is a normal  occurrence.’ Urinary incontinence is a quality of life issue. And there  is no reason that a young woman in her 40s, 50s and even 60s and 70s  should have to leak urine when they don’t want to. There are treatments  out there, your doctors will know about it. So if you want to do  something about it just ask them and if your physician is not someone  who deals with this on a daily basis they can certainly refer you to an  individual who will be able to deal with it. There are physicians all  around the country who do this on daily basis. Some urologists, what we  call urogynecologist, and then a lot of general Ob/Gyns take care of this.  So, this is not something you should be living with. It’s something you  can have fixed and it’s fixed rather easily these days.” 
 
 

  “Thank you very much for this insight for women Dr. Fleischman.” 
 
 

Roberta Speyer

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