# California Urogynecology Center > Empowering Women's Health, Enhancing Life. ## Posts - [Medium-term outcomes of sacral neuromodulation in patients with refractory overactive bladder: A retrospective single-institution study](https://californiaurogynecology.com/medium-term-outcomes-of-sacral-neuromodulation-in-patients-with-refractory-overactive-bladder-a-retrospective-single-institution-study/): Bilal Kaaki 1 2, Digant Gupta 3 Affiliations Expand Abstract Background: Sacral neuromodulation (SNM) is a minimally invasive fully reversible therapy that was approved in 1997 for overactive bladder syndrome (OAB) refractory to behavior modification and pharmacotherapy. Despite being in use for over two decades, the data on medium to long-term safety and efficacy of SNM in OAB is limited. We investigated the medium-term efficacy and safety of SNM along with the predictive factors for its success in patients with refractory OAB. Methods: A retrospective consecutive case series of 66 patients undergoing SNM for refractory OAB between July 2009 and July 2018. All patients underwent a test… - [Feasibility of a Fully Implanted, Nickel Sized and Shaped Tibial Nerve Stimulator for the Treatment of Overactive Bladder Syndrome with Urgency Urinary Incontinence](https://californiaurogynecology.com/feasibility-of-a-fully-implanted-nickel-sized-and-shaped-tibial-nerve-stimulator-for-the-treatment-of-overactive-bladder-syndrome-with-urgency-urinary-incontinence/): Scott MacDiarmid 1, David R Staskin 2, Vincent Lucente 3, Bilal Kaaki 4, Sharon English 5, Peter Gilling 6, Patrick Meffan 7, Matthew Clark 8, Peter K Sand 9, Subhro K Sen 10, Eric Rovner 11 Affiliations Expand Abstract Purpose: We performed a clinical feasibility trial to evaluate the safety and efficacy of a fully implanted, primary battery powered, nickel sized and shaped neuromodulation device called the eCoin® for tibial nerve stimulation to treat refractory urgency urinary incontinence. Materials and methods: This prospective, single arm, open label study included 46 participants with refractory urgency urinary incontinence. It was performed at multiple sites in the United States and New Zealand. The device was implanted in the lower leg over the tibial nerve and activated after… - [Spontaneous intrapartum vesicouterine fistula](https://californiaurogynecology.com/spontaneous-intrapartum-vesicouterine-fistula/): BBilal Kaaki 1, Michael Gyves, Howard Goldman Affiliations Expand Abstract Background: Vesicouterine fistulae as an obstetrical complication have been reported only in women with a history of cesarean. We present a patient with no such history who developed a vesicouterine fistula after vaginal delivery. Case: A 43-year-old gravida 5 at term with no history of cesarean presented in the latent phase of labor. Gross hematuria was noted intrapartum, and a foley catheter was placed. A cystogram showed an extraperitoneal bladder perforation. The patient had urinary incontinence despite Foley catheter drainage. The diagnosis of vesicouterine fistula was made by cystoscopy and fistulogram. The patient had a successful… - [Vesicovaginal fistula resulting from a well-cared-for pessary](https://californiaurogynecology.com/vesicovaginal-fistula-resulting-from-a-well-cared-for-pessary/): Bilal Kaaki 1, Sangeeta T Mahajan Affiliations Expand Abstract An 84-year-old vaginally grand multiparous woman presented with a vesicovaginal fistula (VVF) after appropriate use of a Gehrung pessary for the past 12 years for stage III pelvic organ prolapse. The patient reported strict adherence to removing her pessary nightly and replacing it in the morning for the last 12 years. One morning, she awoke and noted a sudden gush of urine through the vagina followed by continuous leakage. Given the complex nature of VVF repair with concurrent stage III pelvic organ prolapse, the patient was referred to urogynecologic care. A Latzko fistula repair… - [Evaluation and treatment of female sexual disorders](https://californiaurogynecology.com/evaluation-and-treatment-of-female-sexual-disorders/): Sheryl Kingsberg 1, Stanley E Althof Affiliations Expand Abstract Prevalence data suggest that more than 40% of women experience sexual problems and that 12% of these women are distressed by the problem. In the 1960s, Masters and Johnson introduced what is now considered the classic linear model of female sexual response based on a physiologic foundation. Recently, Rosemary Basson introduced a nonlinear interconnected model which emphasizes the importance of emotional intimacy and satisfaction as integral components of the female sexual response cycle. According to the Diagnostic and Statistical Manual (DSM-IV TR), there are six female sexual disorders: hypoactive sexual desire disorder, aversion disorder,… - [Direct cost of hysterectomy: comparison of robotic versus other routes](https://californiaurogynecology.com/direct-cost-of-hysterectomy-comparison-of-robotic-versus-other-routes/): Bilal