GYN: postmenopausal bleeding
From: art fougner, md (evsono@pipeline.com)
Sat Sep 23 10:34:54 2000
1: J Ultrasound Med 2000 Apr;19(4):237-41
Is a full bladder still necessary for pelvic sonography?
Benacerraf BR, Shipp TD, Bromley B
Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard
Medical School, Boston, USA.
The objective was to determine whether a full bladder is routinely necessary for a complete sonographic evaluation of the female pelvis. Over the course of 1 month, all women having a gynecologic sonogram were scanned initially
transabdominally through a full bladder by the sonographer (standard images taken). A physician then joined the sonographer and scanned the patient transvaginally without prior knowledge of the findings seen transvesically. The
physician finished the examination transabdominally, with the bladder empty. The physician and sonographer then determined (1) whether the scan was sufficient
transvaginally only, (2) whether the scan was sufficient transvaginally and transabdominally with an empty bladder, or (3) or whether a full bladder was necessary. Two hundred and six consecutive patients were scanned prospectively.
The transvaginal scan alone was sufficient to demonstrate all findings for 172 (83.5%) patients. The transvaginal and transabdominal scans through an empty bladder were needed for 31 (15.1%) patients. Three patients (1.5%) required a full bladder in addition to the other two techniques to visualize one normal ovary each. In conclusion, transvaginal scanning with an adjunctive transabdominal empty bladder approach can replace the full bladder technique for routine pelvic sonography. The transabdominal scan with an empty bladder is necessary, particularly for patients with enlarged uteri. It is no longer reasonable, however, to subject all patients undergoing pelvic sonography to bladder distention.
PMID: 10759346, UI: 20221096
art
At Sat, 23 Sep 2000, Myer S. Bornstein, MD, CPE, FACOG wrote:
>
>I have to argue with the radiologist that all I want is a TVUS also. I have
>presented them with the literature.
>Myer S. Bornstein, MD, CPE, FACOG
>>----- Original Message -----
>From: "Larry Glazerman" <l.glazerman@rcn.com>
>To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@forum.obgyn.net>
>Sent: Saturday, September 23, 2000 9:46 AM
>Subject: Re: Postmenopausal Bleeding
>
>> Dan:
>>
>> The radiologists in my area still insist on doing transabdominal US with
>TV
>> - they will not to TV alone. For those patients whose insurance won't let
>> me do the ultrasound, that's what we have to put up with. They do a TA
>scan
>> then empty the bladder for the TV scan
>>
>> The radiologists are back in the 70s.
>>
>> At 07:56 AM 9/23/00 -0500, you wrote:
>> >It depends. If you use the traditional system, yes. If you have your own
>> >machine and use it as part of the exam, it is cheaper, less time
>consuming,
>> >and more informative(because you see it in real time, not some
>radiologist
>> >looking at a still picture). Bladder filling????????? You want an empty
>> >bladder for transvaginal US.
>> >
>> >Dan
>> >
>> >R. Daniel Braun, MD FACOG
>> >Clinical Professor
>> >Department of Obstetrics and Gynecology
>> >Indiana U. School of Medicine
>> >Indianapolis, IN 46202
>> >
>> >OBGYN.net
>> >International Representative for United States
>> >
>> >Certified AllExperts Expert
>> >Check out my bio/ratings page!
>> >http://www.allexperts.com/displayExpert.asp?Expert=1236
>> >
>> >-----Original Message-----
>> >From: islesannie@yahoo.com [mailto:islesannie@yahoo.com]
>> >Sent: Friday, September 22, 2000 6:30 PM
>> >To: Multiple recipients of list OB-GYN-L
>> >Subject: Re: Postmenopausal Bleeding
>> >
>> >Excuse me? Ultrasounds are not inexpensive - compare the hospital charge
>> >followed by the radiologists charge - the ease and scant time of doing a
>> >Pipelle while she is there and the pathologist's report is MUCH less
>> >expensive than the time between the office visit and ultrasound, the
>> >bladder filling and 1-2 hours of the patient's day away from her
>> >scheduled responsibilities PLUS the hospital charge AND the radiologists
>> >charge.... How can US the Pipelle be less expensive?
>> >
>> >Sorry - my dander flew at the suggestion of Us first!
>> >
>> >Joanne
>> >
>> >At Fri, 22 Sep 2000, Griffiths Malcolm wrote:
>> > >
>> > >Agreed and maybe throw in a Pipelle biopsy according to results. In my
>own
>> > >practice I tend to do Pipelle and only arrange scan if I can't get
>Pipelle.
>> > >I am aware though that there was a US paper last year which showed US
>first
>> > >then Pipelle if indicated (rather than other way round) is more
>clinically
>> > >and cost-effective approach.
>> > >
>> > >-----Original Message-----
>> > >From: Vivienne Souter [mailto:viv@seaultrasound.com]
>> > >Sent: 21 September 2000 17:13
>> > >To: Multiple recipients of list OB-GYN-L
>> > >Subject: Re: Postmenopausal Bleeding
>> > >
>> > >I would do a pelvic ultrasound scan. I think it is as good if not
>better
>> > >than hysteroscopy
>> > >Viv
>> > >
>> > >ainsron@msn.com wrote:
>> > >
>> > >> 75 yo. on combined/continuous HRT for over 10 years, no bleeding
>before
>> > >> December, no changes in HRT at that time. Hgb has been normal, her
>> > >> bleeding is light.
>> > >>
>> > >> >agree... Hyst for abnormal uterine bleeding might be all you need..
>> > >> >
>> > >> >You have more..
>> > >> >
>> > >> >How old is she? What is her hgb?
>> > >> >
>> > >> >--
>> > >> >_______________________
>> > >> >Geffrey H. Klein, MD
>> > >> >_______________________
>> > >> >geffrey.klein@obgyn.net
>> > >> >200 Medical Center Blvd Suite 103
>> > >> >Webster, TX 77598
>> > >> >(281) 332 6723
>> > >> >
>> > >> >http://www.geffreyklein.com
>> > >> >
>> > >>
>> > >> --
>> > >> Ronald E. Ainsworth, MD
>> >
>> >--
>> >Joanne Bulley, MD, FACOG
>> >Keene, NH, USA
>> >
>> >All decisions are made with insufficient data.
>>
>> Larry R. Glazerman, MD
>> Ob-Gyn at Trexlertown
>> 610-402-0161
>> l.glazerman@rcn.com
>>
