Mona Lisa Touch for Peri and Postmenopausal Women

“It” refers to the changes in gynecologic health and it happens to a majority of women.

Now there’s something you can do about it that is clinically proven to bring relief. Patients are calling this new treatment “life-changing.”

MonaLisa Touch laser therapy delivers a virtually painless treatment that takes less than 5 minutes. It delivers both immediate and lasting relief. And it’s clinically proven to work.

  • In-office, requires no anesthesia
  • Minimal side effects
  • No downtime
  • Symptom relief after just one treatment
  • 3 easy treatments, 6 weeks apart
  • Thousands of women successfully treated since 2012

We’re very pleased to announce that we’re now offering MonaLisa Touch treatment to our patients onsite at our practice.

Call our office at 973-537-5557 to schedule a consultation or contact us to find out if Mona Lisa is right for you and take advantage of our special offer!



“It” refers to the changes in gynecologic health and it happens to a majority of women. Now there’s something you can do about it that is clinically proven to bring relief. Patients are calling this new treatment “life-changing.”

MonaLisa Touch laser therapy delivers a virtually painless treatment that takes less than 5 minutes. It delivers both immediate and lasting relief. And it’s clinically proven to work.

  • In-office, requires no anesthesia
  • Minimal side effects
  • No downtime
  • Symptom relief after just one treatment
  • 3 easy treatments, 6 weeks apart
  • Thousands of women successfully treated since 2012

We’re very pleased to announce that we’re now offering MonaLisa Touch treatment to our patients onsite at our practice in Denville and Whippany, NJ. 

Call our office at 973-537-5557 or contact us in the “Have a Question” spot below to schedule an appointment.

MonaLisa Touch is a registered trademark of DEKA M.E.L.A. Srl – Calenzano – Italy.
Cynosure is a registered trademark of Cynosure, Inc. ©2015 Cynosure, Inc.


Specialized Women’s Health Blog


2/10/14 Top 5 Myths about urinary incontinence

  1. Incontinence is a “normal” part of aging
  2. It is “normal” to wake up at night to urinate
  3. Urinary incontinence only happens to older women
  4. It can’t be prevented
  5. Incontinence usually requires surgery to be fixed.


10/2/13 Nervous to go to the Doctor? You’ll be fine

Every patient comes into the office with different expectations. It is rare that patients come to see me and are excited to be there. Nobody enjoys going to the doctor—this is the basis for what we call “white coat hypertension”, or an elevated blood pressure when people enter the office.

I’ve always prided myself on making patients feel comfortable from the moment they start their journey to our office. Our staff is extremely friendly and even on the phone are able to reassure patients that everything will be okay. Our office will make patients more comfortable, by providing services in a comfortable setting.

So what should you expect when you see the urogynecologist? Well, many of the conditions we deal with involve the female pelvis. Therefore, you’ll almost definitely be getting a pelvic exam—just like at the general gynecologist. Plan on spending about 30-45 minutes for your first visit, as it is important that we take time to evaluate you and interview you.

We expect that you will have an enjoyable and educational experience in our office. If we don’t meet your expectations, then please let us know.

9/3/13 FDA Approves Botox for Overactive Bladder

The U.S. Food and Drug Administration today expanded the approved use of Botox (onabotulinumtoxinA) to treat adults with overactive bladder who cannot use or do not adequately respond to a class of medications known as anticholinergics.

Overactive bladder is a condition in which the bladder squeezes too often or squeezes without warning. Symptoms include leaking urine (urinary incontinence), feeling the sudden and urgent need to urinate, and frequent urination.

When Botox is injected into the bladder muscle, it causes the bladder to relax, increasing the bladder’s storage capacity and reducing episodes of urinary incontinence. Injecting the bladder with Botox is performed using cystoscopy, a procedure that allows a doctor to visualize the interior of the bladder while Botox is being injected.

“Clinical studies have demonstrated Botox’s ability to significantly reduce the frequency of urinary incontinence,” said Hylton V. Joffe, M.D., director of the Division of Reproductive and Urologic Products in FDA’s Center for Drug Evaluation and Research. “Today’s approval provides an important additional treatment option for patients with overactive bladder, a condition that affects an estimated 33 million men and women in the United States.”

