--
Richard Chudacoff, MD
"The fundamental problem with golf is that every so often, no matter how
lacking you may be in the essential virtues required of a steady player,
the odds are that one day you will hit the ball straight, hard, and out of
sight. This is the essential frustration of this excruciating sport. For
when you've done it once, you make the fundamental error of asking yourself
why you can't do this all the time. The answer to this question is simple:
the first time was a fluke." -Colin Bowles
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Mario
Colombo, MD
Sent: Thursday, February 27, 2003 3:09 PM
To: Multiple recipients of list OB-GYN-L
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
