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Led by urologist R. Duane Cespedes, MD, Director of The Continence Center, the Center ings together a team of professionals – including a gynecologist, a continence nurse specialist, and a rehabilitation specialist – who are combining their expertise to provide patients with the best possible care, in a comfortable and sensitive environment to treat conditions related to bladder and bowel control. Together, they provide help for patients with all forms of bladder and pelvic support problems, including incontinence, urinary retention, pelvic prolapse and dysfunctional voiding. Most health plans, including Medicare, cover diagnosis and treatment.
“One thing is certain, and that is, these conditions do not get better over time, so it's important to receive appropriate diagnosis and treatment, and make informed decisions that help prevent complications from arising,” says Dr. Cespedes.
Dr. Cespedes is an experienced clinician and fellowship trained urologist. Prior to joining Shore Comprehensive Urology in 2011, he was an associate professor and the assistant program director for the department of urology at Johns Hopkins University in Baltimore. Dr. Cespedes was also the co-director of the Women's Pelvic Floor Center at the Johns Hopkins Bayview Medical Center. He earned his medical degree from the Uniformed Services University of the Health Sciences in Bethesda, and performed his urology residency training at Wilford Hall Medical Center, Lackland Air Force Base in San Antonia, Texas. He completed a fellowship in female urology, urodynamics and voiding dysfunction at the University of Texas in Houston. Dr. Cespedes is nationally recognized as an expert in the field of urology and women's urinary health through his involvement in research, clinical trials, publications, speaking and teaching. He is board certified by the American Board of Urology.
Improving and Restoring Continence and Pelvic Health
The Continence Center specializes in diagnosing and treating pelvic floor disorders—problems related to the muscles, ligaments and connective tissues that support the pelvic floor in both women and men. These muscles and the surrounding tissues keep all of the pelvic organs in place and help the organs function correctly. Many of these problems are very sensitive and personal, such as disorders of the bladder, vagina, uterus, penis and rectum, urinary or fecal incontinence, pelvic organ prolapse and pelvic pain. The Center cares for patients with a range of these conditions, including urinary incontinence, pelvic organ prolapse, voiding dysfunction, fecal incontinence and defecatory dysfunction. Among these conditions, urinary incontinence and pelvic organ prolapse are most common.
There are many types of incontinence, but it is a treatable problem that can be managed, significantly improved, or often cured. Incontinence is classified by both causes and symptoms:
Stress Incontinence occurs when there is an increase in abdominal pressure, such as when you laugh, exercise, dance, sneeze, or cough, and urine leaks due to weakened pelvic floor muscles and tissues.
Urge Incontinence, often referred to as “an overactive bladder,” is when you have an urgent need to go to the bathroom and may not get there in time. Causes of overactive bladder include damage to the bladder's nerves or muscles, as well as conditions such as bladder infections, MS, diabetes, stroke, and the use of certain medications.
Mixed Urinary Incontinence describes patients who have both of these types.
Overflow Incontinence results when you are not able to empty your bladder appropriately, and leakage occurs. This is more common in men, and may result from intrinsic weakness, nerve injury or blockage to flow. It is also associated with post-surgical or radiation changes in men following prostate cancer treatment.
Other conditions such as urinary tract fistulae (an opening), stroke, spinal cord injury and other neurologic diseases can also cause incontinence and voiding problems.
The Continence Center utilizes the latest technology, such as advanced urodynamics to determine the precise physiologic cause of the problem, and to ensure that each patient receives the proper diagnosis. Urodynamic testing is a series of tests and x-rays that provide a detailed look at the functioning of the bladder, urethra and sphincters, and helps to diagnose problems with storing urine or voiding. The entire test takes approximately 45 minutes – 1hour, and providing this technology on-site allows the delivery of results faster, and gets patients started with proper treatment as soon as possible.
According to Dr. Cespedes, pelvic organ prolapse occurs when one or more organs in a woman's pelvis—the uterus, vagina, urethra, bladder or rectum—shifts downward and bulges into or even out of the vaginal canal, making everyday activities extremely uncomfortable. A pelvic exam, and other lab or imaging tests are done to determine pelvic organ prolapse and which organs are involved.
The team of specialists at The Continence Center is trained in a variety of approaches to offer both men and women comprehensive diagnostic testing and treatment that is personalized to each patient to be most effective, from medications, behavioral changes and musculoskeletal rehabilitation, to injection therapy, minimally invasive surgery, and more extensive procedures. As part of Shore Health and the University of Maryland Medical System, the Center will also provide patients access to any related services they may need.
“No two patients are alike but there are many successful ways to treat those who have the simplest problem, to others who have had prior surgery or radiation, as well as those with neurologic disorders such a multiple sclerosis, stroke, Parkinson's disease and spinal cord injuries,” says Dr. Cespedes.
The Continence Center is located in a newly-remodeled facility at 505-A Dutchman's Lane in Easton, and is open Monday through Friday from 8:00 a.m. to 4:30 p.m. To schedule an appointment or for more information, please call 410-820-0560, or visit www.shorehealth.org.
The Continence Center is a member of Shore Medical Group, a Shore Health System affiliate that provides medical management services for employed physician practices. Shore Medical Group physicians provide primary and specialty care to people of all ages throughout the Mid-Shore region.
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