In the last two weeks, I have done several high tech surgeries. This technology reminded me of where I had come from. I think many young patients have never known what it takes to be a doctor. Most of what patients see regarding the skills and abilities of the surgeons are what they can glean from the internet. Far too few have any appreciation of how doctors are trained. The three main components of becoming a gynecologic surgeon are study, intense training, and practical application of surgery skills. All of these were parts of the training of surgeons well into the 1980's and 90's.

Modern surgeons have seen the advent of technology and so called evidence based procedures. Most of the technology that is in use today is helpful and quicker and has become gradually reliable. But it wasn't always this way. In the past, countless hours of observing, participating with other doctors and finally mastering our own cases led us to the high point of training where many gynecologist can say, "I've seen it all." "I've seen it and done it, and now I can teach it." This is what it meant to field the brotherhood of gynecologists. However of late, technology has in some cases moved in to relieve the gynecologist of the intense study and training required to master his skills. For instance, we used to look at our own Pap smears. We used to make slides of our pathology findings. This forced us to know what we were looking at, how common it was and how it differed from other things we were trained in. Most of these early skills have become automated. I might hazard to say that many young doctors have never gone through this phase of training. In fairness, the new technology is helpful and in general it speeds up the diagnosis and treatment of modern gynecologic disease. Doing a CT scan on everyone with pelvic pain or an MRI on every breast mass has certainly given us piece of mind, but may have relieved the modern surgeons of studying and learning their art. At least, whenever a complication arises, what we have bequeathed to technology may have slipped from our grasp or maybe has not been trained at all.

In spite of all this, that many aspects of our technology have not retarded our growth as surgeons but in fact have underscored our basic training and forced us to look even deeper and learn even more. A case in point is in the new minimally invasive robotic surgery. I think it's clear that robotic surgery enhances our training. It forces us to fall back on our basic skills and rethink every single move and every single purpose. Everything we see through the scope has to be revealed. In this arena, modern technology will only make us better.

Let me also mention that technology in gynecology has not replaced the knife, at least not yet. Knowing when and how to suture a wound is still a marvelous new universe for most of us. When placing the forceps during a complicated delivery strangely enough we still need to know about the babies head, the mother's pelvis and about the complex association between the two. All this while trying to remember the various physiologic and anatomic components that are going on in a living patient while we as the surgeons are applying the arts that were taught to us by masters that are long gone, and whom we thank every day for the basic training they gave us. We still look forward to the technology but we can never forget what goes into training a physician especially a surgeon. I hope those of you who are my patients will appreciate this one nuance and have confidence in our work. Don't forget that caring about the patient proceeds any training that we ever do.

One of the more common complaints of women in the child bearing age and beyond is the uncontrolled leakage or flow of urine during activity. It is a common and universal problem for which there are many causes and fortunately many treatments. 

The treatments of Urinary Incontinenceare under the supervision of the gynecologist or in some cases a urologist. 

Occasional urine loss can occur from holding the urine too long or stressful situations. This should not be construed as abnormal in all situations. The gynecologist generally deals with Urinary Incontinencecaused by changes to the pelvic floor anatomy and injury following childbearing or surgery. Occasionally urine loss is caused by neurologic defects which are brought on by diabetes and other neurologic injuries. 

Abnormal urine loss sometimes occurs with laughing, coughing, heavy or sudden lifting and sometimes during sexual intercourse. The onset of genuine stress Urinary Incontinence can follow the early stages of pregnancy as well as the late stages of pregnancy, vaginal childbirth which can cause both temporary and permanent loss of pelvic tone. This can result in the loss of urine shortly after childbirth or it can become persistent and last into old age. 

There are various medical conditions which can cause neurologic deficit in the bladder resulting in the inability to control urination. The most common of these is diabetes or pelvic surgery. 

Treatment modalities involve medicine, surgery, and various alternative techniques. Medical treatment can be very helpful because by taking one or two pills, control of the bladder can be reinstated and as long as the medicine is taken, the patient should be able to control leakage. 

The surgical techniques used by gynecologists provide instant and long term relief. These are selectable and excellent surgeries to assist in overcoming bladder leakage. There are behavioral techniques, pelvic floor exercises, electrical stimulators and some non surgical devices which can often be used in the early stages of stress Urinary Incontinence. 

With a systematic approach to the treatment of Urinary Incontinence, results are usually very satisfactory. If you are having symptoms of urine loss of any type, please contact Dr. Cowart at LakeView Women’s Healthcare Associates for evaluation, expert advice and knowledge of modern treatment techniques. The effective elimination of this embarrassing problem can usually be achieved in a short time.