Pleas download (click on the PDF logo to the left) and complete this packet prior to your visit.
Be sure to bring all items with you on the day of your appointment.
Patient Registration Form: Complete all sections so we can properly bill your insurance.
Medical History Questionnaire: Please fill out all three pages of the form as completely and accurately as possible. You may wonder whether some questions apply to you, but please answer them nonetheless.
Urogynecology History Questionnaire: Please fill out all three pages of this form, following the same instructions as for the Medical History Questionnaire.
Voiding Diary Form: Please follow the directions on this sheet. Record results on the back of the sheet. You can use a standard 1 cup measuring device and label your volumes in ounces or milliliters. Urine should be discarded after each void. Please try to keep this diary for a complete 24 hour period. It is very important!
Come to the office with a full bladder: We will perform a urinating study at the time of your first visit. If you are uncomfortable on arrival and need to empty your bladder quickly, please advise the receptionist.
Referral Form: If your insurance carrier requires a referral for specialty services, please be sure to present it at the time of your first visit. If no referral is presented at the time of this visit, it is your responsibility for payment of all services rendered that day.
Medical Records: Please bring your previous records, or have your referring physician send us a copy of all your previous records pertaining to your visit with our office. Especially helpful are reports of previous gynecologic surgery.
Co-Pay: Our office will require your co-pay on the day of your visit. We accept personal checks, cash, and credit cards.
New Patient Visit //
Colposcopy is an exam used to look at the cervix, vagina and vulva through a special device similar to a microscope. This can help to detect the problems that cannot be seen with naked eye. Mild vinegar solution is used to paint the targeted area that makes abnormal cells easier to see. If an area of abnormal cells is seen, a biopsy is needed. For a biopsy, a small sample of tissue is removed and sent to a laboratory to be studied. The treatment depends on the test results.
A cystoscope is a small, catheter like instrument with a lighted lens for viewing the inside of your urethra and bladder. The end of the scope has a small hand held camera attached so that the doctor may take pictures and you may view them if you wish on the computer screen.
The test takes about 15-20 minutes.There is no preparation for this test, though it is a good idea to drink plenty of fluids prior to the test. Also, wear two piece clothing that is slacks or a skirt and a top.You will be given one antibiotic to take which is a urinary tract antibiotic to protect you against infection. You may also notice the first and second time you empty your bladder after testing will be uncomfortable or cause some burning. This will subside in a few hours.
A cystoscope (please refer to the cystoscopy visit for details) is used to deliver one of two bulking agents, Collagen or Durasphere. The substance injected into the urethra will aid in better urine control. Numbing medication is administered prior to the injection of the bulking agent and may sting for a few moments.
The test takes about 15-20 minutes. There is no preparation for this test, though it is a good idea to wear two piece clothing that is slacks or a skirt and a top. You will be requested to empty your badder after the procedure is complete. You will be given one antibiotic to take which is a urinary tract antibiotic to protect you against infection. You may also notice the first and second time you empty your bladder after the procedure will be uncomfortable or cause some burning. This will subside in a few hours.
A urodynamic study is a series of tests that gives your doctor a detailed look at the function of your bladder and urethera. These tests can help your doctor evaluate any problems you may be having with storing urine or voiding (eliminating) urine from your body.
The tests are generally painless, so you don’t need sedating medication. A catheter (soft, hollow tube) will with a special sensor will be placed in your urethera and a second catheter in your vagina or rectum. There are 5 small tests that complete the urodynamic study.
Cystometry: This test evalutates how much the bladder can hold, how strong the bladder muscle is, and how well the signals work that tell you when your bladder is full. Through a catheter, your bladder is filled with sterile water or saline solution. You’re asked to report any sensations you feel and whether they’re similar to symptoms you’ve felt at home. You may be asked to cough, stand and walk, or bear down during this test.
Electromyogram: This test helps to evaluate the muscle contractions that control urination. Electrode wires may be placed near the rectum or urethra to make the recording. You may be asked to tighten or relax your sphincter muscles during this test.
Urethral Pressure Profile: This test measures pressure in the urethra and bladder. It measures this pressure both while you are relaxed and when pressure is applied. You may be asked to cough or perform other measures to exert pressure with the abdomen.
Pressure Flow Study: This test measures the pressure and flow of urine out of your bladder. It is often performed after cystometry. You are asked to urinate while a catheter with sensors in the urethera measures the pressures.
Uroflowmetry: This test measures the amount and speed of urine you void from your bladder. You urinate into a funnel attached to a computer that records your urine flow over time. The amount of urine left in your bladder after you void may also be measured immediately after this test.
These tests take an hour or more. Do not apply lotion to your legs prior to this test. Wear two piece clothing (slacks or a shirt and a top). When the study is finished, you’ll get dressed and return to the consultation room. Test results may be available soon after the study is finished, or you may return to the office in a few days for results. The report may include a summary of the study results, the diagnosis and suggestions for further evaluation or treatment. Your doctor can talk with you about the study report and your options.
A pessary is a plastic device that is placed in the vagina to help support a prolapsing bladder, vagina, uterus, or rectum. There are many types of pessaries. The patient may have to try a few types to get a good fit.
A catheter is a small, hollow, flexible tube that is gently inserted into the bladder to drain any remaining (residual) urine after you have emptied (voided) your bladder. A catheterized urine sample is obtained to send a sterile (uncontaminated) sample to the lab for examination and to check for infection. Some patients after surgery will have an “indwelling catheter”, which is a catheter that remains in the bladder for a few weeks while they are recovering from surgery. Some patients desire to be taught to catheterize themselves after surgery rather than have an indwelling catheter.
The test takes about 10 minutes. The teaching visit takes 20-30 minutes. The is no preparation required.
The scope is a small catheter-like instrument with a lighted lens for viewing the inside of your vagina. The end of the scope has a small camera attached so that the doctor may view and take pictures is necessary of the inside of your vagina. If you wish you may also view the images on the computer screen.
The test takes about 15 minutes. There is no preparation for this test, though it is a good idea to wear two piece clothing that is slacks or a skirt and a top.
Uroflowmetry is a noinvasive, simple, urinating test, which only requirement is that you come to the office with a full bladder. You will be asked to empty your bladder a commode chair. The chair has measuring and recording devices attached that provide information about the amount and force of your unire flow.
The test lasts as long as it takes to urinate. Please come to the office with a full bladder.