During cystoscopy a small tube with fiber optics, about the width of a pencil, is placed through the urethra (where your urine exits) into the bladder.  This tube allows the doctor to be able to see inside your bladder and evaluate for abnormalities that may be present.  The cystoscope is sterilized between uses and may either be made of metal (traditional cystoscope) or plastic (flexible cystoscope).  Just prior to cystoscopy, the assistant will place some numbing gel in the urethra.   The procedure itself is usually done in the office and takes approximately 5-10 minutes and should not be very uncomfortable. You will not need a driver and can resume normal activities afterward.

  • If you take aspirin on a daily basis please stop for 3-7 days prior to the procedure. If you are on other blood thinners, like Coumadin, please remain on your medication unless specifically instructed by your physician to stop.

  • If you have had an artificial hip or other joint replacement within the last 10 years please alert the staff because you will be asked to take an antibiotic around the time of the procedure.

Urodynamic Testing

During urodynamic testing two very narrow catheters, about the width of a piece of spaghetti, are placed in the urethra (where your urine exits) and either the rectum or vagina. These catheters are used to fill the bladder and measure pressure in your bladder, urethra, and abdominal cavity/rectal area as we gently fill and have you empty the bladder. This is a functional test of your bladder and we will also be asking you to cough, strain, and bear down during the testing. We will be checking to see the capacity of your bladder which may be a little uncomfortable as we ask you to “hold your bladder until you think you would need to pull to the side of the road to urinate”.

By its nature, urodynamic testing can be a little uncomfortable and an embarrassing test since we will be trying to determine bladder functional status and elicite urine leakage if it is present. Please do not be embarrassed by this, it is part of the reason you are being seen and I can assure you that these problems are common. If you have some vaginal prolapse it may be reduced (pushed up) during the testing.

  • If you have had an artificial hip or other joint replacement within the last 10 years please alert the staff since you will be asked to take an antibiotic around the time of the procedure.

  • Please come to the test with a reasonably full bladder and try not to urinate immediately before testing starts.

  • Please bring your 2-3 days of bladder diaries with you to this test so that it can be scanned into your chart and reviewed.

Bladder Diaries

A bladder diary is simply documenting 2-3 days in your life when you are likely to have symptoms (any days are fine, they don’t have to be in a row). We want to know how much and what you are drinking as well as how much you are emptying and leakage complaints. The diary is important in our evaluation of your problem.

  • Please start documenting after your first morning void (urination).

  • Please document all fluids (type and amount) that you drink over the 2-3 day period in the column on the right of the diary.

  • Please use the provided “urine hat” to catch and measure how much you void when you go to urinate and then dump urine in the toilet.

  • Please mark in the provided column if you have any urine leakage and what you were doing at the time, i.e… “leaked when running”, “leaked with urge to urinate”, “leaked with cough”, etc…..

  • Please bring your diaries to the office on your follow up visit or follow up testing so they can be recorded in your chart and reviewed.

Pelvic Floor Rehabilitation

Pelvic rehabilitation is a way to evaluate and treat musculoskeletal problems in the pelvic floor muscle groups and surrounding connective tissue. These pelvic floor muscle groups may be involved in problems related to bowel/bladder function, sexual function, and pelvic pain disorders. Using appropriate techniques to evaluate these muscle problems your provider will recommend a specific treatment protocol which may include pelvic floor muscle exercises, directed muscle stimulation, and problem specific teaching. Your treatment provider has been specially trained in pelvic rehabilitation techniques. These visits will be one-on-one in a private room and will involve a pelvic examination. It is typical to have 4-6 treatments over a 1-2 month time period as part of a pelvic rehabilitation treatment cycle. Pelvic rehabilitation is safe, does not hurt, and has been very successful for treating many symptoms of pelvic floor dysfunction. Please tell your provider if you are pregnant or believe you may be pregnant prior to treatment.

Anorectal Manometry

Anorectal manometry is a safe, low risk procedure to evaluate rectal and anal function in women with constipation, fecal incontinence, or bowel disorders. The test takes approximately 30 minutes and after the procedure you may drive yourself home and go about normal activities. During the test a small flexible tube, about the size of a thermometer, with a small balloon on the end will be inserted in the rectum and used to measure pressures around the anal canal and rectum at rest and with straining.

  • If you are allergic to latex please let the staff know immediately.

  • Please give yourself a Fleet (or equivalent) enema 2 hours prior to your study. You can purchase this from a pharmacy or supermarket.

  • Please do not eat anything during the 2 hours prior to the procedure. If you are diabetic this may involve adjusting your medications accordingly.

Fractional CO2 Vaginal Laser Therapy

CO2 laser vaginal therapy is a procedure that is performed in the office setting to improve symptoms of genitourinary syndrome of menopause (GSM) symptoms. This treatment has been shown to help reverse some of the vaginal findings associated with menopause and can improve patient symptoms. It is a non-hormonal treatment that can be used for women who are not candidates, or don’t desire, use of hormone based therapies. This treatment doesn’t require anesthesia, doesn’t hurt, and typically involves 3 treatments spaced 4-6 week apart.

  • Stop blood thinners 5 days prior to procedure.

  • Please let staff know if you think you have an active vaginal infection prior to procedure.

  • Please take pre-procedure antibiotics given by your physician.


Minimally invasive surgical options allow women to leave the same day or day after most urogynecology procedures.

We know that sometimes the best treatment is a less invasive approach. Let us help you to achieve your goals.

An effective non-hormonal treatment for genitourinary syndrome of menopause that is safe for women who can’t use estrogen.


“The office staff is professional and caring. Dr. Epstein takes time to educate and explain tests and procedures. He listens to his patient’s concerns and answers questions thoroughly. He is an excellent surgeon and one I would highly recommend.”

Jeanne D.

“Dr Epstein is awesome. He has a great bedside manner and cares about his patients. He takes extra time to answer your questions and makes the most anxious patients (me) feel at ease. Surgery was a huge success and the recovery was honestly short and easy. The office staff is super helpful and sweet and Kristen went over and above to help with scheduling, insurance and coordinating all the moving parts. Thank you so much for a great experience!”

Christine D.

“This is by far one of the best doctors that I have ever had in my life and I am 60. I would recommend him to my most loved family members and anyone else that needed his services.”


Why Choose Us


At First Coast Urogynecology we are committed to improving the lives of our patient’s every day. We understand improving our patient’s quality of life comes not only from treating disease but also increasing pelvic floor wellness through education, therapy, and encouragement.

How We Can Help You


Dr. Epstein and his staff have been focused on helping women with pelvic floor disorders for over a decade. Let us help you achieve your goals.

Experience the Difference


We take pride in the quality of care we provide at First Coast Urogynecology. Experience the difference that a subspecialty center with a strong patient centered approach to care can provide.

Make An Appointment

Have a question about our practice or want to schedule an appointment? Call us and speak with a member of our team.