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Focus on John P. Judd. MD

John P. Judd, MD, is an assistant professor of obstetrics and gynecology. His areas of specialty are urogynecology, incontinence, prolapse, sacral neuromodulation for overactive bladder, minimally-invasive surgery and robotic-assisted surgery.

Dr. Judd sees patients at two convenient locations:

  • The Center for Advanced Medicine, Gynecologic Treatment Center, 4921 Parkview Place, 13th floor, Suite C.
  • The Center for Women’s Wellness and Fetal Health, Missouri Baptist Medical Center, 3023 North Ballas Road, Building D, fourth floor, Suite 450.

FOR AN APPOINTMENT, PLEASE CALL 314-747-1402

What happened in the course of schooling to make you choose your specialty?

During my obstetrics and gynecology rotation in medical school, I was impressed with the technical precision, as well as the level of surgical innovation of the urogynecology specialty.
Most importantly, I witnessed the positive impact the correct urogynecologic treatment could have on a woman’s life. I saw how doctors were able to help these women who had been keeping their health concerns a secret for many years.

What brought you to Washington University?

After completing my fellowship training, I was looking for an institution where I could continue to advance urogynecology through research, while also being able to assist in training the next generation of physicians. Washington University gave me the opportunity to not only help patients through innovative surgical and nonsurgical treatments, but also expand our division by developing a subspecialty training program in our field.

Which aspect of your practice is most interesting?

One of the most interesting aspects of my practice is the ability to take each patient’s unique problems and develop a customized surgical or nonsurgical solution. No two patients are alike, so each treatment plan must create the optimal balance for the patient’s complaints, anatomical findings, testing results, prior history, and goals.

I also enjoy instructing young physicians in ways that will have a lasting positive impact on women’s health in St. Louis and beyond.

What new developments in your field are you most excited about?

Despite the relative newness of the urogynecology specialty, the problems we treat, and many surgeries we perform, have all been around for many years.

For patients with overactive bladder (OAB), who have not responded to medication, sacral nerve stimulation is one of the more recent developments. The initial stage of treatment involves using gentle electrical signals to relax the bladder by placing a small wire next to the nerves in the lower back, or sacrum. The nerves are stimulated using a temporary generator. It is thought that the electrical signals between the bladder and the brain help block premature signals from the bladder saying it wants to contract. It also increases the signals from the brain telling the bladder to relax.

Patients who experience significant improvement during this testing phase then progress to the second stage of therapy. This involves having a pacemaker-like generator implanted during an outpatient procedure. This “pacemaker for the bladder” can be a long-term, effective solution to what often can be a lifestyle-limiting problem.

Other new developments in our field include robotic-assisted (DaVinci) surgery which allows the surgeon to work through several smaller incisions, rather than one large abdominal incision. The DaVinci instruments give 360 degree wrist movement and three dimensional vision, which allows the surgeon to be more technically precise. With this type of surgery, the patient has decreased postoperative pain and a quicker recovery period.

Finally, there are exciting advances being made daily in the genetics of connective tissue in the vaginal walls (fascia) and the role these genes may play in the development and recurrence of vaginal prolapse.

What is prolapse?

The definition of prolapse is when “things fall out”. This can occur when structures such as the rectum, bladder, uterus or vagina drop down out of place to the extent they protrude through the vaginal opening.

The causes of prolapse are multi-factorial. Childbirth can play a role, but prolapse can also be a result of being too heavy, having a disease with increased abdominal pressure like chronic obstructive pulmonary disease (COPD), having genetics that contribute to inherently weak fascia structures, or other reasons we don’t understand.

Where are you from originally?

I grew up in West Texas. Even though I majored in electrical engineering in college, as the son of an orthopedic surgeon and a registered nurse, I always knew I would end up in medical school.

Which particular award or achievement is the most gratifying to you?

During fellowship, I was able to work with my mentor to develop ideas which were successful at obtaining competitive grant funding. Through this funding, I conducted two research trials which helped advance our understanding of sacral neuromodulation (pacemaker for the bladder) for OAB and ways to optimize this therapy for our patients.

This therapy has been approved since 1997, but we don’t entirely know why it works. It helps people who have problems emptying the bladder, as well as people who empty their bladder too easily. These two conditions that seem diabolically opposed to each other, and the treatment shouldn’t work both ways -- but it does.

So the question is, why does it work? There are some good theories, but we don’t entirely understand it.

If you weren’t a doctor, what would you like to be doing?

If I weren’t a physician, I would likely find ways to continue to help people, both here and abroad. I would likely pursue seminary training, and seek out ways to continue to use my faith and skills to have a positive impact on those around me though mission outreach.
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Copyright 2013 Washington University School of Medicine