Pelvic Health Care for Women and Men

We know that navigating your pelvic health can feel uncomfortable, but we’re here to support you. At AdventHealth, we have dedicated teams of urologists committed to providing pelvic health care for women and men in our communities.

Robert W. Santa-Cruz, MD, is a board-certified urologist at AdventHealth who specializes in robotic vaginal prolapse repair, penile implants and treatments and many other leading-edge urologic procedures.

Keep reading to learn more about how Dr. Santa-Cruz treats pelvic health conditions for women and men through leading-edge, minimally invasive procedures.

Pelvic Health for Men

“Erectile dysfunction (ED) is common for men and nothing to be embarrassed about,” says Dr. Santa-Cruz. “It’s estimated that 40% of men at age 40 experience ED and 70% of men by age 70.” ED is a condition that prevents men from getting or keeping an erection. Dr. Santa Cruz says, “Most patients are seeing us through a referral from their primary care provider following their initial treatment failure.” We know navigating ED can feel uncomfortable, but there are a variety of intervention options, including oral medications, penile injections and inflatable penile prosthesis devices (IPP).

The Ins and Outs of an IPP

“One way we treat ED in men is through an inflatable penile prosthesis (IPP),” says Dr. Santa-Cruz. “IPP is a minimally invasive surgical procedure we perform when patients have proven unresponsive to other forms of treatment for ED. This procedure works by implanting an inflatable device into the penis and a pump into the scrotum to allow patients to get an erection,” says Dr. Santa-Cruz.

The inflatable implant has two cylinders as well as a reservoir and pump. Dr. Santa-Cruz says, “We start by inserting the cylinders into the penis. We use several tubes to connect the cylinders to the reservoir under the stomach muscles. We then place the pump under the loose skin of the scrotum and connect the pieces.”

To inflate the implant, the patient must press the button on the pump located in the scrotum. That triggers the pump to transfer fluid from the reservoir to the cylinders in your penis and inflates them to your desired level of hardness. “With an IPP, you’re able to maintain your erection for as long as you’d like. To return to normal, press the button on the pump, and the process reverses,” says Dr. Santa-Cruz.

Benefits, Risks and Candidacy for IPP

“The biggest benefit of an IPP is its ability to guarantee an erection for your desired length of time,” says Dr. Santa-Cruz. “Overall, there are very few risks for this procedure, and most patients are satisfied with the results.” Although it’s rare, there are some risks associated with IPPs, including uncontrolled bleeding, pump or reservoir displacement, infection and decreased blood flow to the head of the penis.

This is typically an outpatient procedure. You’ll be closely monitored over several weeks in the postoperative course to ensure you heal as expected. Your medical staff and a product device representative will also provide necessary education to ensure you’re comfortable using the device.

“A good candidate for an IPP is someone with diagnosed ED or Peyronie’s disease, the desire to gain and maintain an erection on demand and a patient who has demonstrated appropriate hand dexterity to activate and use their device efficiently,” says Dr. Santa Cruz. Whether this is a new concern or a longstanding problem, talk with your doctor to determine if this option is right for you.

Pelvic Health for Women

Pelvic floor prolapse is a condition affecting the pelvic floor, which is the muscles and tissues that support pelvic organs," says Dr. Santa-Cruz. While this condition can affect both men and women, it’s far more common in women. The typical causes of pelvic floor prolapse in women are:

• Age (post-menopausal)
• Extreme physical activity
• Genetics
• Vaginal childbirth

“We can think of the pelvic floor as a hammock of muscles and tissues that hold your pelvic organs in place,” says Dr. Santa-Cruz. “Whether the muscles are overstretched, weakened or torn, it allows the pelvic organs to drop out of their usual placement and dip into the vagina. Patients typically report seeing or feeling a bulge in the vagina, feeling pressure in the pelvis or lower back and experiencing urinary incontinence.”

Treating Pelvic Floor Prolapse

Because pelvic floor prolapse is an anatomical abnormality, it typically requires surgical intervention. “There are different surgical approaches to treat it, but in my practice, we most frequently use a robotic-assisted sacrocolpopexy,” says Dr. Santa Cruz. “This procedure uses a surgical mesh to hold the pelvic organs in their original location.” During this procedure, you have the option to remove your uterus, fallopian tubes and ovaries to reduce the risk of ovarian or fallopian tube cancer.

“We start the procedure with four or five small incisions. We then inflate the patient’s abdomen with carbon dioxide to allow us greater access to perform the procedure. We attach a surgical mesh to the top and bottom of the vaginal walls and the sacrum,” says Dr. Santa-Cruz. This mesh works as a synthetic pelvic floor, returning organs to their proper placement and relieving symptoms of pelvic floor prolapse.

Recovery and Success of Sacrocolpopexy

“Typical recovery time for patients who had sacrocolpopexy is six to eight weeks,” says Dr. Santa-Cruz. “As patients recover, we ask them to avoid lifting heavy objects and sexual intercourse to allow for proper healing.” This procedure is around 90% successful, leaving most patients satisfied.

“It’s important for patients to know that pelvic prolapse can return. However, the abdominal surgical approach has fewer risks compared to other vaginal approaches,” says Dr. Santa Cruz. “It’s best to avoid activities that put you at an increased risk of it returning, like lifting heavy objects and repetitive straining activities.” Talk to your doctor to find out if sacrocolpopexy is right for you.

Helping You Reclaim Your Life

We know that navigating your pelvic health can feel overwhelming, but you aren’t alone. At AdventHealth, we respect your privacy and are committed to providing the medical expertise you deserve so you can get back to the life you love.

Visit us here to schedule an appointment with Dr. Santa-Cruz. You deserve to feel whole.