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Re: I've never seen a prolapse this bad. From: Michael J. Wolpmann, MD (elvisdoc@comcast.net) Tue Apr 30 21:37:49 2002 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Gordon: "HR 4600" Previous message: Michael J. Wolpmann, MD: "Re: I've never seen a prolapse this bad." In reply to: Douglas Krell: "I've never seen a prolapse this bad." Sorry, didn't read your message close enough....that would be a partial colpectomy at this point. One could also do a bilateral uterosacral ligament fixation/plication of the vault apex with partial colpectomy and fix the enterocele/cystocele concurrently but her performance status would be key here. Partial colpocleisis and TVT under spinal and you expose her to less than an hour in the OR....at 87 thats a good thing. Your choice. good luck again, 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: Gordon: "HR 4600" Previous message: Michael J. Wolpmann, MD: "Re: I've never seen a prolapse this bad." In reply to: Douglas Krell: "I've never seen a prolapse this bad."

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