Obstetrics & Gynecology

MSC 10 5580
1 University of New Mexico
Albuquerque, NM 87131

Urogynecology

Who are We? Or What is a Urogynecologist?

Urogynecologists, also known as Women’s Pelvic Floor Surgeons, are gynecologists who have received formal fellowship training (i.e. additional training following a gynecology residency) with American Board of Obstetrics and Gynecology subspecialty certification to treat women who have pelvic floor problems.

These problems include:

  • urinary incontinence (involuntary urine loss)
  • overactive bladder (‘you gotta go, you gotta go’ bladder problems)
  • pelvic organ prolapse (descent of pelvic structures resulting in a sensation of vaginal bulging)
  • fecal incontinence (accidental bowel leakage)
  • interstitial cystitis (painful bladder syndrome)
  • urinary retention (inability to urinate)
  • surgical complications (including mesh complications) from previous prolapse or incontinence operations

Our philosophy: We are a team of physicians, nurses, midwives and physical therapists who are committed to providing comprehensive and individualized care for women who suffer from pelvic floor disorders. 

Our Mission: The Urogynecology Division, A diverse group of individuals, provide the highest standard of care in the prevention and treatment of pelvic floor disorders.  We do this in the safest, most effective and compassionate way to improve quality of life for our patients and for our community by empowering women to partner in their care.

Our Vision: Our vision is to be recognized as the premier center for pelvic floor disorders through our quality care, nationally recognized research programs, and highly sought after educational opportunities.  This will be provided in a welcoming and safe environment resulting in satisfied patients and fulfilled employees.

Problems Treated by Urogynecolgist

Dedicated Pessary Clinic

 At UNM, we have a dedicated pessary clinic focused on the care of women with prolapse and incontinence who prefer non-surgical treatment of their pelvic floor dysfunction.  Staffed by 2 midwives, the clinic offers pessary fitting and care as well as posterior tibial nerve stimulation.  Our midwives are the foremost authorities on pessary care and fitting and serve as consultants for providers throughout the state.  In order to ensure that women receive the best care possible, women referred to the pessary clinic are first evaluated by one of our faculty urogynecologists.

For more information on the problems we treat, please click on each category below. 

Urinary Incontinence

Definition: Involuntary urine loss

Description: A common problem affecting up to 20% of women. “Stress Incontinence” is urine loss which usually occurs with activities such as coughing, laughing, sneezing or exercise (like jumping up and down, or jogging). “Urgency Incontinence” is urine loss which usually occurs with a sensation that ‘you gotta go’ but can’t make it to the restroom in time. If this is a bothersome problem for you, we are happy to evaluate you and discuss treatment options with you.

Treatments:

  • Stress Incontinence
    • Non-surgical treatments
      • Behavioral changes can help
      • Pelvic floor exercise is very helpful (and our specialized physical therapists are experts in helping patients do pelvic floor exercises)
      • Placement of a pessary by our midwife pessary specialists can be very helpful (a pessary is a small ring which can be inserted in the vagina to decrease urine loss
    • Surgical treatments
      • Minimally invasive sling operations (placement of small pieces of synthetic material behind the urethra, the tube leading from the bladder, can greatly improve urine loss)
      • Traditional urinary incontinence procedure (such as a ‘fascial sling’ or ‘Burch procedure’)
      • Periurethral injections (injections of material around the urethra to decrease urine loss)
  • Urgency Incontinence
    • Non-surgical treatments
      • Behavioral changes can help
      • Pelvic floor exercise or other treatment from our physical therapists may help
      • Medications can help
      • Posterior tibial nerve stimulation (weekly placement of a needle in the ankle area, rather like an acupuncture needle, in women who don’t respond to other non-surgical treatments)
    • Surgical treatments (in those patients who do not respond to non-surgical treatments)
      • Botox injections into the bladder
      • Placement of a sacral neuromodulator (something like a ‘bladder pacemaker’

Pelvic Organ Prolapse

Definition: A condition in which there is downward descent of pelvic structures such as the uterus or vagina

Description: This condition can occur to different degrees in many women. It is usually not a dangerous or life-threatening problem. Women typically seek treatment because the “bulge” or feeling that “something is falling out” is bothersome or uncomfortable. If this is a bothersome problem, we are happy to evaluate you and discuss treatments for the problem.

