Dr. Red M. Alinsod is a pioneer in the field of urogynecology. His focus on pelvic surgery has led to innovative techniques, materials and devices that are helping to improve patient safety and outcomes. Dr. Alinsod developed a passion for his specialty during his training at Loma Linda University Medical Center, and while heading the Gynecologic Services at George Air Force Base, Calif. and Nellis Air Force Base, Nev. in the 1990s. Today, Dr. Alinsod has a large urogynecology practice in Laguna Beach, Calif. He shares his passion and commitment to expanding this field by training other surgeons in new techniques of reconstructive surgery.
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Uterus1: Why did you choose the specialty of urogynecology?
Dr. Alinsod: I was highly influenced by one of my friend’s parent who was a gynecologist and renowned pelvic surgeon while I was in high school. I was particularly fascinated by surgeries that this doctor did, and years later I became one of his residents. So it was really because I had a great role model who loved his job, enjoyed his patients and was just a very happy person. I determined from that time on that I would be a pelvic surgeon.
Uterus1: Tell us more about the patients you see in your practice.
Dr. Alinsod: Since I am a urogynecologist and pelvic surgeon, the ladies that come to my office are usually referred patients or patients who have heard about me. These are typically ladies who’ve had multiple babies, they’re done having children, or have entered a second phase of their lives and want a new start. My typical age groups for the pelvic surgeries are 40s, 50s, 60s and 70s. Probably one quarter of my practice are younger women who want cosmetic surgery in their very private areas because of pain and pulling or self-esteem issues. They’re very different populations and that’s why I love my job – because there is something new every day.
Uterus1: How have the surgical procedures unique to your specialty changed within the last few years?
Dr. Alinsod: The techniques that we’ve used for 75 years have changed dramatically within the last seven years or so thanks to new devices and materials that have improved success rates, made surgery safer and allowed us to do these procedures in an out-patient setting. Instead of having three, four or five day hospital stays and two weeks with a catheter, most of our reconstructive surgeries are out-patient or overnight stays with catheters that stay in one to three days.
Uterus1: Less than one percent of surgeons are trained to perform these reconstructions, what are you doing to expand the field?
Dr. Alinsod: My mission is to get the word out to as many doctors as I can that you can help your patients in a less-invasive manner, improve your outcomes and decrease your patients’ risks by re-learning some of the anatomy and learning some newer techniques. I work with some companies who bring in doctors from all over the country and I teach them how to become proficient in these surgeries.
Uterus1: You are one of the few surgeons performing aesthetic vaginal surgery. Will you please describe the three types of surgery that fall under this description?
Dr. Alinsod: The term the public knows is “vaginal rejuvenation,” or “laser vaginal rejuvenation.” It is a tightening of the vaginal canal. The medical term most doctors use is vaginoplasty. It is for people who have had large babies or traumatic deliveries and whose vaginal opening is just so wide that they feel it prevents them from having an enjoyable sex life. The next major part of aesthetic vaginal surgery is labiaplasty, which is surgery performed for malformed or enlarged labia minora. This can be caused by trauma, such as a biking accident, or simple genetics. So we make vaginal area appealing again or more normal looking. And then there are those who are born with asymmetrical labia – the right one being twice as big as the left one, or labias that are so large on both sides that they go down to the inner thigh. It’s more common than some people would guess. So that’s a large part of my cosmetic practice, and I would say most of my patients are in their 20s and 30s who have these procedures done. I also have patients in their teens that are quite active in sports and are very uncomfortable. They cannot wear swimsuits or leotards due to embarrassment of “falling out.” The third procedure, hymenoplasty, is just making news at this time but has been performed for a long time in the Middle East. This procedure tries to re-approximate the hymen so that it appears virginal again. These procedures are mostly done for cultural and religious reasons; there are no health benefits from this procedure… other than saving honor for a family and staying alive in some cultures.
Uterus1: You also treat a lot of women with incontinence or prolapse. What are the common causes of pelvic organ prolapse?
Dr. Alinsod: The most common cause of prolapse is having babies. All those forces stretch out the tissues, and nerves can also be damaged that control the pelvic muscles. We’re also having increased weight gain in our society, and as we get heavier and heavier there is more and more pressure pushing down on the pelvis. Chronic smoking, chronic coughing, or frequent heavy lifting can also lead to prolapse. If you think of the pelvis as a funnel with one opening you can see how forces are created to push pelvic organs out.
Uterus1: What role does a loss of estrogen play in contributing to prolapse?
