Dr. Geoffrey Hsieh is the director of the division of urogynecology and female pelvic-floor disorders at the Women’s Cancer Center of Nevada. Board-certified in obstetrics and gynecology, urogynecology/female pelvic medicine and reconstructive surgery, Dr. Hsieh performs minimally invasive pelvic organ prolapse repair and pelvic surgery for women who deal with incontinence and other common problems. His training includes the Robert Wood Johnson Medical School, residency training in obstetrics and gynecology at the University of Illinois Medical Center, Chicago, and fellowship training in urogynecology at the LAC/USC Women’s and Children’s Hospital in Los Angeles. Here are the highlights of his recent interview with Lisa Stark.
This field is highly specialized. In 2011, the American Board of Medical Specialties recognized female pelvic medicine and reconstructive surgery as its own subspecialty. Imagine if you had been practicing for 20 years and then suddenly you had to take a board exam. Such was the case for me and several colleagues. We are highly subspecialized. To be a surgeon in this field, a physician needs seven years of postgraduate school training. For me, the lightbulb moment to practice in this arena was when I was doing my fellowship at USC. I could see that through these surgeries, I could give women their lives back. It was one of the best decisions I made.
Common problems I treat are pelvic-floor disorders, including urinary and fecal incontinence, pelvic organ prolapses, pelvic pain and interstitial cystitis.
Personal satisfaction is a big part of why I do what I do. It is incredibly rewarding to change the trajectory of a woman’s life. Through surgical intervention, we can get her out of diapers and give her the confidence to leave the home without fear of leakage. These disorders affect all aspects of women’s lives. They affect personal relationships which stem from insecurities. Professional status is also compromised because of missed time at work. Sadly, these women become reclusive. Compounding the problem is the fact that many primary care doctors are overwhelmed treating women’s more life-threatening medical conditions, and it is challenging to make time to treat conditions that are less critical but still very problematic.
The most challenging part of these surgeries is that I have to work with the tissue that a woman already has. I can’t simply put in a new pelvic floor. Surgically, this means I have to focus on anatomy and function. If you are removing an organ, you simply take it, out and if it is done well, that solves the problem. With bladder reconstruction, the tissue may be compromised because of a lack of estrogen that naturally occurs in postmenopausal women. With either prolapse or incontinence surgery, 30 percent of patients will require a second surgery.
There is a national shortage of doctors who specialize in this field. With baby boomers reaching the menopausal years, there is a growing number of women who need these surgeries. Studies have shown that 20 percent of women in the United States by the age of 80 will require some form of urogynecologic surgery for pelvic organ prolapse or incontinence. Ten percent of women who have had children are going to develop some sort of problem with either urinary incontinence or prolapse of their pelvic organs.
[I’d like to emphasize] to women that problems like incontinence and vaginal prolapse are common, but not normal. Treatment is available to improve, if not cure, these conditions and elevate quality of life. I would encourage women to bring problems to their doctor’s attention as soon as possible so they can get their lives back on track.