Treatments:

  • Non-surgical

    Photo of a pessary device
        Pessary Device
     

    • Pessary placement by the nurse midwife specialists can be helpful (a pessary is a small ring which comes in many shapes and sizes, and can be inserted in the vagina to reduce the vaginal bulge or prolapse)—see photo
    • Physical therapy to strengthen the pelvic floor for added support of the organs
  •  Surgical 
    • Vaginal repair of prolapse using your own tissue (the traditional, tried and true vaginal operation performed to support the vagina by attaching it to the ligaments or structures which are higher in the pelvis)
    • Minimally invasive (robotic or laparoscopic) sacrocolpopexy (a procedure done for over 50 years placing mesh on the vagina and attaching it to the sacrum, lifting the vagina higher to its normal position; this operation can now be performed with small incisions using a laparoscopic or robotic procedure)
    • Placement of vaginal mesh to reduce prolapse (this procedure has been the subject of recent controversy and we are happy to discuss this at length with you)

Fecal Incontinence

Definition: Involuntary stool loss (accidental bowel leakage)

Description: A problem which is more common than we realize. Patients are often hesitant to seek treatment for this problem due to embarrassment. It may be due to anatomic abnormalities or bowel problems. We work with the GI doctors and colo-rectal surgeons to treat these problems.

Treatments:

  • Non-surgical
    • Behavioral Changes (keeping track of dietary or life-style situations which may affect this problem)
    • Physical therapy can include strengthening exercises, bowel diary instruction, and biofeedback.
    • Medications (such as use of immodium or other medications)
  • Surgical
    • Placement of a sacral neuromodulator (something like a ‘heart pacemaker’ which is used to control fecal incontinence due to situations such as irritable bowel disease)
    • Repairs of anal sphincters (if stool loss is due to disruption of the band of muscle at the end of the rectum, this muscle can be re-approximated to hold in stool more effectively)
    • Repair of recto-vaginal fistulas (an uncommon but devastating problem where there is a hole between the rectum/lower bowel and the vagina)
    • We also refer to our colo-rectal surgeons if we find other conditions which may be surgically corrected

Other Pelvic Floor Problems

We also treat other problems such as complications from prior prolapse or incontinence surgeries, interstitial cystitis (also called Bladder Pain Syndrome) and urinary retention. We use individualized, multi-modal therapy to treat these problems including patient education, physical therapy, vaginal injections/instillations of medications in the bladder/bladder surgery when appropriate.

Imaging of Pelvic Floor Problems

We are fortunate to have Dr. Peter Jeppson on our faculty. He provides expertise in helping the team diagnose certain pelvic floor abnormalities in the Women’s Imaging Center adjacent to the UNMH Urogynecology Clinic.

Physical Therapy for Pelvic Floor Problems

Embedded within our clinical services at UNM and Sandoval, we offer women’s health physical therapy.   These services are aimed to help women with bladder and bowel control, reduce pelvic pain, and improve pelvic support.  We offer vaginal and anal biofeedback, manual therapies and exercise routines meant to improve pelvic floor health, by experienced therapists all of whom have had specialized women’s health services.

Urogynecology Fellowship Information

To Apply

The Urogynecology Fellowship accepts
applications only through the "Electronic
Residency Application Service" (ERAS)

Deadline/Interview dates:
Last day to apply: March 13th, 2017
Interview dates: April 28th and May 5th, 2017

If you would like further information about the
Urogynecology fellowship program at the University
of New Mexico School of Medicine, please e-mail a
question or request specific information from our
Fellowship Program Coordinator Susan Quintana.

Fellowship Description for Applicants


Welcome!  We are delighted that you are interested in learning more about the Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellowship program at the University of New Mexico.

The primary goal of the University of New Mexico’s Division of FPMRS fellowship is to train well rounded, subspecialist physicians who are experts in the surgical anatomy, physiology, and pathophysiology of the pelvic floor.  In addition, our fellows become expert in the treatment of pelvic floor dysfunction.  We offer a broad range of clinical, surgical, and research experience.   It is also the goal of our program for fellows to develop teaching and research expertise in pelvic floor disorders to assist in the development of successful and productive academic careers.

