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Traumatic SUI ?From: dahmd@gate.netThu Oct 5 18:26:23 1995
I saw an interesting patient recently: 33 y.o. nulligravid who had her pelvis fractured in 9 places during a motor vehicle accident 8 months ago. She denies ever having had urinary incontinence or bladder/renal problems, and has a very benign gynecologic history. She is not sexually active, and denies assault. After she left the hospital in January, she reports worsening SUI with cough, laugh, or sneeze, and denies hematuria, noctura, any medications, or dribbling. Her exam reveals a Q-tip test of 45 degrees from midline (straight up with valsalva), a hypermobile urethra, and bilateral paravaginal defects with a grade II cystocele. The remainder of exam, including a vaginal sono, were normal. The uterus and posterior vagina are well supported. She has a negative urinalysis and culture. She has no kids, no other trauma, no other findings, and symptoms that developed after the car wreck. My theory is traumatic detachment of the vagina from the arcus tendineus. Any other thoughts? D. Ashley Hill, M.D. Assistant Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, FL dahmd@gate.net
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