Botox’s safety and effectiveness for this new indication were established in two clinical trials of 1,105 patients with symptoms of overactive bladder. Patients were randomly assigned to receive injections of 100 units of Botox (20 injections of 5 units each) or placebo.

Results after 12 weeks showed that patients treated with Botox experienced urinary incontinence an average of 1.6 to 1.9 times less per day than patients treated with placebo. Botox-treated patients also needed to urinate on average 1.0 to 1.7 times less per day and expelled an average of about 30 milliliters more urine than those treated with placebo.

Treatment with Botox can be repeated when the benefits from the previous treatment have decreased, but there should be at least 12 weeks between treatments.

Common side effects reported during clinical trials included urinary tract infections, painful urination, and incomplete emptying of the bladder (urinary retention). Patients who develop urinary retention may need to use a catheter until the urinary retention resolves. Patients being treated for overactive bladder with Botox should not have a urinary tract infection and should take antibiotics before, during, and for a few days after Botox treatment to lower the chance of developing an infection from the procedure.


Laser Vein Therapy for Varicose Veins, Spider Veins, Hemangiomas

Price based on time (per session), 15-30 min $500

Note: Fees listed above are per session of treatment and are current as of April 1, 2014. You may book packages and be able to save. You must obtain a free consultation prior to any laser therapies. Please contact our office at 973-537-5557 to schedule an appointment.


Pelvic Floor Muscle Rehabilitation Program for Women

Pelvic floor muscle rehabilitation is a systematic approach for improving strength of the pelvic muscles. These muscles may be damaged due to childbirth, prior surgery, aging, and several other factors. The “pelvic floor” muscles are very important structures in the pelvis which are responsible for supporting the female pelvic organs (uterus, rectum, bladder). Pelvic floor muscle rehabilitation uses many of the same principles as physical therapy for other damaged muscles in the body.

What types of conditions can be helped with pelvic floor muscle rehabilitation?

Any condition which arises from damaged or weak pelvic floor muscles may be treated with pelvic floor rehabilitation. The most common conditions we treat with pelvic floor muscle rehabilitation is urinary incontinence, urinary frequency, urgency, and fecal incontinence. Women with pelvic pain due to pelvic muscle spasm may also benefit from this therapy.

  • The pelvic floor muscles are comprised of the levator ani muscles, which include the pubococcygeus, puborectalis, and iliococcygeus muscles.
  • The pelvic floor muscles are responsible for assisting in urinary and fecal continence.
  • These muscles can be damaged after childbirth and previous pelvic surgery. Likewise, they may be weakened as a result of aging and menopause.

Where is this treatment performed?

Currently, we offer this therapy at our Whippany office.

What is “biofeedback?”

Biofeedback is a process which enables an individual to learn how to change physiological activity for the purpose of improving health. Precise instruments measure physiological activity such as muscle activity, which then “feeds back” information to the brain. Biofeedback has been used for urinary problems for decades.

What is “E-stim?”

E-stim is electrical stimulation which is applied to muscles in order to cause them to contract. When combined with biofeedback, it can provide significant improvements in the ability of patients to use their pelvic floor muscles to stay continent.

What is involved with the Pelvic Floor Muscle Rehabilitation and E-Stim program?

You will be scheduled to have approximately 20-30 minute sessions weekly, for a total of four to six weeks. During the sessions you can expect the following:

  • EMG patches will be placed on the skin to measure pelvic and abdominal muscle activity.
  • A small electrode will be inserted into the vagina and/or the anus to stimulate the pelvic muscles
  • We will teach you how to contract and relax the appropriate muscles so you can continue these at home.

Can’t I just do Kegel exercises at home to stay continent?

Kegel exercises are voluntary contractions of the external urethral sphincter muscle which have been proven to improve stress incontinence in both men and women. While Kegel exercises are helpful, there are additional muscle groups that assist in continence. Using electrical stimulation we are able to increase the force of the pelvic muscle contractions and make the return to continence quicker.

Are there any risks associated with the Pelvic Floor Muscle Rehabilitation program?

