Re: SUI after sacrocolpopexy
From: Andrew Folley (agfolley@hotmail.com)
Tue Nov 7 04:59:38 2006
Glen
Try to get some training from the AMS (American Medical Systems) Apogee and
Perigee mesh systems. You will like and and you will never have to do an
abdominal sacrocolpopexy again. It is a fairly simple and effective
treatment for prolapse. Very similar to AP repair but mesh is being placed
with trocars though the obturator space etc. andy
>From: "Elrod, Darryl G Maj 48 MDOS/SGOBO" <Darryl.elrod@LAKENHEATH.AF.MIL>
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: RE: SUI after sacrocolpopexy
>Date: Tue, 7 Nov 2006 02:58:04 -0600
>
>I used a prolene mesh and attached it with prolene sutures. I have been
>surprised by how little tension I left on the mesh has resulted in such
>a good lift of the vaginal cuff.
>
>I guess I'm not totally surprised either, but with the New England
>Journal article on ASC and Burches being so definitive, I thought for
>sure she'd see some benefit. Although, I know that the NEJ study was in
>women who were asymptomatic prior to surgery, she was already
>symptomatic before surgery.
>
>I've sent her to urology to make sure I'm not missing something obvious,
>but then I'll probably do just that and place a TVT or TOT in another 6
>weeks or so.
>
>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
>
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>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Joe
>Cutchin
>Sent: Monday, November 06, 2006 3:58 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: SUI after sacrocolpopexy
>
>Glen: I see it as a failure of the MM procedure which is not unusual. I
>would wait another month or two and offer TVT . Curious only. What did
>you use for graft and how did you attach to sacrum? Joe C
>
>Elrod, Darryl G Maj 48 MDOS/SGOBO wrote:
>
> > 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.
> >
>
