CONTENTS:

  • MIS
  • LAVH
  • LSH
  • VAGINAL HYSTERECTOMY
  • ESSURE
  • ENDOMETRIAL ABLATION
  • STRESS INCONTINENCE AND PROLAPSE
  • HYSTEROSCOPY
  • ABNORMAL PAP SMEAR
  • COLPOSCOPY
  • LEEP
  • URODYNAMICS
  • IUD
  • INFERTILITY
  • Bladder Diet
  • Intrauterine Insemination Cost
  • Sperm Banks
  • In Office Ablation Instructions
  • Pelvic Muscle Exercise
  • Urodynamic Testing
MIS
Minimally invasive surgical procedures remove pelvic organs such as the uterus and/or ovaries without making a large incision into the abdomen. Generally this means less postoperative pain, shorter hospitalization, quicker return to normal activities. These procedures include LAVH, LSH, and Vaginal Hysterectomy. (For more info, see descriptions below plus (http://hysterectomyoptions.com)
LAVH
Laparoscopic assisted vaginal hysterectomy uses a scope through the navel and 2 instruments placed through 1/4 inch incisions in the lower abdomen. The uterus is removed through the vagina by making an incision at the top of the vagina around the cervix, and pulling the uterus (and cervix) through.
LSH
Laparascopic subtotal hysterectomy uses a scope and 2 thin instruments to completely remove the uterus through small incisions in the abdominal wall. The cervix is left behind. The vagina is not entered. This is the least invasive hysterectomy and affords the quickest recovery.
VAGINAL HYSTERECTOMY
Vaginal Hysterectomy means the uterus and cervix are removed entirely through the vagina, without the need for any abdominal incisions. The tubes and ovaries are left behind. To accomplish this type of procedure, the uterus cannot be too large, and there must be at least some relaxation of the ligaments that hold the uterus in place.
ESSURE
Sterilization for permanent birth control is an option for women of child bearing age who are sure they are done having children. Until recently, however, this required hospital based surgery, general anesthesia and recovery times as long as a week or two.
A new procedure called Essure provides effectiveness equal to hospital based surgery with much less pain and faster recovery. It is a brief procedure performed with local anesthetic in the comfort and convenience of our office, eliminating the need to go to the hospital and making it easier to schedule. No incisions are made, recovery is fast and most women return to their normal activities by the next day. Depending on the details of your insurance coverage, it can also involve significantly lower out-of-pocket expenses.
The procedure involves inserting a small scope, narrower than the width of a pencil, through the vagina and uterus in order to visualize the fallopian tubes. A small spring-like device is then inserted into the opening of the fallopian tube and left there. Your body’s natural healing processes form scar tissue around the spring to completely seal off the fallopian tube. After three months, a return visit for an Xray, confirms that the blockage is complete. (For more info, see http://essure.com)
A new procedure called Essure provides effectiveness equal to hospital based surgery with much less pain and faster recovery. It is a brief procedure performed with local anesthetic in the comfort and convenience of our office, eliminating the need to go to the hospital and making it easier to schedule. No incisions are made, recovery is fast and most women return to their normal activities by the next day. Depending on the details of your insurance coverage, it can also involve significantly lower out-of-pocket expenses.
The procedure involves inserting a small scope, narrower than the width of a pencil, through the vagina and uterus, in order to visualize the fallopian tubes. A tiny catheter is then inserted about 1 cm. into the tube. This area is lightly cauterized for 60 seconds, and then a 3mm silicone plug is placed in that area. Your body’s natural healing processes form scar tissue around the plug to completely seal off the fallopian. After three months, a return visit for an Xray, confirms that the blockage is complete. (For more info, see http://adiana.com)
ENDOMETRIAL ABLATION
Heavy Bleeding and prolonged periods afflict many women, causing anemia, tiredness, pain and annoyances that impair their lifestyle. There are a number of treatment options ranging from hormone therapy to hysterectomy. An intermediate option that many women take is endometrial ablation. You should consider this option to heavy bleeding problems if you:
  • Have determined a benign condition (not cancer related) is the cause
  • Are unable to, or do not wish to, take long-term hormone therapies
  • Have completed childbearing but don’t want a hysterectomy

Unlike hysterectomy, which removes the entire uterus, endometrial ablation removes most or all of the uterine lining using heat and electrical energy. It is a relatively simple treatment that can be performed with just some pain medication and local anesthetic in the comfort and convenience of our office, eliminating the need to go to the hospital and making it easier to schedule. Recovery is fast and most women return to their normal activities by the next day.

