Services for Women
Conditions we Treat
Kidney CancerThe lifetime risk of developing kidney cancer is 1 in 48 people in men and 1 in 83 in women. The incidence increases with age. Some kidney cancers are caused by mutations in a gene, but most
are sporadic. Many kidney cancers are incidental and found during imaging for other reasons. However, symptoms of kidney cancer including blood in the urine, back pain near the kidney (flank pain), abdominal fullness/pain. Treatment depends on stage but often includes removing the kidney (nephrectomy) and immunotherapy.
Bladder Cancer & Ureteral CancerThe incidence of bladder cancer is 11.6/100,000 people per year. Bladder cancer is more common in men than women by 4-fold. Smoking, including past history of smoking, exposure to
environmental carcinogens, recurrent infection, radiation, cyclophosamide chemotherapy drug, and chronic Foley catheter have been linked to bladder cancer. Symptoms of bladder cancer are painless blood in the urine, either microscopic or visible blood, urgency and frequency to urinate, and recurrent bladder infections. Treatment can include resection of the tumor (TURBT), removal of the bladder (Radical Cystectomy), radiation therapy, or chemotherapy.
Stress Urinary incontinenceInvoluntary loss of urine during activity such as coughing, laughing, sneezing, lifting, and exercise. If this condition is bothersome, or preventing women from activities they enjoy, they will be offered
treatment. Treatment includes pelvic floor physical therapy or pelvic floor rehabilitation (PFR), a pessary, injections of bulking material into the urethral wall (Coaptite), and sling surgery.
Urinary Urge IncontinenceInvoluntary loss of urine without warning or activity, and often associated with strong urges. Causes are idiopathic (not known), aging, bladder infection, bladder cancer, or bladder inflammation.
Treatment invisibles treating the underlying cause of there is one. Patient may also be offered pelvic look physical therapy or pelvic floor rehabilitation (PFR), medication, posterior tibial nerve stimulation (PTNS), sacral neuromodulation (Interstim), or Botox injections of the bladder wall.
Interstitial Cystitis/Chronic Bladder Pain SyndromeChronic Bladder Pain is a condition which causes pain in the bladder or urethra particularly when the bladder is full, urinary urgency and frequency.
Often patients complain of constant awareness of the bladder as though they do not empty the bladder. Causes are varied and can be muscular dysfunction of the pelvic floor, pelvic sensory nerve dysfunction, or chronic non-bacterial inflammation of the bladder, or interstitial cystitis. Treatment focuses on control of the symptoms and vary depending on the primary problem and include reduction of acidic foods in the diet, oral medication, instillation of medication into the bladder, cystoscopy with hydrodistension, injection of steroid or Botox into the bladder, pelvic floor physical therapy or pelvic floor rehabilitation, acupuncture, natural compounds such as Quercitin or marshmallow root. The prognosis is usually good but can require multiple treatments and recurrent or continuous treatment.
Recurrent Urinary Tract InfectionsSynonymous with bladder infections or UTI’s. These are infections of the Irene causing pain with urination and urinary frequency. Treatment is antibiotics.
Some women may develop recurrent infections and may need an evaluation of their urinary tract with ultrasound and cystoscopy. Causes of UTI’s in young women may be intercourse, and in most menopausal woman, loss of estrogen is the culprit. Most infections can be easily treated with an oral antibiotic. Rarely IV antibiotics are required. Vaginal estrogens and high dose Cranberry supplementation will be offered in women for prevention.
Urethral StrictureScar can form in the urethral wall forming a concentric ring in the tubular structure, termed a urethral stricture. This condition is most common in men and usually caused by sexually transmitted
disease (chlamydia), or straddle injury to the perineum (space behind the testicles) usually caused by a fall or sports injury. Symptoms are slow urinary stream, pain with urination, difficulty emptying the bladder, and recurrent infections. Treatments initially are urethral dilation in the office, or incision of the stricture cystoscopically (Direct Visual Internal Urethrotomy: DVIU). In 10% of men, these treatments fail, at which point a urethroplasty may be offered. Rarely strictures occur in women, usually caused by birth trauma. Dilation is the only treatment for stricture in women.
