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I've never seen a prolapse this bad.From: Douglas Krell (officekrell@ix.netcom.com)Tue Apr 30 06:46:41 2002
OB/GYN.net colleagues, 87 year old Caucasian female with massive vaginal protrusion. S/P hysterectomy 40 years ago. Recently widowed and moved from the hills of Arkansas where she was told nothing could be done. Pessaries failed years ago. She was seen in the ER for sudden hematuria and inability to void. Ulcerated, bleeding vaginal protrusion obviously containing bladder and small intestine. Catheterizaion revealed gross hematuria, clots in the bladder. Serum creatinine 8.8 All other labs WNL including EKG/CXR. Overnight with foley irrigation and drainage, serum creatinine back to 1.8. Urine grossly clear, but microscopically mixed cellularity. Renal U/S showed mild hydronephrosis. Urine culture pending, but antibiotics begun. -------------------------- What would be your treatment approach and surgical recommendations? -------------------------- How long would you wait before surgery? What procedure would be most -------------------------- likely to leave the patient continent of urine? What procedure would result in the least morbidity?
-- Douglas Krell MD FACOG
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