Re: How to do a hysterectomy
From: Henry Gregor (henrygregor@yahoo.com)
Wed Dec 19 08:40:02 2007
I see where that would work well, with your doing the studies and the comparisons. If you have a patient in hopsital inpatient status, can you still do the postop sonos at bedside, w/o turf battles with the radiologists? (Obviously postop studies done in your office would not have this issue.)
Trust....operative word, isn't it? Great when docs have it. Sad, when they don't. Have you ever read an American comic strip called "Pogo"? Pogo had a great line, "We have met the enemy, and he is us"...unfortuanately, over the years that sometimes characterizes how some folks don't get along for their mutual benefit.
Hank
Dr Eberhard Lisse <el@lisse.NA> wrote:
Hank,
I do the sonars myself. Pre- and Post-Op. No problem whatsoever.
I also do them at ANC and pick up quite a number of pregnancy
related hydronephroses. I work with one particular Urologist
and we have come to trust each other :-)-O
el
on 12/19/07 9:15 AM Henry Gregor said the following:
> Interesting approach. Seems time intensive, with the preop study
> (Is it done on everyone?) and then it seems multiple postop
> clinical assessments involving a decision to repeat ureteral
> sonongraphy or not, and then in some (I assume it would only be a
> few) another sono assessment and comparison of urereteral dimensions
> pre and post op....I'm thinking now of how many times a comparison
> could elicit a radilologic interpertation that weazles and waffles a
> bit, ending with one of those phrases suggesting correlating to
> clinical status, consider 24 f/u study, consider MRI, CT w/contrast,
> etc., etc.
>
> I don't cysto every patient, and don't know anyone who does, but
> where a dissection or an anantomic procerss (such as fibroid down by
> the LUS or cx or broad ligament, or bulbous cx presents) it's a
> reasonable clinical call to do one. While it does make for a better
> sleep for the surgeon, my earlier comments were tongue in
> cheek...where the clinical condition raises some concern, then its
> certainly for the patient's benefit as well. If I were a patient
> with a problem, I'd rather wake up in the PACU stented and/or
> otherwise corrected as opposed to waiting.
>
> That said, in the case of a postop hematoma, that's obviousle going
> to be a post op care evaluation, and not in the least influenced by
> a cysto in the or at completion of hys'y.
>
> Hank
>
> */Dr Eberhard W Lisse /* wrote:
>
> Routine cystoscopy? PULEEZE!
>
> The MPS (the predominant Malpractice Carrier in the
> Commonwealth) suggests having a routine post op checkup in
> place, ie Ultrasound, perhaps on day 5. Preferably with one
> before the operation to compare. That'll show hydronephrosis,
> and you have sufficient time for the Urologist to do her thing.
>
> Served me well, when one of my patients developed a haematoma on
> the right side. We saw it waited another day when the
> hydronephrosis had increased, and we took her to the Operating
> Theatre where my colleague stented her easily.
>
> The results were dramatic, the patient is very happy. The
> priceless moment was when she said: "Is this what you explained
> to me at the consent?"
>
> On expected difficult pelvic anatomy, previous bladder surgery
> and such like, and/or if I ask the Urologist to come to the
> table, I have both urethers stented, after during one case the
> Urologist casually opened the bladder, put in a small feeding
> tube and only then could palpate the ureter.
>
> I do not think there is a place for chromic any more, in
> particular since there is rapidly dissolving vicryl.
>
> On Dec 19, 2007, at 04:03, Joe wrote:
>
> > Steve, I humbly suggest that your legal system is a bit different
> > than ours. Joe C
>
> el
>
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