Obstetrician & Gynecologist (OB/GYN), Surgical Specialist, Urologist
10 years of experience

5303 Harry Hines Blvd
Oak Lawn, Dallas, TX 75390
214-645-2020
Locations and availability (3)

Education ?

Medical School Score Rankings
University of California at Los Angeles (2000)
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Associations
American Urogynecologic Society
Member

Affiliations ?

Dr. Wieslander is affiliated with 3 hospitals.

Hospital Affilations

Score

Rankings

  • Los Angeles County - Olive View - UCLA Medical Center
    14445 Olive View Dr, Sylmar, CA 91342
    • Currently 4 of 4 crosses
    Top 25%
  • Parkland Health & Hospital System
    5201 Harry Hines Blvd, Dallas, TX 75235
    • Currently 1 of 4 crosses
  • St Paul Medical Center
  • Publications & Research

    Dr. Wieslander has contributed to 12 publications.
    Title Clinical Approach and Office Evaluation of the Patient with Pelvic Floor Dysfunction.
    Date April 2010
    Journal Obstetrics and Gynecology Clinics of North America
    Excerpt

    Pelvic floor disorders are common health issues for women and have a great impact on quality of life. These disorders can present with a wide spectrum of symptoms and anatomic defects. This article reviews the clinical approach and office evaluation of patients with pelvic floor disorders, including pelvic organ prolapse, urinary dysfunction, anal incontinence, sexual dysfunction, and pelvic pain. The goal of treatment is to provide as much symptom relief as possible. After education and counseling, patients may be candidates for non-surgical or surgical treatment, and expectant management.

    Title Quantification of Pelvic Organ Prolapse in Mice: Vaginal Protease Activity Precedes Increased Mopq Scores in Fibulin 5 Knockout Mice.
    Date June 2009
    Journal Biology of Reproduction
    Excerpt

    Two mouse models of pelvic organ prolapse have been generated recently, both of which have null mutations in genes involved in elastic fiber synthesis and assembly (fibulin 5 and lysyl oxidase-like 1). Interestingly, although these mice exhibit elastinopathies early in life, pelvic organ prolapse does not develop until later in life. In this investigation we developed and validated a tool to quantify the severity of pelvic organ prolapse in mice, and we used this tool prospectively to study the role of fibulin 5, aging, and vaginal proteases in the development of pelvic organ prolapse. The results indicate that >90% of Fbln5(-/-) mice develop prolapse by 6 mo of age, even in the absence of vaginal delivery, and that increased vaginal protease activity precedes the development of prolapse.

    Title Regulation of Elastolytic Proteases in the Mouse Vagina During Pregnancy, Parturition, and Puerperium.
    Date May 2008
    Journal Biology of Reproduction
    Excerpt

    Recent evidence indicates that failure of elastic fiber assembly and synthesis is involved in the pathophysiology of pelvic organ prolapse in mice. It has been long been hypothesized that parturition-induced activation of proteases in the vaginal wall and its supportive tissues may contribute to pelvic organ prolapse in women. In this investigation, we determined the expression of matrix metalloproteases with elastase activity (matrix metalloproteinase [MMP] 2, MMP9, and MMP12) and their inhibitors in the vaginal wall of nonpregnant, pregnant, and postpartum mice. Data obtained using mRNA levels and enzyme activity measurements indicate that MMP2, MMP9, and 21- to 24-kDa caseinolytic serine proteases are regulated in vaginal tissues from pregnant and postpartum mice. Although suppressed during pregnancy and the early postpartum time period, MMP2 and MMP9 enzyme activities are increased after 48 h, a time when mRNA levels of protease inhibitors (tissue inhibitor of MMP2 [Timp2], cystatin C [Cst3], and alpha-1 antitrypsin [Serpina1]) are decreased. We conclude that recovery of the vaginal wall from pregnancy and parturition requires increased elastic fiber assembly and synthesis to counteract the marked increase in elastolytic activity of the postpartum vagina.