Dr. Alinsod: I believe it plays a large role because all the pelvic tissues have a great deal of estrogen receptors. Estrogen keeps the tissues soft and pliable and estrogen is also responsible for keeping muscle tone quite good in the pelvis. As you get into menopause, estrogen diminishes and the vaginal tissues get thinner and stretchier and you lose collagen. Lack of estrogen means loss of collagen, and as you lose collagen in the tissues in your pelvis things are going to stretch, things are going to fall down.
Uterus1: What are some common questions your patients ask?
Dr. Alinsod: The two most common things I hear from patients is that something is falling out or they feel a lot of pressure in the pelvic region. Many patients with prolapse also have leaking. Another common complaint is problems with the bowels. There’s no correlation of how bad the prolapse is with the symptoms, but we know that if there is increasing pelvic pressure there probably is some kind of prolapse going on.
Uterus1: How do you make an official diagnosis of prolapse (a fallen bladder, rectum, or uterus)?
Dr. Alinsod: After we review the patient’s history, I examine them for the first time and determine how severe the prolapse is by grading it based on certain measurements. Depending on what is found, I may recommend a bladder study to figure out if they are having spasms in their bladder, how much urine their bladder will hold, and if they retain urine. Certain pressure studies and muscle function studies are done at the same time. It’s about a 15-30 minute procedure that we do in the office and it helps to find what is causing the leakage, because all leakage is not from childbirth. There are other causes of leakage. The study helps me decide if and what type of incontinence surgery is needed. So that’s the majority of the workup. Sometimes we do an ultrasound or order an MRI, but those are rare. Also, a diagnosis is done by physical exam. If during physical exam they tell me they don’t like the appearance of their labia, or they feel that they’re stretched out so much that their not having satisfying sexual relations, then I talk about the cosmetic part of surgery.
Uterus1: What is recovery like after surgery?
Dr. Alinsod: Recovery time depends on what kind of surgery someone has. If it’s only incontinence, then surgery time is 15-30 minutes and their recovery time is a few days. The wound itself doesn’t heal for six weeks, but these people, with only a sling put in for incontinence, are up and around and walking the same day and can go back to work in a week. Sometimes they may only have a catheter put in for a day or two to three days, but more often than not they go home without a catheter. But any incision you make on a vagina takes six weeks to heal. We tell them not to exercise. Anytime you have pelvic surgery done, whether it’s a small sling or full reconstruction, it takes six weeks for full healing and I really do not recommend any excessive weight-bearing exercises so the tissues have a chance to heal and the repairs don’t get stretched. They can certainly walk upstairs, go around the block, or go to a mall, but I don’t want them pushing 50 pound carts or lifting 40 pound bags. Now if they’re going to have a bladder repair, that’s also about 30 minutes to an hour surgery and they can go home the same day. If they had just a rectal repair for a rectal bulge, same thing, a 30 to 60 minute surgery and they go home the same day and recovery is six weeks. Now lets say you have to fix a bladder, a rectum, do an incontinence procedure, or even do a hysterectomy or suspend a fallen vagina – that surgery is anywhere from two to three hours and usually it’s an overnight stay. If a patient has a lot of pain, which is not very common, they stay for two to three days, but it is rare for anyone to stay more than one to two days.
Uterus1: How have the less invasive procedures improved patient outcomes in regards to treating abnormal bleeding?
Dr. Alinsod: We used to do so many hysterectomies for women with abnormal bleeding because we didn’t know any better. Now we are able to look inside the uterus with a small flexible camera. We can get a diagnosis with just one visit instead of repeat doctor visits, repeat trials of this hormone and that hormone, or having a D & C (dilatation and curettage). Now, if we find a structural problem inside the uterus, such as a polyp or fibroid, we’re able to recommend an endometrial ablation, and that has dramatically cut down the number of hysterectomies. Hydrotherm endometrial ablation is a very safe 15-30 minute outpatient procedure done in our office, instead of a two to three day hospital stay with a big incision on your tummy. Heated water is used to cauterize the lining of the uterus and decrease or eliminate vaginal bleeding. The technology has been around since about 2002 and we were the first on the West Coast to bring the procedure out of the operating room and into the office. We can even do Essure sterilization at the same time, through the hysteroscope, and without incisions. It is a fantastic combination.
Uterus1: You are described as a pioneer in the field of urogynecology. What has been your motivation to develop such innovative procedures?
Dr. Alinsod: I’ve had a great time in this field and I’m trying to make things just a bit better for both patient and surgeon. For example, when I’m doing a case I am thinking of how I can make the surgery easier, more efficient, and safer. I think, “How can this help the patient have less complications or have a better outcome?” It’s very gratifying when you figure something out that actually helps the physician and the patient. I have a passion for teaching physicians and spreading the gospel of urogynecology and passing on the surgical pearls I have learned over the years.
To learn more about Dr. Alinsod's practice, visit www.urogyn.org.
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