UH Clinical Update - June 2017

Sherif El-Nashar, MD, PhD, has been practicing at University Hospitals for just shy of two years. But in that short time, he has brought valuable expertise in prolapse, incontinence and pelvic pain to his Northeast Ohio patients.

Dr. El-Nashar earned his medical degree in Egypt and fully trained there as an OB/GYN. He then moved to the United States, completing a second residency in obstetrics and gynecology at Mayo Clinic. While at Mayo, he also completed a clinical fellowship in urogynecology – which is also known as female pelvic medicine and reconstructive surgery.

Dr. El-Nashar offers the full range of services for women with pelvic floor disorders, including pelvic organ prolapse, urinary and fecal incontinence and pelvic pain. His surgical expertise includes vaginal surgery and other advanced gynecological procedures, laparoscopic and robotic hysterectomy, and other complex procedures.

A major part of Dr. El-Nashar’s practice taking care of of women with pelvic organ prolapse.

“I do a non-mesh surgery using native tissue for repair of prolapse, so patients don’t have to worry about issues with mesh,” he says. “I also do mesh procedures for repair of prolapse called sacrocolpopexy – which can be done both robotic and laparoscopic. Sacrocolpopexy is a mesh surgery and it’s the gold standard treatment. It’s mostly reserved for cases of failure of the native tissue or if the patient is young and very active. In this procedure, we use mesh to attach the top of the vagina to the ligaments in front of the sacrum.”

Another important part of Dr. El-Nashar’s practice is the treatment of urinary and fecal incontinence.

“Urinary incontinence is a very big problem that greatly affect patient quality of life and unfortunately patients understandably do not talk about it. I need them to know that there are many treatment options that can help them and they do not have to suffer in silence!” he says. “There are several medications that are FDA-approved to treat overactive bladder leakage, which is the most common leaking type in older patients, and there are three FDA-approved outpatient procedures that can help: InterStim, Botox and posterior tibial nerve stimulation (PTNS). InterStim is a pacemaker for the bladder, and it can be done for fecal incontinence as well. It can be done as an outpatient procedure and can help elderly patients.”

InterStim (sacral nerve stimulation) is indicated for overactive bladder that has not responded to one or two incontinence medications after four to six weeks, as well as for urinary retention, Dr. El-Nashar says.

“It sounds like a paradox, but it works for both,” he says.

It’s also indicated for fecal incontinence that has not improved with bulking agents. After receiving the sacral nerve stimulator implant, patients go home with a test battery for two weeks to see if the device improves their symptoms.

“If it’s helping, we put in permanent battery that lasts for five to seven years,” Dr. El-Nashar says. “It’s about 75 percent effective for overactive bladder, about 95 percent effective for fecal incontinence and 60 percent for urinary retention.

Botox injections are another treatment option for overactive bladder, administered either in the office or in the operating room. “These work for overactive bladder for six to nine months and can be repeated multiple times,” Dr. El-Nashar says.

Pelvic pain is another focus for Dr. El-Nashar, making up about 20 percent of his practice.

“As female pelvic medicine sub-specialists, we are best situated to take care of patients with pelvic pain because we look at the whole picture,” he says. “We have a multidisciplinary team working together to formulate the best treatment plan for our patients with pelvic pain, and we get great success. Our group includes physicians from gynecology and urology; we also include physical therapy specialists who work very closely with us to help our patients to relax their pelvic floor and control their pain. We also offer Botox injections in the pelvic floor muscle that help with pain. We also work closely with psychology to optimize therapy – we all work together to get the best outcomes for our patients.”

Dr. El-Nashar sees patients and performs surgery at UH Ahuja Medical Center, UH Cleveland Medical Center, UH Parma Medical Center and UH Westlake Health Center. For more information about his capabilities or to make a referral, please call 216-844-3941.