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  • Why Patients have better outcomes with Dr. Nezhat - Testimonials
    scared and worried before meeting Dr Nezhat There are people we count on whose wisdom and caring help make everything work out just right and you are one of those people read more SB had two consecutive miscarriages prior to Dr Nezhat s surgery After she was blessed with a baby boy This is a very late note of thanks for your skilled treatment of me back in early 2009 read more After 16 years of hoping waiting praying CL becomes pregnant at last after successful laparoscopic surgery I had been burdened with endometriosis for about 15 years and had not only been in extreme agony I was also told by local Doctors that I probably would never be able to have children read more ES s long battle to avoid Hysterectomy Words cannot describe the gratitude I feel for having you as my surgeon to remove my fibroids read more AW s story of suffering from undiagnosed endometriosis Please forgive me because this letter is long overdue It is with heartfelt gratitude that I write to you in appreciation for having my life back read more JW wheelchair bound with excruciating endometriosis now enjoys a pain free life through

    Original URL path: http://www.nezhat.org/camran/testimonials_2.php (2016-04-24)
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  • Dr. Azadeh A. Nezhat
    Courtesy staff Memberships Office and Committee Appointments Fellow American College of Obstetrics and Gynecology Member The Society of Laparoendoscopic Surgeons Bibliography Nezhat Camran Nezhat Farr Nezhat Ceana Admon D Nezhat Azadeh Proposed Classification of Hysterectomies involving Laparoscopy The Journal of the American Association of Gynecologic Laparoscopists Vol 7 299 306 August 1995 Nezhat Farr Brill Andrew Nezhat Ceana Nezhat Azedah Seidman Daniel Nezhat Camran Laparoscopic Appraisal of the Umbilicus to

    Original URL path: http://www.nezhat.org/camran/doctors/doctor_azadeh_nezhat.html?iframe=true&width=85%&height=85% (2016-04-24)
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  • Dr. Nezhat specializes in diagnosing/treating chronic pelvic pain
    patient s own perceptions is equally crucial For example some disorders like neurogenic bladder may be caused by a complication from a previous laparotomy or childbirth Yet many patients report that their concerns about new post surgical symptoms were sometimes downplayed or dismissed altogether In contrast Dr Nezhat knows that it s critical to investigate all potential causes of chronic pelvic pain particularly those that the patient herself believes may be relevant The initial analysis will also include reviewing your past medical records and history assessing your medication history including use of vitamins herbs and or supplements an analysis of how you sit stand and walk is also part of the initial work up Step 2 Abdominal and Pelvic Exam A general physical as well as an abdominal and pelvic exam are also part of your first evaluation Living in such a high tech postmodern world it s sometimes easy to forget that the old fashioned abdominal and pelvic exam can prove surprisingly effective in pinpointing a diagnosis For example finding extreme tenderness at the rectovaginal septum or indurations in the uterosacral ligaments during digital palpation often suggests endometriosis while a boggy sponge like and enlarged uterus combined with diffuse tenderness may indicate adenomyosis The abdominal and pelvic exam will also include an external examination of your abdominal area that includes gently pressing on various areas all over your lower and upper abdomen and pelvic area and asking you to explain where you feel pain an internal pelvic exam inside of the vagina uterus and rectum in order to map internal pain points as well as look for anything that seems unusual an external abdominal ultrasound can help detect some disorders such as masses in the pelvic area an internal transvaginal ultrasound can help visualize some but not all abnormalities of the lower pelvic region a color doppler ultrasound is also utilized because it s very effective for performing a pelvic blood flow analysis and mapping vascularization patterns in your uterus which can help rule out certain conditions like adenomyosis or endometrial cancer a Pap smear to rule out cervical dysplasia precancerous growths cervical cancer cervical endometriosis and check the overall health of your cervix Step 3 Other Imaging Tests Although pelvic exams by a specialist can actually be highly predictive for some disorders other imaging tests are sometimes required to help narrow the diagnosis For example adenomyosis is often misdiagnosed as diffuse fibroids However these conditions look quite different at ultrasound with adenomyosis typically featuring asymmetrically thickened endometrium combined with diffuse vascularization numerous tiny cyst like cavities and increased echogenicity Likewise even laparoscopy can sometimes fail to detect certain conditions like type IV and V rectovaginal fistulas making imaging tests and procedures like rectograms critically important if such fistulas are suspected Assuming there are no contraindications the most common imaging tests include high resolution CT scan of the pelvis which might help visualize abnormal growths adhesions or abnormalities of organs bones muscles or connective tissues ligaments tendons cartilage magnetic