Clinical Experience

  • Surgery:  Our surgical training program includes a large volume of highly complex pelvic reconstructive cases. We have a large referral area encompassing the entire state of New Mexico, and parts of Texas, Arizona and Colorado.
  • Broad exposure to surgical training in laparoscopic, robotic, open and vaginal techniques
  • On-site simulation center to facilitate training experience.
  • Ultrasound:  Fellows participate in weekly clinical ultrasound clinics focused on both transperineal and endoanal imaging of pelvic floor and rectum.
  • Off-Service Rotations:  One month rotations in Gastroenterology, Urology and Colorectal Surgery
  • International Fistula Experience:  During the 2nd fellowship year, fellows are offered a 2 week elective experience traveling with a Division faculty member to Rwanda to participate in a Fistula Camp.

Research Experience

Fellows receive a broad exposure to research including opportunities to participate in ongoing faculty research, weekly research meetings, dedicated research didactics and Clinical Translational Investigator Program supported by UNM’s CTSC.  

  • Thesis: Each fellow must design, develop and complete their own research project with faculty guidance during fellowships. Fellows are encouraged to pick research topics that interest them. Fellows also enjoy free biostatisticial support and multiple grant opportunities.  Previous fellowship research projects include:
    • "Pessary care and hygiene: Data from a Randomized Controlled Trial.“ - K. Meriwether
    • “Standardized vs mnemonic teaching for fecal incontinence: A pilot RCT” – S. Cichowski
    • “External genital measurements in women with pelvic floor dysfunction: Do they relate to body image?” - B. McFadden
    • “Global improvement and goal attainment in patients what choose surgery versus pessary for treatment of symptomatic pelvic organ prolapse” – M. Kulkarni (Mamik)
    • “Validation of a new measure of patient understanding following informed consent” – S. Hammil
    • “Caffiene intake and overactive bladder symptoms” – T. Omotosho (Fashokun)
    • “Informed consent if gynecologic surgery” – H. Abed
    • “Magnetic resonance imaging of women treated with urinary incontinence with a pessary” – Y. Komesu
    • “Diabetes and urinary incontinence in 50-90 Year Old Women:  A cross-sectional population based study” – C. Lewis
    • Recent Research: You can visit our Website for more details about our research via this link.

Current Fellows

The fellows in our program have established a strong tradition of excellence. Each has completed award winning projects during their fellowships and had productive publication records during their training. In addition they gain first-hand experience in writing review articles and chapters in books.

  • Weekly Teaching Conference: Thursday and Friday mornings are reserved for didactics. Fellows also attend departmental grand rounds.
  • Call: There is no in-house or at-home call for general obstetrics and gynecology. The fellows take call for the FPMRS service from home on a rotating basis.
  • House Officer Association: The fellows are a part of the University of New Mexico Officer’s Association that has many benefits for the residents and fellows throughout the institution.
  • Past Fellows
  • Conferences Attended:
    • AUGS
    • SGS

First Year

Tessa Krantz
Tessa
Krantz, MD

Second Year

Jenny Thompson
Jenny
Thompson, MD

Third Year

Cara Ninivaggio
Cara
Ninivaggio, MD

Get to know the Urogynecology Division

Looking for someone? See our Faculty Directory.

Click on each category to get to know our teams.

The Doctors

Peter Jeppson, MD

Undergraduate Education: Utah State University
Medical School: Saint Louis University School of Medicine
Residency: Case Western MetroHealth and Cleveland Clinic
Female Pelvic Medicine and Reconstructive Surgery Fellowship: Brown University, Women and Infants’ Hospital

Professional Interests: I am interested surgical and non-surgical treatment options for women with urinary incontinence, pelvic organ prolapse, fistula, anal incontinence, and pelvic pain.

Personal statement: I enjoy being at an academic medical center where we can provide a full array of treatment options and expertise for patients regardless of their ability to pay for care. I also enjoy teaching fellows, residents, and students to help prepare them to continue to provide the clinical care patients need.


