Obstetricians & Gynecologists
15 years of experience
Video profile
Accepting new patients
Texas Urogynecology Associates
505 N Highway 77
Ste 200
Waxahachie, TX 75165
972-923-1686
Locations and availability (4)

Education ?

Medical School Score
Albany Medical College (1995)
  • Currently 2 of 4 apples

Awards & Distinctions ?

Awards  
Patients' Choice Award (2009)
Compassionate Doctor Recognition (2012 - 2013)
Associations
American Board of Obstetrics and Gynecology
American Urogynecologic Society

Affiliations ?

Dr. Carley is affiliated with 4 hospitals.

Hospital Affilations

Score

Rankings

  • Baylor University Medical Center
    3500 Gaston Ave, Dallas, TX 75246
    • Currently 4 of 4 crosses
    Top 25%
  • Frisco Medical Center
    5601 Warren Pkwy, Frisco, TX 75034
    • Currently 4 of 4 crosses
    Top 25%
  • Doctors Hospital Dallas
    9440 Poppy Dr, Dallas, TX 75218
    • Currently 2 of 4 crosses
  • Baylor Regional Medical Center at Plano
    4700 Alliance Blvd, Plano, TX 75093
  • Publications & Research

    Dr. Carley has contributed to 11 publications.
    Title Distribution of Estrogen Receptors Alpha and Beta Mrna in Mouse Urogenital Tissues and Their Expression After Oophorectomy and Estrogen Replacement.
    Date December 2003
    Journal International Urogynecology Journal and Pelvic Floor Dysfunction
    Excerpt

    Estrogen receptors are present in the urogenital tract. However, little is known about the quantitative distribution of the traditional estrogen receptor (ERalpha) mRNA and the recently identified ERbeta mRNA. By quantitative reverse transcription polymerase chain reaction analysis, the distributions of ERalpha and ERbeta mRNA in mouse urogenital tissues and their expression in selected urogenital tissues after oophorectomy, with or without estrogen replacement, were evaluated. ERalpha mRNA concentrations were higher in the ovary, oviduct, uterus and vagina than in the kidney, ureter or bladder ( P<0.05); ERbeta transcripts were highest in the ovary, oviduct and bladder ( P<0.05). After oophorectomy and estrogen replacement, significant changes were identified in ERalpha and ERbeta mRNA expression. ERalpha and ERbeta mRNA are differentially expressed in mouse urogenital tissues. Oophorectomy and estrogen replacement affect estrogen receptors differently in the bladder, vagina and uterus. These results may explain some tissue-specific responses to estrogen and selective estrogen receptor modulators. The mRNA distributions of estrogen receptors alpha and beta and their expression after oophorectomy, with or without estrogen replacement, differ in mouse urogenital tissues.

    Title Small Bowel Obstruction Associated with Post-hysterectomy Vaginal Vault Prolapse.
    Date October 2003
    Journal Obstetrics and Gynecology
    Excerpt

    BACKGROUND: Patients may present with post-hysterectomy vaginal vault prolapse in conjunction with small bowel obstruction. Prior pelvic surgery, malignancy, and radiation therapy may be associated with this presentation. CASE: An 83-year-old multiparous woman with a history of poorly differentiated endometrial adenocarcinoma was treated with radiation therapy, total abdominal hysterectomy, and salpingo-oophorectomy. Anterior exenteration was performed for a recurrence. Seventeen years after her last pelvic operation, she had small bowel obstruction that coincided with a worsening post-hysterectomy vaginal vault prolapse. Surgical management included a side-to-side ileoileostomy and excision with closure of the vaginal apex. CONCLUSION: Although pelvic organ prolapse primarily affects quality of life, clinicians should be alert for bowel obstruction occurring with post-hysterectomy vaginal vault prolapse.

