Phone: 305-596-3744

Fax: 305-596-3676

www.floridaamigos.com

The Association of Minimally

Invasive Gynecologic Surgeons

...dedicated to healthy lifestyles and safe, state-of-the-art surgery for

women of all ages.

The Association is dedicated to safe, state-of-the-

art, innovative surgeries and healthy lifestyles for

women of all ages. In a nurturing, environment,

the physicians and staff strive to promote a part-

nership in your healthcare and make every effort

to bridge the sterile science of diseases with your

emotional, physical, and spiritual needs. Every-

one is confronted with difficult healthcare deci-

sions at one time or another. You’ll want your

physician and staff to have the knowledge, experi-

ence, and sensitivity to guide you safely through

the decision-making process.

The Association for Minimally Invasive Gyneco-

logic Surgeons provides comprehensive gyneco-

logic office and surgical healthcare. The physi-

cians are certified in laparoscopy and hys-

teroscopy and are experts in advanced gyneco-

logic surgery. Doctors Pietro and Whitted are na-

tional speakers, trainers, and researchers in ad-

vanced surgical techniques. In addition, Doctors

Pietro and Whitted are Certified Menopause Clini-

cians who educate, train, and research the sci-

ence of menopause. Finally, they are certified in

advanced colposcopy

Doctors Whitted and Pietro offer expert care in the

following areas:

If you need surgery, the Doctors perform most

gynecologic surgeries with minimally invasive

techniques to reduce hospitalization, recovery,

scarring, discomfort and absence from work in

most cases.

.Laugh,

Cough,

Sneeze,

Jump…

...And still stay dry

Urinary incontinence is the loss of bladder

control, or uncontrolled urine leakage.

If you suffer from this problem, you are not alone.

Over 10 million women in the United States experi-

ence incontinence. The embarrassment and invon-

venience of incontinence keep many women from

enjoying a healthy, active lifestyle. As a result, you

may have stopped doing the activities that you

once enjoyed, such as playing with your children or

grandchildren, jogging, playing tennis or golf, or

traveling. It also may have interfered with your

everyday activities such as shopping, lifting or

walking. Incontinence can make you feel less femi-

nine and less intimate with others. But, wait...there

is good news!

Regain Bladder Control.

Regain Your Life.

Paul A. Pietro MD

R. Wayne Whitted MD, MPH

Marina Santana MMS, PA

Janet Levick, Office Administrator

8740 North Kendall Drive

Suite 101

Miami, Florida 33176-2212

Abnormal Paps (HPV) Fibroids (Leiomyoma)

Abnormal Menstrual Cycles Loss of Urine

Bladder Prolapse Menopause

Chronic Pelvic Pain Ovarian cysts

Endometriosis Rectocele

Ectopic Pregnancy Uterine Prolapse

Family Planning Vaginal Prolapse

***Evaluation and Diagnosis of Gynecologic Cancers

Association of Minimally

Invasive Gynecologic Surgeons

...

dedicated to healthy lifestyles and safe, state-of-the-art, innovative surgery for women of all ages

There are several types of urinary inconti-

nence that affect women.

The most common type is stress incontinence,

which affects one out of every six women over the

age of forty, and commonly causes urine leakage

when coughing, sneezing, laughing, jumping or

running.

Stress incontinence occurs when your vaginal and

pelvic floor muscles stretch and weaken after

childbirth, weight gain, surgery, or any activity that

chronically increases abdominal pressure.. This

stretching causes the neck of the bladder to sag

or drop. In this lowered position, the bladder neck

can’t stay closed when abdominal pressure in-

creases during coughing, sneezing and physical

activity. As a result, urine leaks out.

Stress incontinence is not a normal part of aging.

It is a medical problem that can be treated and

even cured for most women. This is the only in-

continence that surgery can cure.

Urge incontinence is another type. Women who

suffer from urge incontinence have an incredible

urge to void and often leak on their way to the

bathroom. Sometimes they leak without warning.

It is also common to experience a combination of

stress and urge, or mixed incontinence. There are

other, more infrequent types of incontinence, as

well. The loss of bladder control most often,

though, is a result of stress incontinence.

What can I do about Incontinence?

The first thing to do is see a doctor who under-

stands the issues of incontinence.

A physical exam, a complete medical history and thor-

ough testing will tell you what is causing your problem.

Then, your doctor can tell you what treatment, or combi-

nation of treatments, is best for you.

The following are non-surgical choices currently avail-

able to treat stress and urge incontinence:

FEMININE PADS, PESSARIES,

AND CATHETERS

Many women who try pads find that they are embar-

rassing, inconvenient, and expensive. Long-term use

can lead to bladder infections and skin irritation. Pes-

saries are small plastic supports which arer inserted into

the vagina to support the bladder. Catheters are in-

serted into the bladder through the urethra to capture

urine. Pessaries and catheters give only temporary

relief and can be irritating to wear.

MEDICATIONS

Medications typically improve urge incontinence. These

include estrogens, bladder anti-spasmodics (detrol,

ditropan, etc.),

Medications for stress incontinence are being investi-

gated. Duloxetine is approaching FDA approval and will

likely be available in the next year.

AVOIDANCE OF BLADDER IRRITANTS

Foods that are acidic are considered irritants. These

are:

Alcoholic beverages, Apples and Juice, Cantaloupe,

Carbonated Beverages, Chili and spicy foods, Citrus

Fruits, Chocolate, Coffee (even decaffeinated), Cran-

berry Juice, Grapes, Guava, Peaches, Pineapple,

Plums, Strawberries, Sugar, Tea, Tomatoes, Vitamin B

Complex, Vinegar.

Low-acid substitutes include: apricots, papaya, pears,

watermelon. Coffee drinkers can drink Kava or Postem.

Tea drinkers can use non-citrus herbal and sun-brewed

teas.

KEGEL EXERCISES

These strengthen the pelvic floor muscles that support

the bladder. In mild incontinence cases improvement is

seen in 60%. 75 exercises per day should be per-

formed for 3 months before improvement is seen.

BLADDER TRAINING

Retraining the bladder can be difficult. In short, when

you get an urge to void you attempt to suppress the

urge with a kegel exercise and distraction prolonging

the interval each week until voiding occurs 6-8

times/day.

SURGICAL OPTIONS ARE FOR STRESS

INCONTINENCE ONLY!

There are over 200 de-

scribed stress incontinence surgeries. The following

are the most effective and are minimally invasive.

The Laparoscopic Burch Bladder Neck Suspension

The Tension-Free Vaginal Tape Sling Operation

These operations usually are outpatient and require

minimal recovery.

In this procedure the

space between the pubic

bone and the bladder is

dissected. Sutures are

placed in the peri-

bladder-urethral fascia

and attached to the Coo-

per”s ligament on the Pu-

bic Bone. This procedure

has an 80% 5 years suc-

cess rate.

A synthetic mesh is placed

under the mid-portion of the

urethra and and sus-

pended above the pubic

bone. It has a 85-90% cure

rate at 5 years.