PFMR, including E-stim is considered to be a non-invasive, painless treatment for a variety of urologic and non-urologic disorders. They have both been utilized for decades and have little or no risk to patients. Please consult your physician with any specific questions.


Interstim Peripheral Nerve Evaluation (PNE)


InterStim Therapy is indicated for the treatment of overactive bladder, including urinary urgency and frequency, urinary urge-incontinence, non-obstructive urinary retention or incomplete emptying of the bladder, and fecal incontinence.


The bladder itself is a muscle, which contracts when nerves that innervate the bladder release acetylcholine into the bladder muscle. In men and women with overactive bladder (urinary urgency, frequency, or urge incontinence), using medicines that block this acetylcholine “relax” the bladder muscle. These medicines include Detrol. Ditropan, Sanctura, Enablex, Vesicare, Toviaz, and Gelnique.

 If these medicines don’t work, there can be an issue with the sensory nerves that travel back to the brain which tells brain that the bladder is full, when, in fact, there is not a high volume of urine in the bladder.
InterStim therapy works by altering the sensory (sacral) nerves from the bladder. If medication has not worked for you, your symptoms may not be due to the bladder muscle itself, but rather to a miscommunication between your brain and the nerves that innervate your bladder. Gentle stimulation of these nerves may improve your symptoms.

Office Evaluation:

The diagnostic evaluation is a minimally invasive procedure with no incision. The average evaluation lasts from 15-30 minutes. Your physician will begin by numbing your skin over your tailbone with local anesthetic and then placing two small thin wires under the skin near the tail bone with a needle. The nerves that control bladder and bowel function are found below this area.

The two thin wires will be attached to an external device which will accompany you for approximately three to five days. The device will provide mild pulses of energy to the nerves that control the bladder as you return to your normal activities. Over the course of the test period, if you show an improvement in symptoms of 50% or greater, you may be a candidate for long-term treatment with InterStim therapy.



Prefer Email or want us to contact you? Contact us via the form on the bottom right of the page. 

Our center has the latest technology in laser and light-based hair reduction. The Cutera CoolGlide (1064 Nd:YAG) is the first laser cleared for permanent hair reduction in all skin types and is endorsed by physicians worldwide. Some features of the Cutera Nd:Yag laser include

·         Treat all skin types (I-VI) including tanned skin in the summer

·         Patented PowerFlexTM technology provides fast treatments and high efficacy; allows independent control of fluence, pulse duration and repetition rates to tailor treatment parameters

·         Copper cooling provides the most efficient method of cooling for optimal skin protection and comfort

·         Large spot size (10mm) for maximum speed and optimal penetration at all follicle depths