    Title Concomitant Urethral and Uterovaginal Prolapse in a Postmenopausal Woman. A Case Report.
    Date March 2003
    Journal The Journal of Reproductive Medicine
    Excerpt

    BACKGROUND: Urethral prolapse is frequently encountered in girls. Although its occurrence in elderly women is not rare, little published information exists regarding this clinical condition or its management. CASE: A 90-year-old woman (gravida 1, para 1) with a four-year history of intermittent vaginal bleeding had both urethral and uterovaginal prolapse. The condition was initially managed conservatively with estrogen and a pessary. Ultimately, surgical intervention was required for complete resolution. CONCLUSION: Urethral prolapse can occur in elderly women and may present concomitantly with other forms of pelvic floor dysfunction such as uterovaginal prolapse. Conservative treatment with estrogen is partially effective in reducing the size of the urethral prolapse and may point to hypoestrogenism as one potential cause of this condition in elderly women. However, surgical management may ultimately be required for complete resolution of these problems, even in medically compromised patients.

    Title Atypical Glandular Cells of Undetermined Significance. Review of Final Histologic Diagnoses.
    Date November 2002
    Journal The Journal of Reproductive Medicine
    Excerpt

    OBJECTIVE: To review recent literature that examines the histologic characterization of women with atypical glandular cells of undermined significance (AGUS) on a Pap smear. STUDY DESIGN: The English-language literature published between January 1995 and April 2000 was reviewed. The MEDLINE database and the search terms atypical glandular cells of undetermined significance and AGUS were used. The references cited in the studies were reviewed to identify additional publications. Studies that reported data from patients with a cytologic diagnosis of AGUS without an associated squamous lesion identified by Pap smear were used to summarize the final histologic diagnoses. RESULTS: Eight percent of women with the diagnosis of an AGUS Pap smear without a concurrent squamous lesion had a malignancy. CONCLUSION: A thorough initial evaluation is recommended for all women with a cytologic diagnosis of AGUS.

    Title Laparoscopy Versus Laparotomy in the Management of Benign Unilateral Adnexal Masses.
    Date October 2002
    Journal The Journal of the American Association of Gynecologic Laparoscopists
    Excerpt

    STUDY OBJECTIVE: To compare operative characteristics and charges of laparoscopy and laparotomy for women with a benign unilateral adnexal mass 7 cm or less in greatest diameter. DESIGN: Historical cohort study (Canadian Task Force classification II-2). SETTING: Clinic department of obstetrics and gynecology. PATIENTS: One hundred six women. INTERVENTION: Unilateral oophorectomy or unilateral salpingo-oophorectomy performed by laparoscopy or laparotomy. MEASUREMENTS AND MAIN RESULTS: When patients were compared on an intent to treat basis, no differences in greatest mass diameter (4.2 vs 4.5 cm), patient age (49.2 vs 46.4 yrs), or body mass index (26.0 vs 27.0 kg/m(2)) were found between 62 laparoscopies and 44 laparotomies. Laparoscopy was associated with longer operating times (94 vs 63 min, p <0.001), shorter hospital stay (1.6 vs 2.5 days, p <0.001), higher sterile supply charges ($1031 vs $40, p <0.001), and lower hospital room charges ($672 vs $1351, p <0.0001). No significant differences in total hospital charges, febrile morbidity, or transfusion rates were identified. CONCLUSION: Patient charges and early operative morbidity are similar for laparoscopy and laparotomy. Therefore, patient and surgeon preference should be a primary consideration when deciding on operative approach in carefully selected women with a unilateral adnexal mass.

    Title Incidence, Risk Factors and Morbidity of Unintended Bladder or Ureter Injury During Hysterectomy.
    Date September 2002
    Journal International Urogynecology Journal and Pelvic Floor Dysfunction
    Excerpt

    To determine the incidence, risk factors and morbidity of unintended operative injury to the bladder or ureter during hysterectomy, a retrospective case-control study of women with these injuries from 1 January 1993 to 1 January 1998 was performed. The incidence of bladder and ureter injury, respectively, was 0.58% and 0.35% for abdominal hysterectomy, 1.86% and 0% for vaginal hysterectomy, and 5.13% and 1.71% for hysterectomies performed for obstetric indications. Women with injury during abdominal hysterectomy were found to have greater blood loss, longer operative times, longer postoperative stays, more febrile morbidity, and more frequent transfusions. Similar trends were seen for other hysterectomy types. The incidence of operative bladder or ureter injury is relatively low. However, even when recognized, these individuals experience greater operative and postoperative morbidity. This highlights the importance of surgical technique directed toward minimization of these injuries, and careful intra- and postoperative surveillance aimed at early detection.