Endometrial ablation is a very brief ( 2 minute ) procedure. The inside of the uterus is cauterized (burned) with a special wand. This removes the uterine lining, which sheds with each menses, seals the underlying blood vessels , and creates a layer of scar tissue which stops or at least minimizes future bleeding.
If you are plagued by heavy bleeding, Dr. Heidtke will evaluate your problem and thoroughly discuss your options with you. (For more info, see http://minervasurgical.com/)
STRESS INCONTINENCE AND PROLAPSE
Incontinence and Prolapse problems can afflict women of any age and cause significant life style impairment. Childbirth, abdominal surgeries, certain types of heavy activities, or lack of appropriate exercise can cause weakening of pelvic support structures that keep the pelvic organs in place. The result is what is referred to as prolapse. There are different types of prolapse caused by different pelvic organs pressing onto or out of the vagina, including:

  • Bladder (Cystocele)
  • Small bowel (Enterocele)
  • Rectum (Rectocele)
  • Uterus (Uterine Prolapse)
  • Vagina (Vaginal vault), which can happen after hysterectomies.
Certain types of prolapse can cause incontinence, while others cause pelvic, back, or vaginal discomfort. Prescription medications and/or pessaries are sometimes helpful, but a more effective treatment involving surgical reconstruction is sometimes needed.
To identify the underlying cause and determine the best approach for each patient, Dr. Heidtke does a detailed history and exam. After a thorough discussion with you regarding findings and treatment options, we help you chose the best approach for you.
HYSTEROSCOPY
A very thin scope is passed through the cervix into the uterus. If abnormalities are found, they can often be removed. Bleeding and infertility problems can sometimes be treated this way. Diagnostic procedures can be done in the office. Therapeutic procedures are done as outpatient hospital procedures, but there is minimal postoperative pain and recovery.
ABNORMAL PAP SMEAR
A pap smear is only a screening test and an abnormal reading means that more testing is needed. The majority of abnormals are either nonspecific changes, or viral infections which spontaneously resolve. But sometimes it may indicate a precancerous change which should be treated. There are different categories of abnormal readings including ASCUS (minimally abnormal changes), LGSIL (low grade or mild abnormality), and HGSIL (high grade or potentially more significant change). Most abnormal paps are due to HPV infection (human papilloma virus). HGSIL or persistent ASCUS or LGSIL readings should be evaluated with colposcopy.
COLPOSCOPY
Similar to the taking of a pap smear except the doctor swabs the cervix with a little vinegar and looks through a microscope. This allows her to see very small spots on the cervix or vagina which may be precancerous. If a suspicious area is found, a biopsy of the area is taken. This will give a more definite answer as to whether there is a significant growth present. This process is no more uncomfortable than a pap smear.
LEEP
Loop Electrosurgical Excision Procedure. Removing an area of abnormal, precancerous cells from the surface of the cervix using a thin wire loop. Local anesthetic is used and there is minimal discomfort or bleeding.
URODYNAMICS
Testing to measure the quality of urine flow, the capacity of the bladder, and the pressures in the bladder and urethra. This is done by 1st voiding into a special commode. Then a tiny catheter is placed in the bladder to fill it with water and take the measurements. This information is helpful in determining the various causes of bladder symptoms and the best treatment options.
IUD
Intrauterine Device. There are currently 2 types of IUD’s available.They are both flexible 1″x1″ devices that are easily inserted in the office. The Paragard is coated with copper and gives protection for 10 years. The Mirena secretes a small amount of Progesterone hormone which thins the lining of the uterus and allows minimal, if any, menstrual bleeding. This will work for 5 years, and is an added benefit for women who have heavy menstrual flow.
INFERTILITY
Infertility is a medical condition that results when you, your partner or both of you have physical conditions that interfere with the reproduction process. A couple is usually deemed infertile if they are unable to conceive after 12 months of unprotected sexual intercourse (for women over 35, this decreases to six months of unsuccessful conception).
Many people are surprised to learn how common infertility is. Approximately 6.1 million couples in the United States are infertile – that is one in six couples, or about 10% of the reproductive age population.

  • Infertility affects men and women almost equally. Infertility is identified as a male issue in about 40% of cases, and a female concern in 35% to 40% of cases.
  • Infertility results from a combination of medical conditions from both partners in approximately 25% of cases. About 20% of infertility problems remain unexplained even after complete medical evaluations.
  • A woman is most fertile in her mid-20s. Her fertility declines until she reaches 30, and then drops rapidly. The most common female infertility factor is an ovulation disorder.
  • Men also experience a decrease in fertility as they age. The most common reasons for male infertility include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced).
Therapy for infertility includes treatment with drugs that stimulate the growth and maturation of the egg cells (oocytes) in a woman’s ovaries so they are ready for fertilization. Fertilization may then proceed naturally at home or in the office with the help of intrauterine insemination (prepared sperm which is placed directly through the cervix into the uterus), or may occur in vitro (outside the body) using assisted reproductive technology (ART).
A complete evaluation is necessary to determine the best treatment option for you. Most of the basic fertility tests can be accomplished in 1 or 2 cycles.Women who are diagnosed with ovulatory dysfunction (do not ovulate normally) may be treated with ovulation induction therapies, while couples whose infertility condition is thought to be due to factors that result in insufficient numbers of sperm reaching the woman’s uterus may initially be treated with intrauterine insemination (IUI). Sometimes a combination of both of these treatments is the most effective. For those couples who have failed the above approaches, or where age is becoming a significant factor, moving directly on to In Vitro Fertilization (IVF) may be the best approach to achieving pregnancy.