    Original URL path: http://www.nezhat.org/chronic_pevic_pain/diagnosing_chronic_pain.php (2016-04-24)
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  • The Stages of Endometriosis
    surgically treated in a completely minimally invasively way without resorting to a large incision laparotomy without having to remove your uterus or ovaries and without leaving behind any disease Don t settle for living another day in unbearable pain Related Topics Why is it so painful Overview of endometriosis which can cause extremely crippling pain with periods Myths about painful periods and endometriosis Patients testimonies from those who used to have crippling periods Endometriosis Surgery Myths Endometriosis Excision Surgery White Paper Bowel Bladder Endometriosis Surgery Diaphragm Endometriosis Surgery Thoracic Endometriosis Surgery Alternatives To Surgery History of how women with painful periods have been treated for 4000 years Other reasons for abdominal pelvic pain Please email us at if you would like to receive additional medical articles about Severe stage 4 endometriosis Doctor Camran Nezhat is one of the best known world s endometriosis excision expert This email address is protected from spam turn on Javascript New Patient Returning Patient Just have a few questions We are here to help We always welcome new or returning patients If you d like to make an appointment or just have a few questions we welcome your calls emails Twitters or Facebook messages Our

    Original URL path: http://www.nezhat.org/endometriosis/severe-stage-4-endometriosis.php (2016-04-24)
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  • Silent Loss of Kidney Seconary to Ureteral Endometriosis
    disease burden Asymmetric involvement of endometriosis with the left pelvis more commonly involved than the right is readily explained by anatomic differences of the pelvis 12 The distal segment of the ureters and bladder are the more frequently involved locations due to the proximity of the reproductive organs 13 Additionally ureteral endometriosis is more likely to be associated with rectosigmoid lesions as opposed to bladder involvement 14 Two major pathological types exist extrinsic and intrinsic ureteral endometriosis In the extrinsic type which is the most common endometrial glandular and stromal tissue involve only the adventitia of the ureter or surrounding connective tissues whereas the intrinsic type involves the muscularis propria lamina propria or ureteral lumen 15 Ureteral involvement can potentially lead to urinary tract obstruction with subsequent hydroureter and hydronephrosis These sequelae can occur in both minimal and extensive disease It has been reported that as many as 25 to 50 of nephrons are lost when there is evidence of ureteral endometriosis and 30 of patients will have reduced kidney function at the time of diagnosis that may result in silent kidney loss 6 case 2 is the only case where there was evidence of intrinsic endometriosis The other 2 cases were consistent with extrinsic endometriosis None of our patients had a change in their creatinine because there was one fully functioning kidney remaining Overall an uncommon pathologic finding ureteral endometriosis can be a silent cause of unilateral or bilateral renal atrophy in an undefined number of patients The clinical manifestations of genitourinary endometriosis are quite variable Progressive ureteral obstruction can be insidious and can ultimately lead to renal failure if there is bilateral compromise However in most instances the disease is clinically silent 16 One third of patients will have nonspecific symptoms consistent with pelvic endometriosis and some patients will have symptoms of urgency frequency suprapubic and flank pain hematuria and dysuria 17 20 Specific genitourinary symptoms as listed previously in most instances are related to endometriosis of the bladder and are seldom seen with ureteral involvement thus making the diagnosis difficult Cases 1 2 and 3 did not have any genitourinary symptoms However all 3 cases had symptoms of pelvic pain dysmenorrheal and vague back pain Diagnosis of genitourinary endometriosis relies heavily on clinical suspicion As noted previously ureteral endometriosis occurs in conjunction with pelvic endometriosis thus symptoms consistent with pelvic endometriosis may aid in the differential diagnosis However this diagnosis is extremely elusive With the potential of silent loss of kidney function clinical suspicion may prompt preoperative investigation in patients in which there is a high likelihood of genitourinary endometriosis either based on symptoms or severity of disease Additionally ureteral involvement should be kept in mind when the uterosacral ligaments are clinically involved We recommend that when there is evidence of infiltrative endometriosis that imaging be used either pelvic ultrasound intravenous pyelography ureteroscopy CT or MRI to facilitate diagnosis 20 21 However preoperative diagnosis is difficult and ultimately final diagnosis requires demonstration of deeply infiltrative disease on laparoscopy or endometrial tissue on a pathology specimen It is clear that there are multiple imaging modalities utilized and each giving varying information Intravenous urography and CT scan are often used for their ability to localize laterality and level of ureteral constriction Ureteroscopy is important in the diagnosis of intrinsic endometriosis Magnetic resonance imaging has the ability to differentiate between intrinsic and extrinsic forms of ureteral endometriosis and has high specificity for bladder and renal lesions 22 Laparoscopy and cystoscopy allow for direct visualization and then potential treatment 23 The best treatment approach for ureteral endometriosis is still contentious Treatment is generally aimed at relieving symptoms and ureteral obstruction and rescuing the involved kidney A multidisciplinary team approach including a skilled advanced laparoscopic gynecologist urologist and colorectal surgeon play key roles in the successful treatment of extensive disease Although it is true that medical treatment has long been considered the first Step in the management of symptoms it is expensive recurrence is high with discontinuation and the potential risk of renal function loss is an indication for surgical intervention Laparoscopy is the gold standard for definitive diagnosis and surgical treatment of endometriosis The advent of video laparoscopy has changed how endometriosis is approached and treated 24 25 Laparoscopy offers many advantages over conventional laparotomy namely a magnified view of the pelvis and greater exposure that allows for close examination and visualization of endometriotic implants Larger implants or deep endometriotic nodules are best treated with resection Careful destruction of all endometriotic implants is important to prevent recurrence 24 26 Surgical excision of all endometriosis has been proven to be the most effective method for symptom relief and advanced laparoscopy has replaced laparotomy as the mode of choice 24 25 27 28 Surgical interventions for relief of obstructive uropathy include ureterolysis ureteroureterostomy distal ureterectomy and ureteral reimplantation or interposition of ileal segment between the ureter and bladder 20 28 Nephroureterectomy is a successful treatment alternative in refractory cases Additionally this is performed if there are recurrent urinary tract infections or persistent flank pain All surgical approaches begin with identification of the ureter Ureterolysis is carried out starting proximal to the diseased area at a level of healthy tissue unaffected by endometriosis Careful dissection proceeds down to the level of damage A decision is made at this point based on extent and localization of disease as to whether ureterolysis will be adequate to relieve obstruction Ureterolysis is often acceptable in cases of extrinsic nonobstructive disease 20 23 28 30 Additionally instruments are used to appreciate the consistency of any endometriosis surrounding the ureters It is not easy at the time of surgery to differentiate intrinsic extrinsic disease However any evidence of obstruction will dictate surgical intervention Highlighting the importance of preoperative imaging that can delineate stenosis or if an MRI image is attained actual differentiation between extrinsic and intrinsic is made Often if stenosis is noted only at the time of surgery and there is a question of whether the process is intrinic

