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Re: SUI after sacrocolpopexy From: Atkinson, Samuel M (ATKINSONS@ECU.EDU) Mon Nov 6 10:49:55 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Elrod, Darryl G Maj 48 MDOS/SGOBO: "Re: SUI after sacrocolpopexy" Previous message: Anna Meenan, MD: "Gardasil patient assistance program" Maybe in reply to: Elrod, Darryl G Maj 48 MDOS/SGOBO: "SUI after sacrocolpopexy" Darryl: One of the things we weren't taught is that the Burch can widen the urethra and actually cause ISD. Your patients problem was common with Burch's prior to urodynamics. Then when they were studied after the fact, ISD was noted. So the mantra developed that if we were going to do a Burch, be sure they didn't have ISD before we did the Burch. Now, we do the studies and find that while they didn't have it before, gee, now they do. So I suspect an obturator sling will be needed. I would put her on your favored military antichlolinergic as Burch also favors causing DI as well.... Give her some time and she eill probably get significantly better. sAm ________________________________ From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Elrod, -- ________________________________ Darryl G Maj 48 MDOS/SGOBO Sent: Monday, November 06, 2006 10:38 AM To: Multiple recipients of list OB-GYN-L Subject: SUI after sacrocolpopexy I did my first abdominal sacrocolpopexy post residency now 5 weeks ago for symptomatic vaginal prolapse after a hysterectomy. The pt also had symptoms of stress incontinence and what I felt to be a paravaginal defect cystocele. I did an abdominal sacrocolpopexy, abdominal paravaginal repair, Burch and a posterior repair. I did cystoscopy after completing the Burch. Her postop course was uneventful. She had the catheter out the next morning and was discharged later that afternoon after she spontaneously voided and her pain was controlled by Percocet. The only complication she has noticed since surgery is a much more pronounced symptoms of stress incontinence than prior to surgery. Now she has to do very little to cause leakage. Although the vagina looks very nicely supported, I have obviously changed the vaginal angle enough to promote incontinence rather than prevent it. At this point how would you guys (and gals) manage her? I think she is likely too close to her original surgery to consider a midurethral sling (TVT, TOT) but as I've not been in this position before I wouldn't know. Thanks in advance, Glen //SIGNED// D. Glen Elrod, Maj., USAF, MC Obstetrician/Gynecologist Chief of Obstetrics 48 MDOS/SGOBO RAF Lakenheath, England Telephone DSN: 314-226-8130 Comm: +44 (0) 1638 52 8130 Notice of Confidentiality Under the Privacy Act of 1974, you must safeguard all information reflected on this e-mail and, if applicable, all attachments. Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI 37-131, AFI 37-132, AFI 33-219, and PL 93-579" This e-mail message including any attachments is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. Any questions pertaining to disclosure should be directed to the privacy officer. Next message: Elrod, Darryl G Maj 48 MDOS/SGOBO: "Re: SUI after sacrocolpopexy" Previous message: Anna Meenan, MD: "Gardasil patient assistance program" Maybe in reply to: Elrod, Darryl G Maj 48 MDOS/SGOBO: "SUI after sacrocolpopexy"

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