Marie-Blanche Tchetgen, MD, is in the quality of life business.
“It can be embarrassing to have incontinence problems, whether urinary or fecal. These are not things we were raised to talk about in daily conversation. I want to create a haven where patients—men and women—can speak openly and naturally about these disorders without feeling embarrassed.” As Medical Director of the Pelvic Health and Reconstructive Surgery Center at Texas Health Presbyterian Hospital Flower Mound, Dr. Tchetgen is doing just that.
While these conditions are usually not life-or-death matters, they can wreak havoc on a patient’s quality of life. Lack of bladder control comes with disrupted sleep, social isolation, and any number of associated medical challenges. Dr. Tchetgen and her team work to normalize seeking care for pelvic floor conditions to address sensitive issues in a matter-of-fact yet caring and compassionate manner. “By seeking help for their issues and visiting the Pelvic Health Center, patients are empowered to take control of their health and directly address sensitive issues many people do not want to talk about,” she said.
A Silent Problem
“One of every four women in the United States is affected by a pelvic health disorder,” Dr. Tchetgen said. “Historically, women have just ‘lived with’ conditions such as urinary and fecal incontinence, bladder pain, pelvic pain, and more. They felt it was a part of aging or a natural consequence of pregnancy and childbirth and believed they had to suffer silently. They were often too embarrassed to consider seeking help. Now, we see patients not only talking to their doctors about these sensitive issues but also with their friends, family, and other women in their social group. It’s about time!”
Meet Dr. Tchetgen
Marie-Blanche Tchetgen, MD, is a physician dual-board certified in Urology and Female Pelvic Medicine and Reconstructive Surgery. She completed her fellowship training in Female Urology at the Cleveland Clinic and her Urology training at the University of Michigan. She attended Medical School at The Johns Hopkins School of Medicine and has been practicing in the Dallas-Fort Worth area since 2002. She is a urologist with Urology Clinics of North Texas, on the medical staff of Texas Health Flower Mound, and currently serves as the Pelvic Health Center’s Medical Director.
“I love what I do,” she said. “No two incontinence stories are the same because no two patients are the same. Many people do not seek help until their condition has completely derailed their life. I ask them to tell me what is going on, and the stories come pouring out—often with tears. Sometimes the solution is as simple as altering their diet or liquid intake. Others may need medication, Botox injections in the bladder, or surgery.”
“Our bladders age just like the rest of our bodies,” Dr. Tchetgen said. “Education is a big part of my job—that and lending a compassionate ear. The more people understand their pelvic floor health, the better they are able to make the changes they need to make. Often, we start with simply having them keep a diary. They come back having realized on their own the changes they need to make. Those kinds of self-realizations can be very liberating.”
The core mission of the Pelvic Health Center is to offer comprehensive care for pelvic disorders with advanced diagnostic and treatment modalities.
Dr. Tchetgen collaborates with other specialists, including gynecologists, colorectal surgeons, pelvic floor therapists, and pain management professionals to help patients struggling with pelvic floor conditions, including:
- Urinary incontinence
- Urinary urgency and frequency
- Pelvic organ prolapse
- Pelvic pain
- Voiding difficulties
Pelvic Organ Prolapse
Muscles and tissues that control a woman’s pelvic floor (often called the “pelvic hammock”) can become stretched, weak, or damaged. The support system can become so weakened that one of the organs normally located within the pelvis will herniate through the pelvic hammock and into the vaginal canal, which is referred to as “prolapse.”
In severe cases, the organs can appear at the opening of the vagina or even drop through the vaginal opening. In uterine prolapse, the entire uterus can literally herniate through the vaginal canal. Prolapse can happen individually or comprehensively. It is a fairly common issue for women, and can lead to a great deal of discomfort, pelvic pressure, and disruption in urinary and bowel function. The symptoms may be distressing and a sensitive subject to talk about, but they can be treated.
