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Re: PVUS probs From: Andrew Folley (agfolley@hotmail.com) Tue Sep 27 12:30:28 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Andrew Folley: "Re: Opinions on laparoscopy (long)" Previous message: Andrew Folley: "Re: OB: Preeclampsia?" In reply to: Lynn D. Montgomery, M.D.: "PVUS probs" Next in thread: Lyndon Taylor: "Re: PVUS probs" I agree with taking everything down. I would defer second operation until 8 to 12 weeks later to see what resolution of symptoms occur. Consider Trans Vaginal Obturatro Tape rather than TVT to avoid pladder. Also suggest EMG of left leg and CAT of spine r/0 disc problem etc. andy >From: "Lynn D. Montgomery, M.D." <apgar10@montanadsl.net> >Reply-To: ob-gyn-l@obgyn.net >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> >Subject: PVUS probs >Date: Tue, 27 Sep 2005 07:24:34 -0500 > >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: Andrew Folley: "Re: Opinions on laparoscopy (long)" Previous message: Andrew Folley: "Re: OB: Preeclampsia?" In reply to: Lynn D. Montgomery, M.D.: "PVUS probs" Next in thread: Lyndon Taylor: "Re: PVUS probs"

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