Yuko Komesu, MD

Undergraduate Education: University of Michigan
Medical School: University of Michigan
Residency: University of Michigan
Pelvic Surgery Fellowship: Cleveland Clinic
Female Pelvic Medicine and Reconstructive Surgery Fellowship: University of New Mexico

Professional Interests: I am particularly interested in treating women with urinary incontinence and pelvic organ prolapse and am interested in exploring the role of mind-body therapies in chronic, pelvic floor disorders.

Personal statement: I am honored to care for women afflicted by these Urogynecologic abnormalities which have a profound impact on their quality of life. As a clinician and researcher, I may have learned more from my patients than they have learned from me.

Gena Dunivan, MD

Undergraduate Education: University of New Mexico  
Medical School: University of New Mexico
Residency: University of California, San Diego
Female Pelvic Medicine and Reconstructive Surgery Fellowship: University of North Carolina at Chapel Hill

Professional Interests: I enjoy caring for women with a broad range of pelvic floor disorders; including urinary incontinence, fecal incontinence and pelvic organ prolapse. I am interested in providing both non-surgical and surgical treatment options for my patients.

Personal Statement: I did my initial medical training at UNM and am so grateful to my first teachers, the women of New Mexico, and have returned to UNM as it allow me to participate in the training of the next generation of care providers. I am privileged to serve and care for the women of New Mexico and feel I can best do that because of the outstanding group with which I work.


Sara Cichowski, MD

Undergraduate education: Wheaton College
Medical School: University of Washington
Residency: Akron General Hospital
Fellowship: University of New Mexico

Professional Interests: I am interested in urinary and fecal incontinence, pelvic organ prolapse, non-cyclic pelvic pain and fistula; I enjoy helping women with these pelvic floor disorders choose the surgical or non-surgical option that would most improve their quality of life.

Personal statement: I am privileged to be jointly appointed to the Veteran’s Hospital and the University of New Mexico. This has allowed our division to expand our services to both veterans and military dependents. Where ever you choose to receive your care, UNM, SRMC or the VA, our Urogynecology team is fantastic!

Faculty

Frances Alba, MD

Medical School: University of New Mexico
Internship: University of Texas - Houston, HSC
Residency: University of Texas - Houston, HSC

She is an Assistant Professor in the Department of Surgery, Division of Urology.  She supervises the fellows' urologic experience at SRMC.  The SRMC fellows spend one full day a week in the operating room with Dr. Alba performing urologic procedures.

Rohini McKee, MD

Medical School: St. John's National Academy of Health Sciences
Internship: Rhode Island Hospital
Residency: Brown University Program in Colon and Rectal Surgery

She is an Associate Professor in the Department of Surgery, Division of Colon Rectal Surgery.  She supervises the fellows on their colorectal rotation.  She is the NSQIP Champion for UNM and has a special interest in quality and safety outcomes and functional bowel disorders.

Archana Kaza, MD

Medical School: Jawaharaial Institute
Internship: University of New Mexico School of Medicine
Residency: University of New Mexico School of Medicine

She is an Assistant Professor in the Department of Internal Medicine, Division of Gastroenterology.  She supervises and educates the fellows on anorectal manometry and serves as a consultant for complicated patients with anal incontinence and bowel dysfunction.

The Physical Therapy Team


Christy Miller, BS, MPT

Education: Bachelor of Science in Sports Medicine at UNM, Masters of Physical Therapy at UNM

Professional Interest: My interests include treating women with chronic pain and pelvic floor disorders.

Personal Statement: My passion is treating women and educating them about their bodies.  I strive to improve women's quality of life, and empower them to be a collaborative partner in their healthcare.

Erin Yane, BA, MPT

Education: BA, Duke University 1989, Masters in Physical Therapy, UNM 2003.

Professional Interest: Pelvic pain and movement dysfunction.

Personal Statement:  I enjoy helping people move toward more optimal functioning.

The Certified Nurse Midwifery Team for Pessary Care and Other Specialized Services


Lisa Bishop, BSN, MSN

Education: BA at University of Massachusetts; BSN, MSN, Certificate in Midwifery at University of Pennsylvania

Professional Interests: To empower women through knowledge about their bodies; to provide respectful, evidence-based care to optimize the health of women and their communities.