The Cutera CoolGlide Difference

The Cutera CoolGlide is the best laser hair removal system on the
market for all skin types and tones, from light to dark, including
tanned patients. Its unique design, longer wavelength, and
innovative cooling design, allow extremely effective, safe and
permanent results.
What areas can be treated with
the CoolGlide?
The CoolGlide can remove hair from all parts of the body including
the face, legs, arms, underarms, and back. It can also treat sensitive
areas like the chest, nipples, and bikini line.
What do CoolGlide treatments feel like?
As the name implies, the CoolGlide handpiece cools and soothes as
it glides along your skin. When the pulse of light is delivered, some
patients experience a mild pinching or stinging sensation. No local
anesthesia or pain medication is typically required; however, some
patients may prefer to use a topical anesthetic when sensitive areas
are treated.
How many treatments will I need?
Most areas require 3-6 treatments. However, the number of
CoolGlide treatments required for optimal long-term benefits
depends on multiple factors – hair thickness, the area treated and
your hair’s growth cycle. Interestingly, not all hairs are actively
growing at the same time and actually go through three distinct
phases: growth, regression, and resting. CoolGlide treatments work
by disabling the hair that is principally in the active growth phase at
the time of treatment. Since other hairs will enter this active growth
phase at different times, additional treatments may be necessary to
disable all of the hair follicles in a given area.
What happens after the treatment? 
Immediately following your CoolGlide treatment, the area may appear
a bit red and swollen. Three to seven days after treatment you may
experience what seems to be regrowth of hair. Actually, most of
these hairs are being shed as a result of your treatment and are not
regrowing. Between treatments you should not wax or pluck your
hair, but it is permissible to shave.
Are there any restrictions on my activity after treatment?
Following the treatment, you can return to your normal activities
right away, but some redness may occur. The use of sunscreen is
recommended on any treated areas exposed to the sun. In addition,
your physician may recommend that you use a specially formulated skin
care product line or prescribe a skin care regimen especially formulated
for your skin type.
What are the possible side effects?
Although patients experience few side effects, the most commonly
noticed are slight reddening and local swelling of the skin, similar to a
sunburn. These effects typically last for several hours or less. In rare
instances, blistering may occur. Consult with your medical professional
for complete information on the benefits and risks of treatment.
How does the CoolGlide compare with other hair removal methods?
Shaving, waxing, and depilatory creams are all temporary methods
which must be repeated on a frequent basis. The CoolGlide offers
permanent hair reduction for lasting results.
How does the CoolGlide compare with electrolysis?
Electrolysis is a tedious, invasive, and painful process that involves
inserting a needle into each individual hair follicle and delivering an
electrical charge to them one at a time. Electrolysis often requires years
of treatments at regular intervals. By delivering light energy to hundreds
of hair follicles at a time, the CoolGlide effectively treats an area in just
seconds that would take over an hour with electrolysis.
Why choose CoolGlide over other laser hair removal systems?
Using the latest technology in laser hair removal, the CoolGlide can
rapidly treat large areas without the limitations of older technologies. The
CoolGlide longer wavelength allows it to be used safely and effectively on
patients with light or dark skin as well as tanned skin. Unlike other
systems, the CoolGlide can treat the fine hair on a woman’s upper lip just
as easily and effectively as the coarse hair on a man’s back. The cooled
handpiece increases patient comfort and minimizes the adverse skin
reaction commonly seen with other lasers.

Come in for a FREE Consultation and learn about our latest special prices!


(or fill out the form at the bottom right of this page and we will get in touch with you)

Laser and light-based hair reduction techniques have risks associated with them. You should consult your physician prior to any hair reduction procedure.



No-Scalpel Vasectomy

Vasectomy is a simple, safe, and effective means of permanent birth control or sterility. Each year about one-half million men in the United States are choosing vasectomy as their method of birth control. It is an important decision because it is potentially irreversible.

Two are two important decisions that you need to make before proceeding with a vasectomy. Number one is that you don’t want to have any more children. This is a decision that you need to make with your partner. A vasectomy may not be for you if you are very young, if your current relationship is not permanent, if you are having a vasectomy to please your partner and you do not really want it, if you are under a lot of stress, or if you are counting on it being reversed at a later day.

Your Reproductive System


  • Erection and ejaculation continue as before, but the semen contains no sperm
  • The testes still produce sperm and hormones
  • The seminal vesicles and prostate secrete the same amount of fluid as before
  • The vas deferens are cut, preventing sperm from coming from the penis

To understand how a vasectomy works, you need to know how sperm is produced, stored and released by your reproductive system.

The testes are glands that sit inside a pouch of skin called the scrotum. The testes produce tiny sperm (male reproductive cells) and male hormones.

The epididymis is a coiled tube that holds the sperm while they mature.

The seminal vesicles and the the prostate gland secrete sticky white fluids semen) to nourish the sperm and carry them along.

The urethra is the tube in your penis that transports urine and semen. When you have an orgasm, semen (containing 2% sperm) is ejaculated out of the urethra.

The vas deferens are tubes that carry the sperm from the epididymis to the penis.

Sperm are made in the testes and at the time of ejaculation, travel up through the vas deferens through the prostate and out through the tip of the penis. What vasectomy does in to interrupt the sperm from getting from the testes to the tip of the penis by tying off the vas deferens. Most of the fluid in the ejaculate is made in the seminal vesicles and prostate area. So even after a vasectomy fluid will still come out but it will not have any sperm in it. The testes have two functions, one is to produce the male sex hormone Testosterone. Testosterone is secreted in the blood stream. This will not be affected by the vasectomy. In other words testosterone secretion will be status quo. The other function of the testes is to produce sperm. Sperm will continue to be produced after vasectomy at a much slower rate. These sperm will hang out, will die, and get reabsorbed. We have not found any harmful effects of this ongoing process. Vasectomy will not affect urination, erection, orgasm, or ejaculation, All it will do is to eliminate sperm from the ejaculate.