Kaaki 1 2, Emma Lewis 3, Sukruta Takallapally 4, Benjamin Cleveland 5 Affiliations Expand Abstract The aim of this study was to investigate the direct cost of robotic hysterectomy in comparison with abdominal, vaginal, and laparoscopic routes past the initial learning curve. We examined a consecutive case series of 348 patients undergoing abdominal (AH), vaginal (VH), laparoscopic (LH), or robotic hysterectomy (RH) for benign conditions between January 2015 and March 2017. The primary outcome was the direct cost of hysterectomy, while the secondary outcome was length of stay. Multiple linear regression was used to examine the cost and length of stay across the four hysterectomy groups after controlling… ## Pages - [Blogs](https://californiaurogynecology.com/blogs/) - [Doctor Onepage](https://californiaurogynecology.com/doctor-onepage/): psychological help Stop Searching for Answers Alone Make an Appointment Sed ut perspiciatis unde omnis iste natus ut perspic iatis unde omnis iste perspiciatis ut perspiciatis unde omnis iste natus. Anna Green Psychologist Q nsectetur adipiscing elit, sed do eiusm onsectetur adipiscing elit, eiusm ode tempor ut labore eiusm od sed. Consectetur adipiscing elit, sed do eiusm onsectetur adipiscing elit, sed do eiusm od tempor ut labore sed adipiscing do eiusm od tempor. Consectetur adipiscing elit, sed do eiusm onsectetur adipiscing elit, sed do eiusm od tempor incididunt ut. 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Urinary Incontinence Read More here are two main types: Stress incontinence: Leakage with coughing, laughing, or physical activity. Often linked to pregnancy, obesity, smoking,… - [Appointment](https://californiaurogynecology.com/appointment/): September 2024 Mon Tue Wed Thu Fri Sat Sun 262728293031123456789101112131415161718192021222324252627282930123456 - [Blog Portfolio](https://californiaurogynecology.com/blog-portfolio/) - [Service Plus](https://californiaurogynecology.com/service-plus/): Dear Customers, Our primary goal is developing a secure and customizable theme framework that meets the needs of the end user. Therefore, our customers are able to create websites using our templates as easy as 1-2-3! This process requires minimum knowledge of WordPress and coding, and extended documentation and our Support Team is always at your service. However, we ask you to keep in mind that sometimes issues occur not because of templates malfunction. 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A urogynecologist is a gynecologist with additional years of subspecialty training focusing on pelvic floor disorders like incontinence and prolapse How does this differ from a regular gynecologist? Unlike general OB–GYNs, urogynecologists undergo Extra training in pelvic floor medicine and reconstructive surgery What symptoms should prompt seeing a urogynecologist? You should see a specialist if you experience urinary leaks, pelvic pressure, bulging, bowel leakage, frequent UTIs, or pelvic pain Is urinary leakage normal as I age? While common—affecting ~40% of women aged 60–79—it’s not normal… - [Our Team](https://californiaurogynecology.com/our-team/): Amy Walker General dentist Stanley Hood Pediatric dentist Damon Cain Oral pathologist Neila Carter Dental technician Brian Long Dental hygienist Steven More Oral surgeon Steps Steps for reliable lab results Sed ut perspiciatis unde omnis iste natus ut perspic iatis unde omnis iste perspiciatis ut perspiciatis unde omnis iste natus. 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Services Urinary Incontinence Urinary incontinence is characterized by the unintended leakage of urine due to the inability to fully control bladder function. It’s commonly caused by weakened pelvic floor muscles from… - [Our Provider](https://californiaurogynecology.com/our-provider/): Expert Urogynecologist Specializing in Pelvic floor disorders, and Personalized Women’s Care. Dr. Bilal Kaaki is a leading urogynecologist dedicated to enhancing women’s health and quality of life. With over 20 years of experience, he is nationally recognized for his expertise in reconstructive pelvic surgery , minimally invasive and robotic surgery, having successfully performed over 5,000 pelvic reconstructive surgeries and 3,000 robotic laparoscopic procedures.  Dr. Kaaki provides comprehensive care for a wide range of conditions in female pelvic medicine including, urinary and fecal incontinence, pelvic organ prolapse, overactive bladder, sexual dysfunction, genito-urinary fistula, vaginal agenesis, and cosmetic gynecology. He routinely treats… - [My Account](https://californiaurogynecology.com/my-account/) - [Checkout](https://californiaurogynecology.com/checkout/) - [Cart](https://californiaurogynecology.com/cart/) - [Blog Standard](https://californiaurogynecology.com/blog-standard/) - [Contact Us](https://californiaurogynecology.com/contact-us/): Contact Us Have questions? Get in touch! 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