Re: SUI after sacrocolpopexy
From: Efrain Ramirez (eramirezt@coqui.net)
Wed Nov 8 23:30:09 2006
Same her - except urologist does the Burch - excellent results.
Ef
At Tue, 7 Nov 2006, Elrod, Darryl G Maj 48 MDOS/SGOBO wrote:
>
>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.
>>
--
“ The greatest obstacle to knowledge is not ignorance,
it is the illusion of knowledge.” Daniel J. Boorstin - Historian
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