    Title Factors That Are Associated with Clinically Overt Postpartum Urinary Retention After Vaginal Delivery.
    Date September 2002
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: This study was undertaken to determine the incidence of clinically overt postpartum urinary retention after vaginal delivery and to examine what maternal, fetal, and obstetric factors are associated with this problem. STUDY DESIGN: This was a retrospective case-controlled study of women who had overt postpartum urinary retention after vaginal delivery from August 1992 through April 2000. RESULTS: Fifty-one of 11,332 (0.45%) vaginal deliveries were complicated by clinically overt postpartum urinary retention. In most cases (80.4%), the problem had resolved before hospital dismissal. Persons with urinary retention were more likely than control subjects to be primiparous (66.7% vs 40.0%; P <.001), to have had an instrument-assisted delivery (47.1% vs 12.4%; P <.001), to have received regional analgesia (98.0% vs 68.8%; P <.001), and to have had a mediolateral episiotomy (39.2% vs 12.5%; P <.001). On multivariate logistic regression analysis, of these 4 variables, only instrument-assisted delivery and regional analgesia were significant independent risk factors. CONCLUSION: Clinically overt postpartum urinary retention complicates approximately 1 in 200 vaginal deliveries, with most resolving before hospital dismissal. Factors that are independently associated with its occurrence include instrument-assisted delivery and regional analgesia.

    Title P2x(3) Receptor Subunit Messenger Rna Expression in the Female Mouse Bladder After Oophorectomy with or Without Estrogen Replacement.
    Date July 2002
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: This investigation was undertaken to determine whether the sensory neuron adenosine triphosphate receptor subunit (P2X(3)) messenger RNA expression is altered in female mouse bladders after surgical oophorectomy with or without estrogen replacement. STUDY DESIGN: The mean relative concentrations of the P2X(3) receptor in 30 female mouse bladders (10 sham operated, 10 oophorectomized, and 10 oophorectomized with estrogen replacement) were determined with quantitative reverse transcription-polymerase chain reaction analysis. RESULTS: P2X(3) expression increased after surgical oophorectomy (0.91 +/- 0.16 vs 1.04 +/- 0.11, P =.048). However, P2X(3) expression after oophorectomy and immediate estrogen replacement did not differ from that of oophorectomy alone (1.11 +/- 0.15 vs 1.04 +/- 0.11, P =.206). CONCLUSIONS: The P2X(3) sensory neuron receptor messenger RNA expression is increased after oophorectomy but is not influenced by subsequent estrogen replacement. This has clinical significance because sensory neuron receptors may be associated with certain forms of bladder dysfunction.

    Title Patient Characteristics That Are Associated with Urodynamically Diagnosed Detrusor Instability and Genuine Stress Incontinence.
    Date June 2002
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: We sought to compare characteristics of patients with urodynamically diagnosed detrusor instability or genuine stress incontinence. STUDY DESIGN: A retrospective audit of 293 consecutive women who were referred to a urogynecologist for evaluation of urinary incontinence between June 1996 and April 2000. RESULTS: Of the 293 patients, 289 women had a physical examination and urodynamic testing, which revealed genuine stress incontinence (35%), detrusor instability (32%), mixed incontinence (29%), or normal urodynamic function (4%). Compared with patients with detrusor instability, those women with genuine stress incontinence were more likely to be white than African American (P <.0001) and to have a cystocele(P =.027), rectocele (P <.0001), or paravaginal defect (P =.004). No differences in age, gravidity, parity, estrogen treatment, or previous anti-incontinence procedure were identified between women with detrusor instability and women with genuine stress incontinence. CONCLUSION: In a tertiary referral center, the distribution of urinary incontinence is evenly divided among genuine stress incontinence, detrusor instability, and mixed incontinence. Patients with genuine stress incontinence are more likely to be white and to have pelvic floor prolapse and symptoms of pure stress incontinence.

