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Re: PVUS probs From: Joe Cutchin (forcep@intercom.net) Tue Sep 27 08:22:04 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: OB: Preeclampsia?" Previous message: Elrod Darryl G MAJ 48 MDOS/SGOBO: "Re: PVUS probs" In reply to: Lynn D. Montgomery, M.D.: "PVUS probs" Next in thread: Atkinson, Samuel M: "Re: PVUS probs" Lynn: I would cut the suture in bladder , wait , and see what you have accomplished. Surprising that urologist did not do same. Joe C Lynn D. Montgomery, M.D. wrote: > Had a 47 y.o. patient come and see me yesterday for an opinion. She had a > paravaginal suspension performed 10 months ago for incontinence. She was an > extremely fit, healthy athlete prior to the surgery. Following the surgery, > she developed the following symptoms: > -severe bladder pain > -urinary frequency > -parathesia and weakness of her left leg > -profuse diarrhea > -excessive sweating of her upper inner thigh and perineum > -persistent post-void residuals > > She has been seen by three urologists, all of whom have documented a stitch > visible in the bladder(ethibond), but all have shrugged their shoulders > regarding any solution. > > Now I haven't been around PVUS's since residency when we were forced to > operate with the PVUS king, Stanley Rogers. However, it seems to me that > there are three components to this patient's problems; 1)the stitch in the > bladder, 2)nerve entrapment from stitch placement, 3)the suspension is > likely too tight. > > My guess is that at the very least, the stitch in the bladder should be > addressed. The nerve entrapment issue would be complicated by scarring by > this point and "take down" would not likely remedy this. My inclination is > to take down the PVUS and perform a sling. > > I appreciate any thoughts on this complicated case. This poor woman is > miserable. > Lynn > > Lynn D. Montgomery, M.D. > Maternal-Fetal Medicine, OB/GYN > Rocky Mountain Women's Health > 2835 Fort Missoula Rd., Suite 304 > Missoula, Montana, 59804 > 406-549-0978 > fax 406-549-0987 > e-mail: apgar10@montanadsl.net > Next message: art fougner, md: "Re: OB: Preeclampsia?" Previous message: Elrod Darryl G MAJ 48 MDOS/SGOBO: "Re: PVUS probs" In reply to: Lynn D. Montgomery, M.D.: "PVUS probs" Next in thread: Atkinson, Samuel M: "Re: PVUS probs"

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