CystoceleA condition whereby the anterior or front wall of the vagina develops a weakness or hernia, and the bladder falls into the vagina. Risk factors for developing prolapse are vaginal delivery,
family history, obesity, and chronic constipation or coughing. Symptoms are vaginal bulging or felling of something protruding from the vagina, urinary urgency, and, inability to empty the bladder. Treatment involves controlling constipation with diet or medication, pessaries, or surgery (cystocele repair).
RectoceleA condition whereby the posterior or back wall of the vagina develops a weakness or hernia, and the rectum pushes into the vagina. Chronic constipation and vaginal delivery are risk
factors for developing a rectocele. Women may complain of difficulty emptying their rectum, fecal incontinence, and bulging from the vagina. Treatment involves controlling constipation with diet or medication, observation, a pessary, or surgery (Rectocele repair).
Uterine ProlapseA condition whereby the uterus drops from the vagina causing symptoms of vaginal bulging or pressure. Chronic constipation, lifting, or coughing and vaginal delivers are risk factors for
developing uterine prolapse. Treatment options include observation of low stage, a pessary, or hysterectomy with vaginal vault suspension.
Vaginal Vault Prolapse/EnterocoeleOccurs in women who have had a hysterectomy. The top of the vagina, termed the vaginal vault, falls through the vaginal opening. Oftentimes intestine will be prolapsing with the vaginal vault.
Symptoms are vaginal bulging or pressure. Chronic constipation, lifting, or coughing and vaginal delivers are risk factors for developing vault prolapse/enterocele. Treatment options include observation of low stage, or a pessary or vaginal vault suspension.
UPJUreteral Pelvic Junction is the region of the kidney where the ureter inserts into the kidney. UPJ obstruction is a congenital condition where the region is narrow, or a blood vessel
from the kidney compresses the area, creating obstruction at this site. Symptoms are flank pain, either constant or after drinking fluids that cause urine productions such as beer, soda, or large volumes of water. When severe, this condition can impair the function of the kidney. Kidney function tests may be done to determine renal function before offering treatment. Treatment involves removing the UPJ stricture, or reforming the UPJ so that it is no longer compressed by the renal blood vessel. This procedure is termed a pyeloplasty.
Vesico-Ureteral RefluxThis condition occurs more often in children than adults. It is a congenital condition whereby the urine refluxes, or pushes back up, the ureter as the bladder is filling or during urination.
Reflux can cause kidney infections and is often treated in children. If it is thought to cause recurrent kidney infection in adults, surgery may also be offered. Treatment is either injection of the ureteral valve with Deflux, or a surgical ureteral implant.
Kidney StonesKidney stones form from crystals in the urine and can be composed of calcium oxalate, Uric acid, cystine, or ammonium magnesium phosphate.
As stones grow in the kidney they are asymptomatic, but as they move out of the kidney and into the ureter, an individual will experience severe back pain often associated with nausea or vomiting. Smaller stones can be passed by the patient, but larger stones often require intervention. Lithotripsy (ESWL) or ureteroscopy with laser lithotripsy with or without a ureteral stent is offered to patients struggling to pass a stone. Larger stones may require percutaneous access into the kidney to treat the stone (PCNL). Hospitalization may be required to control pain. The stone, once passed or treated, will be tested and based on composition, a special diet or medication may be offered to prevent further stones. Prevention of stones always includes increasing water intake to at least 60 oz a day, and reducing high oxalate foods such as coffee, tea, chocolate, nuts, and green leafy vegetables. If the stone is uric acid in composition, a medication to reduce urinary and serum uric acid may be offered. Cystine stones are hereditary and caused by a mutation a gene that regulates how cystine is processed in the kidneys. These stones are recurrent and often patients with cystine stones require many treatments over their lifetime.