    Original URL path: http://www.nezhat.org/endometriosis/loss-of-kidney.php (2016-04-24)
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  • Infertility - Treatment of infertility - IVF
    proper function by minimally invasive surgery Diagnosis Uterine Abnormalities Uterine abnormalities are a significant cause of infertility and recurrent pregnancy miscarriages Usually these abnormalities are congenital meaning that they have been present since birth Two uteri Many don t realize it but the female fetus actually starts out with two uteri which at first are located on the side of each kidney Eventually each uterus migrates to just above the vagina In normal development the two uteri will fuse together to form one uterus If anything goes wrong during these fetal developmental stages reproductive tract anomalies can result The most common anomalies include septate uterus bicornuate uterus unicornuate uterus uterine didelphys Septate Uterus A septum occurs when the two uteri fuse incompletely leaving a portion of tissue in the middle of the uterus This extra tissue can interfere with proper implantation of a pregnancy Even if implantation does occur miscarriage often happens Bicornuate Uterus This occurs when the two uteri only fuse at the bottom and remain separate at the top In this condition the patient has two small uterine cavities and a single cervix These cavities each have an attached fallopian tube Therefore while pregnancy is possible the chances are significantly reduced In addition when pregnancy does result the risk of premature labor and miscarriage is very high as the uterus cannot grow as large as it normally would with a normal pregnancy Unicornuate Uterus Sometimes only one of the two uteri forms during embryologic development This uterus has only one fallopian tube and it is called a unicornuate 1 horn uterus Both ovaries will still be present as they derive from different embryologic tissue The chance for pregnancy in these patients is also reduced because pregnancy can only occur during months in which the woman ovulates from the ovary on the same side as the fallopian tube Uterine Didelphys On very rare occasions both uteri are present but they fail to fuse at all This condition results in two separate uteri each with its own fallopian tubes and cervix This condition can be diagnosed on a routine pelvic exam because there are two cervices Diagnosis Other abnormalities In addition to the congenital uterine abnormalities described above there are a variety of other uterine abnormalities that can develop after birth Examples include endometrial polyps intrauterine adhesions and uterine fibroids Infections can also interfere with fertility Therefore many tests and exams are performed to detect whether infections are present Diagnosis Intrauterine Adhesions Intrauterine adhesions usually result from damage to the uterine cavity Damage can happen from previous surgeries to the uterine cavity pelvic infections and even from previous pregnancies The most common cause is from a previous D C procedure Intrauterine adhesions can be minor or they can affect the entire uterine cavity These adhesions can prevent proper implantation of a pregnancy or can cause miscarriages Diagnosis Uterine Polyps Uterine polyps usually grow inside the uterine cavity These growths originate from one cell of the endometrial lining which then begins