The Vasectomy Procedure

Vasectomy is a procedure which is performed in Franklin Surgical Center. The procedure will take about 20 minutes. We ask that you read all the
information in this article and sign the consent before you go for your procedure. It is important that you read the list of medications not to take.
These medications can not be taken a week prior to the vasectomy so it is important that you look at this list well in advance. Tylenol is okay to take
at any time before the procedure. If you are on any blood thinners or have a bleeding problem, please let your doctor know. The day of your surgery
shower and wash the scrotum with betadine or another antiseptic solution. Bring a pair of clean cotton briefs or a jock strap. Do not wear boxer shorts.
You do not need to shave the scrotum.


A no- scalpel vasectomy will be performed. This will involve using a special vas-fixation clamp to encircle and firmly secure the vas. The tips of a
special clamp are then used to make a small hole in the skin through which the vasectomy is performed. The vas is then exposed with a portion of it
being removed. The ends of the vas are clipped and sealed by heat (cauterized) to try to prevent auto-reversal. In a similar fashion the second side is
performed. Dr. Ingber may or may not place a suture in the skin. If a suture is used, it may dissolve in 3 to 7 days.

Post- Surgery

After surgery it is wise to go home and place an ice pack over the area. It is vest to stay off your feet as much as possible that evening. It is best to take it easy to keep swelling down to a minimum. If swelling occurs, it may take a few weeks to go away so you are better off trying to prevent it. Please change the dressing daily for the next day or two. Do not be alarmed at some slight oozing or discoloration of the scrotum after the procedure. If there is significant swelling, i.e., 2 to 3 times the normal size, please call Dr. Ingber. There is a doctor available at all times by calling the office. You make take a shower the following evening. Do not use tub baths for 4 days. Do not have intercourse, do heavy lifting, or participate in significant physical activity for about one week, you may want to plan a slightly lighter day than usual until you see how you do. If you are in an occupation that requires a lot of heavy lifting, please ask your doctor for recommendations. As far as pain, Tylenol or Advil are usually enough for the pain. Dr. Ingber may give you a prescription for some pain medicine as well.

You will need to get two negative semen analyses after the procedure. It is important that you use some form of contraception until you get these negative analysis. We ask that you get a semen analysis at 6 weeks and 3 months after the procedure. It takes about 15 ejaculations to clean out all the sperm downstream from the vasectomy. Occasionally these analyses will show some sperm and you will be asked to have further sperm analysis. Again, It is a very important to get these analysis and to uses contraception until you have a negative sperm count.

Risks and Complications

Even with a minor procedure, problems can occur. The following is a list of problems associated with vasectomy. Internal bleeding in the scrotum or infection: Any time an incision is made in the skin there is a small risk of bleeding or infection. Bleeding usually presents as increasing pain or swelling in the scrotum. This usually happens within the first day or two after the procedure. If you experience excessive swelling, please call the office. This is not a problem and usually represents a small amount of blood that has tracked under the skin. Infection usually presents with increased pain, swelling, redness and tenderness of the scrotum, and occasionally fever. If this occurs call your doctor.

Other complications are rare and may occur in the first few months after surgery. Sperm Granuloma is a small lump at the site of the vasectomy. It usually is of no particular significance. It usually causes no symptoms. Occasionally it can be associated with some intermittent discomfort which usually gets better with anti-inflammatory medicines.

Congestion is caused by back pressure on the epididymis associated with the vas being tied off. It usually doesn’t occur but occasionally this discomfort will take few weeks and rarely a few months to resolve. No treatment is usually indicated.

