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Re: I've never seen a prolapse this bad. From: Efrain Ramirez (eramirezt@coqui.net) Tue Apr 30 19:40:07 2002 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Efrain Ramirez: "Re: Twins case part I" Previous message: Efrain Ramirez: "Re: Incisional Hernia" In reply to: Douglas Krell: "I've never seen a prolapse this bad." Next in thread: Michael J. Wolpmann, MD: "Re: I've never seen a prolapse this bad." At that age LeFort is definitively an option - with pre-op local estrogen until it is ripe -- if that does not work - abdominal sacropexy -- we use rectus fascia as graft material. >At Tue, 30 Apr 2002, Douglas Krell wrote: > >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 > -- "Life is neither the notes nor the silence between the notes, but the music that arises out of sound and silence felt as a living whole. Stop choosing...between chaos and order, and live at the boundary between them, where rest and action move together..." David Whyte Next message: Efrain Ramirez: "Re: Twins case part I" Previous message: Efrain Ramirez: "Re: Incisional Hernia" In reply to: Douglas Krell: "I've never seen a prolapse this bad." Next in thread: Michael J. Wolpmann, MD: "Re: I've never seen a prolapse this bad."

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