Hadley Narins, MD, urologist at Crouse Health, brings expertise to women’s pelvic health that spans a wide range of treatments — from robotic sacrocolpopexy to physical therapy to medication — in a subspecialty that adds to the health system’s reputation as a magnet for women’s health issues and offers patients control over their own care.
In more than one way, building the Female Urology and Pelvic Reconstruction Program at Crouse Health is a homecoming for Dr. Narins. Not only did she grow up in nearby Buffalo, but she also completed her residency at the State University of New York — and so did a number of the physicians at her new practice, Associated Medical Professionals of NY.
Dr. Narins also feels at home in her new job, which was practically tailor-made for her after a year of intensive learning and practicing medicine at Minnesota Urology’s Female Urology and Pelvic Reconstruction Fellowship. Crouse Health’s focus on women’s health in general and the system’s desire to design a program for urology and pelvic health was very appealing to Dr. Narins.
“Hearing that there was a need in this particular community, that they had been looking for someone with this interest and skill set to help them take care of their patients was ideal,” she says.
At the same time, Dr. Narins did not follow the traditional route to becoming a physician. Her undergraduate degree from Yale is in English literature. But after completing a few internships in the publishing world during college, she realized the industry was not for her. Growing up, she had spent time working in the office of her uncle, a dermatologist, and she has several other physicians in her family, so she switched gears and decided to pursue medicine as her career choice. After Yale, Dr. Narins earned a post-baccalaureate certificate at Bryn Mawr College and then her medical degree from Thomas Jefferson University in Philadelphia.
Although Dr. Narins has always been interested in women’s health, she did not know from the beginning the direction she would turn.
“In medical school, I realized that I loved urology. I really liked performing surgery; I liked being in a surgical subspecialty,” she says.
She started at SUNY–Buffalo in a general surgery internship, then moved on to a formal urology residency.
“Urology is traditionally pretty male-dominated, and there’s a lot of focus on men’s health, oncology and infertility,” she says.
But following in the footsteps of a mentor who had done the same fellowship she pursued at Minnesota Urology, Dr. Narins turned back toward her interest in women’s health.
“There are not many female providers who specialize in urology,” Dr. Narins says.“Yet, female patients with urologic concerns, more often than not, want to be treated by a female.”
“I am well-versed in multiple treatment modalities we have to offer patients. I have good experience, and I am very comfortable using various treatment methods to provide individualized care for each patient.”
— Hadley Narins, MD, urologist at Crouse Health
There’s an increasing awareness of women’s pelvic health needs. According to the NIH, more than one third of U.S. women have a pelvic floor disorder, which occurs more often as women age. In 2010, 377,000 women had surgery for pelvic organ prolapse or to correct a bladder control problem.
To women, who often are more stoic about health problems after a lifetime of menstruation and childbirth, Dr. Narins communicates two key concepts.
“Pelvic organ prolapse or urinary incontinence, while it’s common with aging, doesn’t have to be considered a normal part of aging. There are many treatment options, so that’s my No. 1 message,” she says. “My No. 2 message is, if it doesn’t bother you, you don’t have to do anything. Because these are considered benign quality-of-life conditions, any treatment is completely driven by the patient.”
While many pelvic organ prolapse patients are older, Dr. Narins sees women as young as age 18, as well as women in their 20s or 30s, who may have issues related to childbirth, for example.
“The treatment I offer them isn’t fundamentally very different from the treatment I would offer someone a little bit older,” Dr. Narins says.
Options for Treatment
While developing a robust surgical team is important, Dr. Narins emphasizes the full range of options available for women’s pelvic health.
“A huge component of how I manage many of my patients is pelvic floor physical therapy, which can address incontinence, pelvic organ prolapse and pain — many types of issues for which women see me.”
Dr. Narins is working with pelvic floor physical therapists at Crouse to make sure that, together, the health system can offer the most up-to-date and advanced treatments.
Surgery and Safety
While all options for treatment are on the table, robotic sacrocolpopexy, a surgery to address pelvic organ prolapse, is an important tool that Dr. Narins brings to Crouse Health. The laparoscopic procedure involves pulling the top of the vagina up and securing it to the tailbone, with a bridging piece of surgical mesh. She always reviews potential complications related to mesh with patients. The mesh used in sacrocolpopexy is similar to that used for hernia repair.
“The complications for mesh from sacrocolpopexy are significantly lower than the complications for vaginal mesh,” Dr. Narins says.
Building a Team
Safety, in general, is a major focus as Dr. Narins builds her surgical team at Crouse Health. It’s not about hiring new people but about keeping surgeries as short and standardized as possible, reducing the time patients spend under anesthesia.
“Like any industry, whether it’s the airline industry or manufacturing or whatever, repetition leads to higher quality,” she says.
That’s why physicians are particular about the operating room setup, such as patient positioning, the correct number of surgical tools and even the way that X-rays are taken.
“When you bring a lot of cases to a particular hospital system and you work with the same people, all those little things help you make the surgery as successful as possible,” Dr. Narins says. “An experienced team helps provide the safest and most efficient care for each patient.”
Dr. Narins also is pleased with the potential for future research at AMP Urology and Crouse Health.
“We have a very nice research division here at AMP,” she says. “We have the volume of patients and the infrastructure; my hope and my plan going forward is that I will be able, if my patients wish, to involve them in research for new treatments or new uses for existing technology.”
To learn more about women’s health services at Crouse Health, visit crouse.org/services/womens-services.