Sperm Antibodies are formed by the body in some men. These antibodies are of no particular significance expect possibly in men who wish to have their vasectomy reversed. Vasectomy reversal is possible and usually requires a few hours under an operative microscope to perform. The data shows if vasectomy reversal or vasovasostomy is performed in the first ten years after vasectomy that 90% of men will get good sperm counts. The pregnancy rate however is only 60%. Some of this discrepancy is possibly attributed to these anti-sperm antibodies. As the time from vasectomy increases the likelihood for successful reversal decreases. The take-home message is that vasectomy is potentially reversible with a pregnancy rate of 60%. Sperm banking is also a possibility before your vasectomy. Few men choose to have this done because it is expensive and doesn’t work that well. Most men choose to rely on vasectomy reversal if they change their mind down the road. It is important to be sure that you don’t want any further children prior to choosing to have the vasectomy done.

Testicular discomfort lasting several years is extremely rare and can be treated. Spontaneous return of fertility or auto reversal occurs very rarely. Numbers reported range from 3% to 1 in 10,000. This can happen if the cut ends of the vas deferens reconnect. Because of this, it is imperative that you get your semen checked for the presence of sperm after the procedure at 6 weeks and 3 months. When you come in for your vasectomy, you will be given two containers for these specimens enabling you to bring them to a lab. It is important that you use some form of contraception until these analyses come back with a negative sperm count. Rarely this auto-reversal can occur after three months even after having a negative sperm count. We don’t know how to identify this extremely rare patient, but some patients choose to have their semen analysis checked at one year. If you wish to do this, please call the office and we will send you a slip.

Prostate Cancer: One study in 1992 showed a possible increased incidence of prostate cancer in men that had a prior vasectomy. There have been numerous studies before and after this study, which have not shown any increased incidence of prostate cancer with vasectomy. There is no physiological reason why the two would be associated. It is the opinion of the American Urological Association that there is no association between prostate cancer and vasectomy.


Vaginal Prolapse Procedures

Over 120,000+ cases of uterine and vaginal vault prolapse are surgically treated each year in the U.S. Prolapse (or falling) of any pelvic floor organ (vagina, uterus, bladder or rectum) occurs when the connective tissues or muscles within the body cavity are weak and unable to hold the pelvis in its natural orientation.

The weakening of connective tissues accelerates with age, after child birth, with weight gain and strenuous physical labor. Women experiencing pelvic organ prolapse typically have problems with pelvic and vaginal pressure,
urinary incontinence, vaginal ulceration, sexual dysfunction and/or having a bowel movement.

Cystocele Repair (bladder lift)

A cystocele occurs when the bladder falls from its normal anatomic position and bulges through the vaginal canal. Symptoms of a cystocele include feeling pelvic pressure, a vaginal bulge, trouble emptying the bladder, or frequent urinary tract infections. In order to restore the normal anatomy, the bladder can be lifted by simply tightening the muscles underneath (anterior colporrhaphy), or by using a special netting called mesh.

Rectocele Repair

A rectocele can form when the rectum bulges into the vaginal opening. Symptoms of a rectocele can include pelvic pressure, vaginal bulge, constipation, or having to place fingers within the vagina in order to have a bowel movement (“vaginal splinting”). Traditional rectocele repairs include simple tightening of the muscles around the rectum, or your surgeon may use mesh in order to strengthen the repair. Occasionally, a perineorrhaphy is performed to recreate the perineal body which sits between the anus and the back wall of the vagina.

Uterine Suspension

When the uterus and/or cervix falls out the vaginal canal, it can be lifted and attached to a strong ligament within the pelvis. Your surgeon may discuss a sacrospinous hysteropexy which involves placing sutures through the uterus/cervix and securing this to a strong ligament found in the pelvis called the sacrospinous ligament.

Vaginal Vault Suspension

After the uterus is removed, the top of the vagina (vaginal vault) can fall. his can occur several months to years after hysterectomy. In order to prevent the vaginal scar from prolapsing, or in cases of post-hysterectomy vaginal vault prolapsed, the top of the vagina can be suspended vaginally to a strong ligament in the pelvis. The two ligaments typically used are the uterosacral ligaments or the sacrospinous ligaments, both which can be accessed vaginally.