    Title Posterior Division of the Internal Iliac Artery: Anatomic Variations and Clinical Applications.
    Date December 2007
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: The objective of the study was to characterize the anatomy of the internal iliac artery (IIA) and its posterior division branches and to correlate these findings to IIA ligation. STUDY DESIGN: Dissections were performed in 54 female cadavers. RESULTS: Average length of IIA was 27.0 (range, 0-52) mm. Posterior division arteries arose from a common trunk in 62.3% (66 of 106) of pelvic halves. In the remaining specimens, branches arose independently from the IIA, with the iliolumbar noted as the first branch in 28.3%, lateral sacral in 5.7%, and superior gluteal in 3.8%. The average width of the first branch was 5.0 (range, 2-12) mm. In all dissections, posterior division branches arose from the dorsal and lateral aspect of IIA. The internal iliac vein was lateral to the artery in 70.6% (12 of 17) of specimens on the left and 93.3% (14 of 15) on the right. CONCLUSION: Ligation of the IIA 5 cm distal from the common iliac bifurcation would spare posterior division branches in the vast majority of cases. Understanding IIA anatomy is essential to minimize intra-operative blood loss and other complications.

    Title Neurovascular Anatomy of the Sacrospinous Ligament Region in Female Cadavers: Implications in Sacrospinous Ligament Fixation.
    Date December 2007
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: The objective of the study was to further characterize the anatomy of the coccygeus muscle-sacrospinous ligament (C-SSL) complex and to correlate the findings with sacrospinous ligament fixations (SSLF). STUDY DESIGN: Dissections were performed in 21 female cadavers. RESULTS: In all dissections, nerves originating from S3, S4, S5, or a combination passed over the anterior surface of the C-SSL at its midsegment, and either the pudendal or third sacral nerve coursed on the superior border of C-SSL at its midpoint. In 100% of specimens, the internal pudendal artery (IPA) passed behind or just medial to the ischial spine. The average distance of the inferior gluteal artery (IGA) from the ischial spine and the superior border of the C-SSL was 24.2 (range, 15-35) mm and 3.4 (range, 1-5) mm, respectively. CONCLUSION: Nerves to the coccygeus and levator ani coursed over the midportion of the C-SSL where SSLF sutures are placed. The pudendal nerve and IGA were in proximity to the superior border of the C-SSL at its midportion, whereas the IPA passed behind the ischial spine, lateral to the recommended site for suture placement.

    Title Anatomic Relationships of the Distal Third of the Pelvic Ureter, Trigone, and Urethra in Unembalmed Female Cadavers.
    Date December 2007
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: The objective of the study was to examine the relationship of the ureter to paravaginal defect repair (PVDR) sutures and to evaluate the anatomy of distal ureter, trigone, and urethra relative to the anterior vaginal wall. STUDY DESIGN: Dissections of the retropubic space were performed in 24 unembalmed female cadavers following placement of PVDR sutures. Lengths of the vagina, urethra, and trigone were recorded. RESULTS: The mean distance between apical PVDR sutures and the ureter was 22.8 (range, 5-36) mm. The average lengths of the urethra, trigone, and vagina were 3 cm, 2.8 cm, and 8.4 cm, respectively. The trigone was positioned over the middle third of the anterior vaginal wall in all specimens and the distal ureters traversed the anterolateral vaginal fornices. CONCLUSION: The ureters may be injured during paravaginal defect repairs, anterior colporrhaphies, and other procedures involving dissection in the upper third of the vagina. Cystotomy during vaginal hysterectomies is most likely to occur 2-3 cm above the trigone.

    Title Uterosacral Ligament Suspension Sutures: Anatomic Relationships in Unembalmed Female Cadavers.
    Date December 2007
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: The objective of the study was to characterize anatomic relationships of uterosacral ligament suspension (USLS) sutures. STUDY DESIGN: The relationship of USLS sutures to the ureters, rectal lumen, and sidewall neurovascular structures was examined in 15 unembalmed female cadavers. RESULTS: The mean distance of the proximal sutures to the ureters and rectal lumen was 14 mm (range, 0-33) and 10 mm (range, 0-33), respectively. The mean distance of the distal sutures to the ureters was 14 mm (range, 4-33) and to the rectal lumen 13 mm (range, 3-23). Right sutures were noted at the level of S1 in 37.5%, S2 in 37.5%, and S3 in 25% of specimens. Left sutures were noted at the level of S1 in 50%, S2 in 29.2%, and S3 in 20.8% of cadavers. Of 48 sutures passed, 1 entrapped the S3 nerve. Sutures perforated the pelvic sidewall vessels in 4.1% of specimens. CONCLUSION: USLS sutures can directly injure the ureters, rectum, and neurovascular structures in the pelvic walls.