    Title Urinary Incontinence and Pelvic Organ Prolapse in Women with Marfan or Ehlers Danlos Syndrome.
    Date June 2000
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: This study was undertaken to determine the prevalence of urinary incontinence and pelvic organ prolapse in a cohort of women with either Marfan syndrome or Ehlers-Danlos syndrome.Study Design: Female patients with either Marfan syndrome or Ehlers-Danlos syndrome were identified through a medical records search at two urban hospitals. Each patient's medical record was reviewed, and the history of pelvic organ prolapse and urinary incontinence was obtained through telephone interview. RESULTS: Twelve women with Marfan syndrome were identified. Among these women 5 (42%) reported a history of urinary incontinence and 4 (33%) reported a history of pelvic organ prolapse. Eight women with Ehlers-Danlos syndrome were identified. Among these women 4 (50%) reported a history of urinary incontinence and 6 (75%) reported a history of pelvic organ prolapse. CONCLUSIONS: Women with Marfan or Ehlers-Danlos syndrome have high rates of urinary incontinence and pelvic organ prolapse. This finding supports the hypothesized etiologic role of connective tissue disorders as a factor in the pathogenesis of these conditions.

    Title Obstetric History in Women with Surgically Corrected Adult Urinary Incontinence or Pelvic Organ Prolapse.
    Date March 1999
    Journal The Journal of the American Association of Gynecologic Laparoscopists
    Excerpt

    STUDY OBJECTIVE: To compare obstetric histories of women who had surgical correction of urinary incontinence or pelvic organ prolapse with a similar group who did not. DESIGN: Case control study (Canadian Task Force classification II-2). SETTING: Urban, community-based, private practice teaching hospital. PATIENTS: Four hundred eighty women (age 51.4 +/- 13.0 yrs) who underwent corrective surgery for urinary incontinence, pelvic organ prolapse, or both, and whose obstetric history was obtainable through chart review. The control group was composed of 150 women (age 50.7 +/- 9.6 yrs) having routine screening mammography who completed a questionnaire regarding obstetric, gynecologic, and urologic history. MEASUREMENTS AND MAIN RESULTS: Patients and controls did not differ significantly in terms of age, race, height, weight, body mass index, or smoking history. Women who underwent surgery were of greater parity (2.5 +/- 1.2 vs 2.0 +/- 1.2, p <0.001), less often nulliparous (3% vs 18%, p <0.001), less likely to have had a cesarean delivery (4% vs 15%, p <0.001), and more likely to have had a vaginal delivery (94% vs 77%, p <0.001) than those with no surgery. The odds ratio of patients who had a vaginal delivery compared with controls was 4.7 (2.3-8.3), and that for cesarean delivery was 0.22 (0.11-0.43). Analysis of specific delivery information found that, compared with controls, patients were older by 4 years at time of their first delivery (28.9 +/- 4.9 vs 24.9 +/- 4.9 yrs, p <0.001) and more commonly received epidural analgesia intrapartum (87% vs 40%, p = 0.004). Comparisons within the patient group, categorized by indication for surgery, revealed that women who had surgery for either prolapse alone or for both prolapse and incontinence were most likely to have had vaginal deliveries (85% incontinence alone vs 94% prolapse alone vs 97% both, p <0.001). CONCLUSION: Increased parity, vaginal childbirth, maternal age at time of delivery, and use of epidural analgesia are associated with need for operative correction of pelvic organ prolapse or adult urinary incontinence. Conversely, cesarean delivery is associated with less need for surgical correction of incontinence or pelvic organ prolapse.


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