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Re: I've never seen a prolapse this bad. From: Michael J. Wolpmann, MD (elvisdoc@comcast.net) Tue Apr 30 21:28:38 2002 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Michael J. Wolpmann, MD: "Re: I've never seen a prolapse this bad." Previous message: DoctorJoe@aol.com: "Re: no subject received Tue, 30 Apr 2002 18:03:31 -0500" 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." Doug, LeFort colpcleisis with concurrent posterior repair/perineoplasty to narrow introitus would be an excellent option with minimal OR time under spinal. Would perform after resolution of her cystitis and 4-6 total weeks of Vagifem 2x weekly after 2 weeks continuous therapy. As for the incontinence issue, urodynamic assessment with reduction of prolapse can give you a good idea of what you're dealing with here and what to expect postop...may have significant de novo detrusor instability due to chronic urethral kinking...trial of anticholinergic may help and may obviate any need for incontinence procedure. If urethral hypermobility proven incontinence and good performance status, TVT procedure under spinal anesthesia and concurrent with LeFort, would be a very reasonable choice. good luck, Michael 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 > -- Michael J. Wolpmann, MD, FACOG, FACS Next message: Michael J. Wolpmann, MD: "Re: I've never seen a prolapse this bad." Previous message: DoctorJoe@aol.com: "Re: no subject received Tue, 30 Apr 2002 18:03:31 -0500" 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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