    Title Vascular Anatomy of the Presacral Space in Unembalmed Female Cadavers.
    Date December 2006
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: The purpose of this study was to characterize the vascular anatomy of the female presacral space (PSS) and to correlate findings to the abdominal sacrocolpopexy. STUDY DESIGN: Detailed dissections of the PSS were performed in 52 unembalmed female cadavers. RESULTS: The closest cephalad vessel to the mid sacral promontory (MSP) was the left common iliac vein (LCIV), mean distance 27 mm (9-52 mm). The closest vessel lateral to MSP was also the LCIV, mean distance 22 mm (9-35 mm). The average distance of the middle sacral artery and vein to the MSP was 4 mm (0-15 mm) and 7 mm (0-17 mm), respectively. The mean distance of the sacral venous plexuses to the MSP was 34 mm (4-86 mm). CONCLUSION: Anatomic location of the vascular boundaries and contents of the PSS is highly variable. Careful dissection and exposure of the anterior longitudinal ligament of the sacrum before suture placement should minimize potentially life-threatening vascular complications.

    Title Endovascular Workforce for Peripheral Vascular Disease: Current and Future Needs.
    Date July 2002
    Journal Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
    Excerpt

    BACKGROUND: The current status and future needs of peripheral endovascular utilization and training have not been well defined. This topic is particularly relevant to the future of four specialties: interventional cardiology, cardiothoracic surgery, interventional radiology, and peripheral vascular surgery. We attempt to analyze the current numbers of cardiovascular patients and procedures and the numbers of treating physicians and surgeons to make predictions and recommendations for the future. METHODS: The numbers of cardiovascular patients and procedures were obtained from the Healthcare Cost and Utilization Project Trend Query web site. The number of endovascular abdominal aortic aneurysm repairs was obtained with telephone or e-mail contact with the aortic endograft manufacturers. The numbers of different cardiovascular specialists were obtained with contact with different cardiovascular professional societies and the American Board of Specialists via telephone, e-mail, or web site. The numbers of accredited US cardiovascular fellowship programs and first year spots were obtained from the Graduate Medical Education Directory 2000 to 2001. Finally, the numbers of endovascular fellowship programs and first year spots were obtained with contact with the individual programs. RESULTS: The numbers of cardiovascular patients and procedures have risen from 1993 to 1997. This trend is expected to continue as the population ages. Despite the rapid rise of endovascular procedures, the number of open cases has continued to rise as well. However, the number of cardiovascular specialists is predicted to remain stable. Specific numbers and trends are depicted in the manuscript. CONCLUSION: Our analysis shows that a critical shortage of endovascular trained specialists will exist in the future. More surgeons need to receive endovascular training to meet these future needs.

    Title Current Developments in Thoracoscopic Sympathectomy.
    Date January 2001
    Journal Annals of Vascular Surgery
    Title Endoscopic Surgery for Arterial Occlusive Disease.
    Date
    Journal Surgical Technology International
    Title Endoscopic Surgery for Arterial Occlusive Disease.
    Date
    Journal Surgical Technology International
    Excerpt

    Endoscopic surgery is not a recent development. In fact, the application of the Edison light bulb to the cystoscope in 1883 was followed by widespread use of endoscopy. In 1910, Jacobeaus proposed the diagnostic use of the cystoscope for investigation of serous cavities, and in 1922, he reported lysis of pleural adhesions to promote artificial pneumothorax in 40 patients with pulmonary tuberculosis. For the next 30 years, the thoracoscope was widely used for pneumolysis in tuberculosis patients, but its use waned considerably after the development of effective antibiotic treatment for tuberculosis. With the advent of laparoscopy, endoscopy has become popular again and here we review the application of endoscopic techniques in cardiovascular surgery.

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