Personal Statement: I love working with our Pessary patients and helping them find safe, low tech solutions to their pelvic organ prolapse and urinary incontinence problems.

Aleda (Noelle) Borders, MSN

Education: BA at College of William and Mary, Virginia; ADN at Parkland College, Illinois; MSN, University of New Mexico

Professional Interests: I am interested in women's health throughout the lifespan. My goal as a midwife is to accompany a woman on her journey of learning about her body and help optimize her health.

Personal Statement: I greatly enjoy helping women with pessaries and PTNS treatment. I learn so much from women's stories about their lives.

Ellen Craig, BSN, CNM

Education: University of Pennsylvania:  BSN

Professional interest: Nonsurgical treatment of prolapse and urinary incontinence with pessaries. Treatment of overactive bladder with PTNS Percutaneous Posterior Tibial Nerve Stimulation.  Education of patients and providers on nonsurgical treatment of prolapse and incontinence.  Participating in research studies in women’s health and pelvic floor disorders.

Personal statement: I have been a midwife for 40 years, most of which has been in Albuquerque. Retired from UNM after more than 25 years of service with the OB/GYN Department, working in fullscope midwifery practice, part of which was founding and developing the Pessary Clinic in the Urogynecology Division.  I have loved returning to work part time in the Pessary Clinic one day per week. I enjoy teaching patients and providers about pessaries- those wonderful little silicon vaginal devices that support and comfortably relieve symptoms of prolapse and also can be an effective treatment for stress urinary leakage.  Many women, once fitted, can learn to take care of the pessaries themselves.

The Nurse Specialist Team

Peggy Gurule, BSN, RN

Education: BSN, Nursing. 1 year Post-grad Chemistry

Professional interest: Surgery, Geriatric Nursing, Urogynecology

Personal statement: I have been a nurse for 39 years at UNMH Hospital in the areas of surgical (post-op), burn, trauma, ICU, and 21 years in Urogynecology due to my great interest in bowel and bladder problems.

Gwendy Beer, BSN, RN

Education: University of California, San Francisco, BSN

Professional interest: I very much enjoy teaching patients.  I am particularly interested in neuromodulation.

Personal statement: I have worked in women’s health since 1990.  It is a joy to meet so many women with diverse backgrounds.  Teaching female patients about their pelvic floor disorders and that there is hope is a remarkable experience.  It is wonderful to be a part of such an amazing division that has the privilege of helping so many women.

Aurora Chavez, RN

Education: Bachelors of Nursing, UNM College of Nursing

Professional interest:  Women’s Health

Personal statement:  Every day is a learning experience for me and my best mentors are my patients.

Tiauna Montoya, MA

Education: Medical Assistant

Professional interest: Urogynecology, Gynecology, and Surgery

Personal statement: I love that most patients are very happy to have found our clinic because they have had no luck finding care for their problem, or none of their previous Doctors understand their symptoms.  It is nice to see that we can help them.

Urogynecology Research Division

The Urogynecology Research Division provides patients and providers with a unique opportunity to work together in an effort to improve care and treatment for all types of pelvic floor dysfunction. The research team focuses on providing supporting women participating in trials with pelvic organ prolapse, urinary and fecal incontinence, and other issues pertaining to pelvic floor disorders. The research team is comprised of research coordinators and facilitators, research nurses, administrative support staff and the UNM Urogynecology faculty and fellows. Our goal is to provide the best care possible for our current patients while creating a better future for the treatment of urogynecology issues.

Our Location:

University of New Mexico Main Hospital (UNMH)

Obstetrics and Gynecology Department
Division of Urogynecology
Located on the 4th floor, Ambulatory Care Center of the Main UNMH
Phone: (505) 967-8428
Fax: (505) 272-6385
Contact the Research Team 

UNMH Women's Care Clinic

2130 Eubank NE, Albuquerque, NM 87112 (directions)

Call for more information (505) 967-8428

Research Team

Research Team:

Karen Box
Karen Taylor, BA in Human Services
Program Specialist

“I’m excited to be working with patients in women’s health and about the benefits it can bring them and women in the future.”