Sacral Colpopexy
Sacral Hysteropexy

In the past, these surgeries were performed as an open surgery. A 15-30 cm incision was made in the lower abdomen in order to manually access the inter-abdominal organs, including the uterus.

What do these surgeries entail?

Vaginal prolapse procedures are either performed on an outpatient basis, or typically with a stay of 23 hours in the hospital or in an ambulatory surgical center. Occasionally we perform concomitant vaginal hysterectomy at the time of suspension if a uterus is still in place. Since these procedures involve only small incisions with minimal dissection, there is less discomfort and more rapid healing. Occasionally, a permanent mesh material,
made out of polypropylene is used as added support, which typically can reduce recurrence rates. You should speak with your doctor about the specific risks of mesh use if he or she recommends this during prolapse and incontinence surgery. Often times, if you have stress incontinence (leakage of urine with coughing, laughing or sneezing), or if your surgeon discovers this during bladder testing, a vaginal sling is placed at the time of
surgery in order to prevent this problem in the future.

What are the risks and complications of vaginal prolapse surgery?

Complications of this type of procedure are rare but may occur. The most common complications include bleeding and infection, erosion or infection of the graft material possibly requiring further surgery (if mesh is used), injury to nearby structures, pain, inability to urinate (retention of urine), recurrent or worsening incontinence, new or worse vaginal prolapse, urgency or urge type-incontinence.

What happens after surgery?

Following your surgery, your vagina may be packed for a short time with a gauze roll to act as a bandage to prevent bleeding. You may have a catheter exiting from the urethra for a short period of time. In most cases, patients go home without a catheter, as most patients void in the recovery area. The catheter is in place to allow you to empty your bladder, as there is often swelling after surgery that prevents you from being able to urinate. After the swelling subsides you will gradually be able to urinate. The normal pattern of urination may not occur for a few weeks so there is no cause for alarm. You can resume a normal diet but should limit your fluids to no more than 6 glasses per day. You will be discharged home with narcotic pain
medicines. Every patient’s pain tolerance is different; some do not require any narcotics after surgery, while others require several days’ worth. We typically recommend stool softeners which can be purchased over the counter.

You should not lift anything heavy (more than 5 to 10lbs) for 4-6 weeks following these procedures. Additionally, you should refrain from sexual activity for 4-6 weeks. Your doctor will instruct you when it is safe to resume your usual activities.



Botox Injection

Botulinum Toxin (BOTOX) for the Bladder


Botox is currently FDA-approved for the treatment of overactive bladder (OAB) and neurogenic detrusor overactivity (NDO). Proper bladder function requires an intact pathway from the brain, to the spinal cord, to the peripheral nerves going to the bladder. Nerve damage occurs to the bladder due to a variety of reasons. Occasionally, the nerve damage is obvious, for example, in patients with chronic neurologic disease of the brain, spinal cord, or peripheral nerves (see figure). Other times, the nerve damage is not so obvious:


How does Botox help in patients with bladder problems?

Botox prevents the bladder muscle (detrusor) from squeezing when it shouldn’t. It does this by blocking the nerve endings from releasing acetylcholine. Acetylcholine is a neurotransmitter which plays a role in the contraction of the bladder muscle.

How is Botox injected into the bladder?

A Botox injection into the bladder is done through a 5-minute procedure. A small telescope (cystoscope) is inserted through the urethra into the bladder. Your doctor will inject Botox into the bladder using a very small needle. This procedure is tolerable with little or no anesthesia.

How long will it take to work?

Typically, the results are seen in as little as two weeks.

What are the risks of Botox injection?

Botox injections into the bladder are typically very safe, and the majority of patients tolerate the procedure well. In 6% of women getting 100 units (overactive bladder), and approximately 15% of patients getting 200 units (neurogenic bladder), patients have difficulty emptying their bladder (urinary retention) after the procedure and require intermittent catheterization or a indwelling catheter until the effect wears off. Rare side effects include difficulty breathing, muscle weakness, or allergic reactions. Please refer to the Botox packet which your doctor will provide you.

How do I schedule this procedure?

Call the office at (973) 947-9066 so we may assist you in this process.

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