Dr. Deborah Levy, MD

More and more, gynecologic surgery is moving towards the use of minimally invasive surgery. Minimally invasive surgery uses several small incisions and tiny tools and scopes to perform the operation, rather than one large opening. While it is not appropriate in every case, minimally invasive surgery can lead to less scarring, less blood loss, faster recovery, and a lower chance for infection. Minimally invasive gynecologic surgery may be performed with a laparoscope, a thin tube with a camera on the end that allows the surgeon to see inside the body. It may also be performed robotically, using even smaller tools and cameras that a surgeon controls from a computer. Robotic surgery allows even better vision, precision, and control than laparoscopic surgery.

Over the course of a lifetime, many women need pelvic surgery to stay healthy. Qualified gynecologic surgeons will have the right tools at their disposal to provide care with a minimum of discomfort.

There are many benefits to robotic surgery, both for the patient and the surgeon. Robotic surgery allows for more precise movements and increased control during very delicate surgical procedures. This makes performing surgery accurately much easier for surgeons and reduces fatigue. The smaller 'hand' of the robot can enter the body via a much smaller opening, which reduces the risk of infection and scarring and leads to a faster recovery. The robotic hands also contain tiny moveable cameras among their tools, giving surgeons a much closer view of the procedure than would be possible with traditional surgery.

• The bladder, which stores urine.
• The urinary sphincters, which are muscles around the opening of the bladder that hold urine in.
• The urethra, which is the tube where urine flows out of the body.

Urodynamics tests are normally performed together as one series, but depending on patients' symptoms, only one or some of them may be necessary. The most common tests are:

• Cystometrogram, which measures the amount of urine the bladder can store and how full it is before someone has the urge to urinate. Doctors may order this test if she suspects their patient has a weak bladder.
• Pressure flow study, which measures the pressure in the bladder while urinating. This test helps locate a blockage in the bladder.
• Uroflowmetry, which measures how much and how fast urine flows out of the body. This test is usually recommended when patients have difficulty urinating or they have a slow stream.
• Urethral sphincter electromyography, which measures how strong the muscles and nerves in the bladder and sphincters are. Doctors may request this test if the problem they are experiencing is linked to muscle or nerve damage in the lower urinary tract.
• Urethral pressure profile, which measures the pressure along the urethra while the bladder is gradually filled with fluid. Low pressure could mean someone has a weak urethra, a contributing factor to urinary incontinence (loss of bladder control).

For a few hours following a urodynamics study, patients will likely feel some soreness or discomfort. It is recommended to drink at least one glass of water every half hour for two hours to relieve these symptoms. Holding a warm, moistened washcloth over the area where discomfort is felt or taking a warm bath may also help. Results for cystrometrograms and uroflowmetry are typically available immediately after the test, but results for the other tests may take a few days. When doctors have reviewed a patient's test results, he or she will discuss them with the patient, along with any treatments the patient may need.