Cynthia Wenzl
Cynthia Wenzl, BS in Psychology
Research Coordinator

Hyp-hOP, OPTIONs, CUTI, HTN, Liberate and PeerS

“I first began working in research as a research assistant in the Department of Psychiatry with Dr. Brandi Fink and worked at the Clinical and Translational Science Center as a research and regulatory coordinator in a variety of studies.  I enjoy working in urogynecology as our research leads to a higher quality of life in our patients who struggle with conditions common to women.  Research is incredibly valuable to the medical community because it provides practitioners and patients more treatment options as well as advance medical science for future patients.”

Katherine Mullé
Katherine Mullé, BA English/Professional Writing
Research Coordinator

SUPeR, ASPiRe, MU-Vi and PASEo

“I am honored to be a part of the UNM Urogynecology Research Division that is committed to improving the lives of women.  I've had a few opportunities more rewarding than to be an advocate for women's health, and it's exciting to envision how our research may impact women in the future!  I am proud to be a part of such a dedicated and enthusiastic team.”

Julissa Zambrano
Julissa Zambrano, Working towards BS in Biochemistry
Student

“I joined the Urgoyn research team in October 2016. Since then, I have enjoyed collaborating with the medical students, nurses, doctors and my research team.  I chose research because it is innovative and unique.  Research allows us to offer patients a different approach in treatment; one that they could not get anywhere else.  It is rewarding to be in an environement where we can advocate to improve pelvic health in women of New Mexico.”

Funding

The Urogynecology Division receives funding from the National Institutes of Health as well as various foundations. In addition, we have worked with industry partners on ongoing research.

Visiting Residents

The FPMRS Division at the University of New Mexico is pleased to offer 2 visiting residents spots per academic year.  3rd year residents in good standing with their residency program and interested in pursuing an FPMRS fellowship are encouraged to apply for this 1 month experience.  The primary focus of this elective is to gain exposure to research and clinical Urogynecology.  The resident will work closely with the Urogynecology faculty and fellows.  Prior to arrival we will work with the visiting fellow to involve them in a research project and provide a daily schedule.  No obstetrical call will be expected during this elective.  Visiting residents will also be able to observe surgical cases, will participate in our weekly journal club and didactics.  They will also be expected to provide one formal didactic session at our interdisciplinary meeting.  Learning objectives for this rotation are as listed by the ACGME listed here.  The resident will participate in the learning provided to our fellows during this time period and not all objectives will be covered.

Interested residents are encouraged to apply in the spring of their 2nd year.  Positions are granted on a rolling basis.  Interested applicants should send an updated CV, 250 word personal statement about their interest in FPMRS, and a letter of support/good standing from their residency director with the preferred dates for the elective to:

Susan Quintana

Fellowship Program Coordinator

Female Pelvic Medicine & Reconstructive Surgery

University of New Mexico

Department of Obstetrics & Gynecology

After electronically submitting your application we will contact you within 2 weeks and let you know if the time requested is available.  If selected additional information will need to be submitted to the University of New Mexico Graduate Medical Education Office and New Mexico Medical training license will be required.

Clinic Addresses

University of New Mexico Urogynecology Clinic

2211 Lomas NE, Albuquerque, NM 87106 (directions)
Located on the 4th floor of UNMH next to the UNMH Ob-Gyn Clinic
Appointment Phone Number: (505) 272-9474 or (505) 272-1878
Fax Number: (505) 272-9866

Sandoval Regional Medical Center Urogynecology Clinic

3001 Broadmoor Blvd NE, Rio Rancho NM 87144 (directions)
Located on the 2nd floor of Sandoval Regional Medical Center
(the Urogynecology, Urology and Gynecology are all in the same location)
Phone Number for Urogynecology Appointments: (505) 994-7000 or (505) 994-7434

University of New Mexico Westside Clinic

UNMH Family Health Clinic (the Urogynecology staff works within the Family Health Clinic)
4808 McMahon Blvd NW, Albuquerque, NM 87114 (directions)
Located in the Family Health Clinic located on McMahon Boulevard across the street from Lovelace Westside Hospital in NW Albuquerque near Rio Rancho
Appointment Phone Numbers: (505) 272-2900