Treatments we Offer
Abdominal SacrocolpopexyA procedure used to support the vaginal in women with pelvic organ prolapse. A piece of soft Y-shaped mesh is placed around the vagina through the abdomen, and the base of the mesh is attach to the
supportive ligaments of the spine from inside the abdominal cavity. This procedure is most often done using Robotic Assisted Laparoscopy.
Anterior Vaginal Prolapse Repair or Cystocele RepairA procedure that uses an incision in the anterior wall of the vagina under the bladder to build support for the bladder. This repair can be done with sutures to repair the weakened tissues or by placing a biologic graft or mesh if needed.
Apical Prolapse RepairA procedure that restores the support to the top of the vagina. This surgery can be done at the same time as a hysterectomy for uterine prolapse or the top of the vagina can be suspended if you have
already had a hysterectomy. We offer all methods of suture based apical repairs including the uterosacral ligament suspension and sacrospinous ligament suspension. We also offer robotic sacrocolpopexy whereby soft mesh is placed around the outside of the vagina and the base of the mesh is attach to the supportive ligaments of the spine from inside the abdominal cavity.
Excision of Vaginal MeshThis procedure is performed when a patient has suffered a complication of vaginal mesh which has been diagnosed by one of our physicians. Washington Urology will not remove vaginal mesh unless there is a documented complication, and not upon patient request only.
Interstim neuromodulationA nerve stimulator implant placed for Overactive Bladder symptoms that have not improved with other treatments such as physical therapy or medications. The nerve stimulation is done through a
small wire placed along the sacral nerves through a small skin incision near the buttocks. If a test stimulation is successful in improving symptoms, then a permanent wire is placed and connected to a small control device that is implanted in the buttock region.
LabioplastyA surgical procedure offered to patient who wish to reduce the size of their labia.
Periurethral Bulking InjectionsA treatment we offer for stress urinary incontinence. This procedure is performed as an outpatient with local anesthesia. The procedure is performed by using a thin needle to inject a filling agent into the walls of the urethra to increase the strength of the urethral closure and reduce urine leaking.
Pessary FittingPlace of a ring shaped supportive device that is used to hold up pelvic organ prolapse, or to treat stress urinary incontinence. The fitting is done in the office by either an MD, PA, or medical assistant trained in pessary placement. The patient is taught to remove the pessary once a week to once a month to clean it.
Posterior Tibial NeuromodulationThis office treatment is used to treat patient with overactive bladder. A small acupuncture needle is placed near the ankle to stimulate a nerve that runs from the lower spine to the foot. Stimulations over the course of several weekly sessions produces relaxation of the bladder.
Posterior Vaginal Prolapse Repair or Rectocele RepairA procedure that uses an incision along the back wall of the vagina to repair the damaged fascial tissues and muscles. This repair is usually done with sutures but can be done with a graft if needed. This repair includes a repair of the perineal muscles and the vaginal opening if these have been damaged by vaginal birth.
Botox Chemodenervation of the BladderThis procedure if offered to women and men with overactive bladder (urgency, frequency, and/or urge incontinence) who have failed alternative therapies such as medication, behavioral therapy, or
physical therapy. Botox, a neurotoxin that safely paralyzes muscles only where injected, is injected into the bladder muscle to relax the bladder spasms. Botox is a safe, effective, outpatient procedure that requires reinjection on average every 6 months.
Bladder InstillationsThis treatment is used for interstitial cystitis patient, or chronic bladder pain patients, to control their symptoms of urgency, frequency and bladder discomfort. The instillation is a cocktail of different medications, including DMSO or Heparin, that soothes the bladder.
ColpocleisisIs an Obliterative vaginal procedures can be done for uterine or vaginal prolapse if intravaginal intercourse is no longer desired. The procedure involves sewing the vaginal walls together with sutures to support prolapse of the vagina or uterus. This is a lower risk prolapse repair and offers excellent long-term support.