    Original URL path: http://www.nezhat.org/infertility/infertility-diagnosis.php (2016-04-24)
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  • Breast Cancer - Gynecologic Malignancies
    at all of the available studies on breast cancer screening and came out with official recommendations in August of 2011 The following were their recommendations which were endorsed by the American Cancer Society Woman should begin self breast exams at age 20 years and look for any changes or lumps that may arise Women ages 20 39 should have clinical breast exams by a physician every 1 3 yrs Women age 40 yrs or older should have annual clinical breast exams Also at age 40 women should begin yearly mammography exams If the woman has a first degree relative who has had breast cancer she should start screening tests 10 years prior to the age of diagnosis of her relative Breast cancer is made through tissue diagnosis of a breast biopsy If there is a suspicious lesion seen on mammogram your doctor will refer you to a breast surgeon who can biopsy the lesion Risk Factors Family History genetics BRCA1 2 gene positive older age caucasian race having no children late onset of menopause or early onset of menstruation history of benign breast disease smoking obesity radiation therapy A woman who had radiation therapy to the chest including the breasts before age 30 is at an increased risk of developing breast cancer throughout her life diffuse and indeterminate breast microcalcifications or dense breasts lobular carcinoma in situ Preventive mastectomy is sometimes considered for a woman with lobular carcinoma in situ a condition that increases the risk of developing breast cancer in either breast Prevention Protective factors for breast cancer include Women who are at high risk of developing breast cancer may consider preventive mastectomy as a way of decreasing their risk of this disease Preventive mastectomy also called prophylactic or risk reducing mastectomy is the surgical removal of one or both breasts depending on what your doctor recommends it may or may not involve the removal of the nipples It is done to prevent or reduce the risk of breast cancer in women who are at high risk of developing the disease Existing data suggest that preventive mastectomy may significantly reduce by about 90 percent the chance of developing breast cancer in moderate and high risk women Like all surgical procedures of this nature it s important to talk with a doctor about the risk of developing breast cancer the surgical procedure and its potential complications and alternatives to surgery Treatment Treatment is surgical and varies depending on the stage of breast cancer Earlier staged breast cancer can often be surgically resected without further treatment For more advanced stages radiation and chemotherapy may also be given Contrary to popular beliefs gynecological cancers can be treated minimally invasively The removal of gynecological cancers previously required a large incision along the entire length of the abdomen laparotomy often hip bone to hip bone These painful surgical methods of yesteryear often led to serious life threatening complications that often caused more injury and mortality than the cancer itself However Drs Camran and Farr

    Original URL path: http://www.nezhat.org/gynecological-cancers/brest-cancer.php (2016-04-24)
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  • Excision of Endometriosis - By Barbara Page
    are specialists Faced with such a bewildering array of often contradictory information it is easy to understand how medical misconceptions can sometimes slip into the narratives and be mistaken as scientific fact or simply differences of opinion Recently however there seems to have been an uptick in misleading claims being circulated on the internet particularly concerning laser and excision surgery Patients with endometriosis are already burdened with a devastating disease yet now it seems they face even more hardship by having to navigate through a minefield of misinformation at a time when they are making some of the most critical medical decisions of their lives It was clearly time for an information intervention Considering that over 500 new articles on endometriosis are published each year not to mention the thousands of others overflowing from archives attempting to summarize such a vast and ponderous range of opinions and theories is needless to say quite difficult if not impossible Add to that the fact that so many lingering unknowns and enigmas are still limiting our understanding of endometriosis then it becomes all the more clear that we have a colossal task before us in trying to find coherence amidst the confusion All the same here s our best effort to provide unvarnished jargon free explanations to common misconceptions about the various surgical options for treating endometriosis As the references demonstrate the information is based on recommendations by national medical regulatory agencies and gynecological surgery s most well respected textbooks and medical journals Laser Excision There are some illustration about endometriosis Please email us at if you would like to receive additional medical articles about Excision of Endometriosis This email address is protected from spam turn on Javascript New Patient Returning Patient Just have a few questions We are here to help We

    Original URL path: http://www.nezhat.org/specialties/excision_of_endometriosis.php (2016-04-24)
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