A resource for patients and for other physicians - Richard S. Bercik, MD

For female patients with incontinence or pelvic organ prolapse, a visit to Richard S. Bercik, MD, often brings resolution to a problem that hasn’t responded to treatment. “One of the things that’s unique about our practice is that we act as a resource not only for patients but for other physicians who have patients experiencing complications,” says Bercik, who routinely receives referrals from physicians around the state.

Bercik, head of the Yale Pelvic Medicine & Continence Center, was named chief of urogynecology at Yale-New Haven Hospital and Yale School of Medicine this month. In his practice he offers both surgical and non-surgical approaches. For incontinence, he might use medication, physical therapy, or nerve stimulation. If a patient requires surgery, he can offer minimally invasive vaginal surgery, often on an outpatient basis. “We usually help about 90 percent of our patients with urinary incontinence,” said Bercik.

For prolapse, a condition in which organs fall out of place, he sometimes places a pessary, a plastic or silicone device, into the vagina to hold up wayward organs. “In the past, hysterectomy has been almost a knee jerk response to pelvic organ prolapse,” he says, noting that he often ends up operating despite his efforts. “We have other ways of supporting the vagina, bladder and rectum without doing hysterectomy.” Bercik frequently uses surgical mesh, a non-dissolvable synthetic fabric that’s inserted either under the urethra, under the bladder, or over the rectum to support the organs. In use for decades in other surgeries, its use in urogynecology is more recent. Bercik, who has been using the mesh for about two years, was one of the first gynecologists in Connecticut to use it for pelvic organ prolapse.

When a problem requires surgical repair, Bercik strives to use minimally invasive procedures. Most surgeries he performs can be done laparoscopically or vaginally, but Bercik has recently investigated using robotics for prolapse surgery. He is still evaluating whether it offers any advantages over traditional techniques.

Regardless of the treatment he uses, Bercik tries to maintain a collaborative approach with patients and he prides himself on maintaining communications with referring providers. “Many times a tertiary practice results in a one-way relationship, and the referring doctors don’t always find out exactly what management is recommended for their patient,” he says. “We try to close the loop.”

- Originally published in the October 2007 edition of Yale Practice.