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Re: Recurrent rectocele From: Elrod, Darryl G Maj 48 MDOS/SGOBO (Darryl.elrod@LAKENHEATH.AF.MIL) Thu Nov 30 09:22:13 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: ND84MD@aol.com: "Re: Recurrent rectocele" Previous message: Andrew Folley: "Re: Recurrent rectocele" In reply to: Andrew Folley: "Re: Recurrent rectocele" Next in thread: ND84MD@aol.com: "Re: Recurrent rectocele" How does the Apogee company support using mesh if all the current literature says that its (mesh) safety can't be proven for use in the posterior vagina? Where is all their data to support its use? 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. -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Andrew Folley Sent: Thursday, November 30, 2006 2:11 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Recurrent rectocele Consider future repair with Apogee syteby AMS using mesh. andrew >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: Recurrent rectocele >Date: Thu, 30 Nov 2006 02:20:30 -0600 > >I figured I'd change the tone of the conversation to something along the >clinical lines. > >35 yo G4P4 with TVH/abdominal paravaginal repair/Burch/McCalls and a >posterior repair with perineorrhaphy about a year ago presents back for >recurrent rectocele symptoms. Although not as bad as before surgery, >she still feels the need to splint with bowel movements and has >increased pressure rectally. > >On exam there is still a significant bulge in the posterior vagina. On >rectal exam, the sphincter feels intact, the posterior vaginal wall can >be brought nearly to the hymen (better than before her last surgery when >I could bring it past the hymen). The anterior vagina and the cuff are >well suspended. I don't feel anything that would make me concerned for >an enterocele and the upper half of the vagina there feels to be good >support. > >Endoanal ultrasound shows a normal internal and external sphincter. > >Under normal circumstances I wouldn't be to concerned about either >tackling this repair myself or sending her to a urogyn to repair. >However, I got one of those turn the head, get red with embarrassment >looks from her. I questioned what that was for and got 'do you think >this might have something to do with liking anal sex???' Turns out, she >likes it enough to not really want to be without it for any lengthy >period of time. > >Oddly enough, I can't seem to find much literature at all on management >of recurrent rectocele and none on risk of recurrent rectocele with anal >sex. > >Any thoughts on a) if this would be enough to undo a perfectly good >posterior repair (probably) b) if you repaired it again, how long would >you prescribe nil per anus (6 months???) c) would you tackle this >yourself or refer? > >Thanks, > >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: ND84MD@aol.com: "Re: Recurrent rectocele" Previous message: Andrew Folley: "Re: Recurrent rectocele" In reply to: Andrew Folley: "Re: Recurrent rectocele" Next in thread: ND84MD@aol.com: "Re: Recurrent rectocele"

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