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Re: Retention after Pereyra procedure From: Gerald P. Rodriguez (geraldpr@cybermesa.com) Thu Feb 27 14:34:36 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Richard Chudacoff, MD: "Re: Retention after Pereyra procedure" Previous message: Mario Colombo, MD: "Retention after Pereyra procedure" Maybe in reply to: Mario Colombo, MD: "Retention after Pereyra procedure" Next in thread: Ricardo Savaris: "Re: Retention after Pereyra procedure" Have you tried a parasympathomimetic, such as bethanecol chloride? If not, I would try this and continue self-catheterization for a long time before doing any more surgery. Gerald P. Rodríguez, M.D., FACOG Santa Fe > ----- Original Message ----- From: Mario Colombo, MD To: Multiple recipients of list OB-GYN-L Sent: Thursday, February 27, 2003 2:08 PM Subject: Retention after Pereyra procedure Dear urogynecologists of the list, I have a case for you. On January 21, I performed a standard vaginal operation for advanced uterovaginal prolapse and potential stress urinary incontinence in a 64-year-old patient: VH, BSO, McCall culdoplasty, Pereyra suspension, and anterior colporrhaphy (no posterior repair because the woman was sexually active with no rectocele). Preoperatively her bladder was stable, she had a positive stress test result with prolapse repositioning, her urethra was hypermobile by the Q-tip test and she had a normal urethral profilometry at rest with microtransducers. Before being operated the patient regularly emptied her bladder with no residual urine. She was sent home on postoperative day (POD) 5 with self-intermittent catheterism (spontaneous voiding was totally absent). On POD 14 I removed the right Pereyra suture under local anesthesia as an outpatient office procedure. Chronic retention of urine was not resolved. On POD 23 I removed the second (left) Pereyra suture and performed a mild urethral dilation with Hegar dilators (untill number 10), but the situation did not change. Today is POD 37 and the patient is still on self-catheterism because she doesn't even void a single drop of urine spontaneously. Urethral catheterization seems absolutely normal (apparently, no obstacle is encountered). I think that I will hospitalize the woman next week to perform a vaginal urethrolisis under general anesthesia. I don't really see at this point what other I could do to resolve her condition. I never had a case like this before. I will thank you very much for your advices and suggestions. Mario Colombo Urogynecology Unit San Gerardo Hospital Monza Italy Next message: Richard Chudacoff, MD: "Re: Retention after Pereyra procedure" Previous message: Mario Colombo, MD: "Retention after Pereyra procedure" Maybe in reply to: Mario Colombo, MD: "Retention after Pereyra procedure" Next in thread: Ricardo Savaris: "Re: Retention after Pereyra procedure"

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