Types of Prolapse:
- Vaginal vault prolapse (apical)
- Posterior vaginal prolapse (rectocele)
- Anterior vaginal wall prolapse (bladder prolapse)
- Rectal prolapse
- Uterine prolapse
Dr. Tchetgen and her team can perform minimally invasive surgery to address and repair these prolapses. “First we need to determine which aspect of a patient’s support is defective,” Dr. Tchetgen said, “Then we discuss different approaches to restoring some of that function.”
Pelvic Health in Men
Men can also have urinary problems often relating to prostate enlargement. Those problems include difficulty urinating, high frequency of urination, and poor bladder control. Men who have undergone prostate cancer treatments may suffer from urinary leakage, sometimes years after successfully beating cancer. These issues can be very distressing and negatively impact one’s quality of life.
Surgical and Nonsurgical Treatment Options
Dr. Tchetgen, her team, and collaborators offer traditional surgical approaches as well as the latest minimally invasive techniques available to manage these conditions. In-office procedures are also available to manage certain conditions such as incontinence and prolapse.
The Pelvic Health Center also uses advanced diagnostic equipment to conduct, for example, video-urodynamic testing, as well as robotic-assisted laparoscopic equipment to use for certain procedures. The Pelvic Health Center also offers Sacral Nerve Stimulation or “Sacral Neuromodulation,” which is an advanced treatment for patients with refractory bladder control issues.
“We see patients who have tried everything and are still having bladder control issues,”
Dr. Tchetgen said. “By the time they come to us, they have often already attempted lifestyle changes, physical therapy, and medications but still have incontinence problems. They feel defeated and have lost all hope of a solution.” Sacral Neuromodulation gently stimulates the nerves that control the bladder. Stimulation can improve symptoms by restoring normal communication between the brain and bladder, thus facilitating better control.
Sacral Nerve Stimulation can help treat the following conditions:
- Overactive bladder (OAB) – the urgent need to urinate, which may result in frequent urinary and/or incontinence (leakage) episodes
- Urinary urgency frequency – the need to urinate eight or more times a day
- Urinary urgency incontinence (UUI) – the urgent need to urinate or trouble holding urine before making it to the restroom
- Fecal (bowel) incontinence – sudden urges to pass stool and experience leakage of stool before making it to the restroom
- Non-obstructive urinary retention (UR) – the inability to empty the bladder which results in symptoms of frequent urination or trouble urinating
Dr. Tchetgen is trained in Sacral Nerve Stimulation, and the Pelvic Health Center offers the recently FDA-approved Axonics® Sacral Neuromodulation device. This device can provide a long-term treatment solution which:
- Safely delivers therapy with a miniaturized implant
- Is designed to provide therapy for at least 15 years
- Is MRI compatible, allowing you to undergo a full-body MRI
- Can provide symptom relief
Urologic Robotic Surgery
Texas Health Flower Mound houses three advanced da Vinci surgical systems, allowing the Pelvic Health Center’s team to perform minimally invasive urologic robotic surgery. This system utilizes a robot to translate the surgeon’s hand movements into smaller, precise movements inside the patient’s body.
Compared to traditional surgery, urologic robotic surgery uses smaller incisions resulting in faster recovery, less pain, and less swelling and scarring. The surgical “robot” has computer-controlled “arms” programmed to aid in the positioning and manipulation of surgical instruments. This provides surgeons with better accuracy, flexibility, and control. Yet, the surgeon is in control at all times.
Urologic robotic surgery offers many benefits to patients compared to traditional open surgery, including:
- Shorter hospitalization
- Reduced pain and discomfort
- Faster recovery time and return to normal activities
- Smaller incisions, resulting in reduced risk of infection
- Reduced blood loss and transfusions
- Minimal scarring
- Less trauma to surrounding tissue
Whether you are a man or a woman and whether your condition is simply bothersome, or extremely stressful, the goal of the Pelvic Health and Reconstructive Surgery Center at Texas Health Presbyterian Hospital Flower Mound is to form a partnership with patients to get them back to a healthy and functional status.