Cystoscopy and hydrodistensionThis procedure is used to treat and diagnose patients who have, or are thought to have, Interstitial Cystitis, or Chronic Bladder Pain. The bladder is stretched with fluid under general anesthesia. Sometimes sores, known at Hunner’s Ulcers, are injected with steroid and the surface of the ulcers is fulgurated.
Mona LisaThis is an outpatient office laser treatment of the vagina offered to patients with vaginal atrophy, or thin vaginal skin resulting of menopause. The treatment involves applying laser energy to the vaginal tissues to “resurface” the vaginal lining to improve vaginal dryness and vaginal tone.
Robotic HysterectomyThe removal of the uterus using laparoscopic incisions with the addition of the robotic surgical platform to add precision and control. We offer this for women with known or suspected endometriosis, adhesions, enlarged uterus with fibroids or other reasons to have a laparoscopic surgery.
Sling Surgeryis done for stress urinary incontinence such as leaking with a cough, sneeze or laughing. The sling is a small strip of surgical mesh that is gently placed under the bladder opening or urethra through a small vaginal incision. This is an outpatient surgery with minimal recovery and high success rates – greater than 90% of women are happy with the outcome of reduced or resolved urinary leaking.
Urethral DiverticulectomyRemoval of an outpouching or sac from the urethral in women. We offer diverticulectomy in women who have symptoms from their diverticulum, including recurrent urinary tract infection, pain with
intercourse, vaginal bulging, post-voiding dribbling or incontinence. The sac is surgically excised through a vaginal incision. A catheter is used to drain the bladder to allow healing of the urethral incision after surgery.
Vaginal Hysterectomyis the removal of the uterus through a vaginal incision. We offer vaginal hysterectomy for women with uterine prolapse, menstrual bleeding abnormalities, fibroids or other gynecologic concerns requiring a hysterectomy. This is the safest method for hysterectomy and we have a vast experience and expertise with this procedure.
Services we Offer
CystoscopyA telescope or cystoscope is placed into the bladder by way of the urethra and the bladder is inspected for pathology such as cancer. This test is used to evaluate patient with blood in the urine, or
difficulty emptying their bladder. It is also used to monitor patients who have a history of bladder cancer.
Post Void ResidualThis test is a simple ultrasound of the bladder to assess volume in the bladder after voiding. This number should be close to 0cc if a patient is emptying the bladder well.
This is used in the evaluation of incontinence and obstructive voiding.
UltrasonographyUltrasound is an imaging modality whereby sound waves are used to take pictures of internal organs. Washington Urology uses ultrasound
to image kidneys, bladder, testicles, and the prostate gland.
UrinalysisThe urine is tested for blood, infection, protein. The urine is usually obtained from a voided sample, but can be obtained from a catheter.
Urethrogram/cystogramContrast dye is instilled through a catheter into the urethra or bladder or both. Patient who may have bladder or urethral abnormalities
such as a urethral stricture or who have had recent bladder surgery, may require this test.
UltrasonographyThis is a radiologic study that uses sounds waves to take detailed pictures of internal organs. At Washington Urology we image the kidneys looking for stones, tumors,
or hydronephrosis; the prostate looking for infection or cancer; the bladder to determine residual bladder volume or other bladder pathology; and the uterus/ovaries to diagnoses benign or malignant tumors of the uterus or ovaries.
Video UrodynamicsThis test is used to evaluate bladder function in patients with urinary incontinence or who are unable to urine well. A catheter is inserted into the bladder, and the bladder filled to capacity.
During the study, the patient may be asked to cough and strain to determine pressures that cause them to have incontinence. The urethra and bladder will be evaluated during voiding to determine efficiency of voiding and voiding pressures.
WUA is pleased to expand our services in Issaquah, with the establishment of our clinic, open Monday through Friday. Now, with better access and availability, Dr. Kripa Kavasseri is accepting new patients in our Issaquah office, conveniently located on the Swedish Issaquah campus. Call today for an appointment close to home!