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Re: tention after Pereyra procedure From: Michael J. Wolpmann, MD (elvisdoc@comcast.net) Thu Feb 27 16:59:48 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Garry E. Siegel, M.D.: "Re: Newly pregnant existing patients" Previous message: Karen: "Sorry, disregard last message ,I posted to wrong board!!!!!!" I would wonder if both your sutures are truly cut. I would also vote for giving this more time before reoperation. A suprapubic catheter will help you get her to go along with this, then would wait 8-12 weeks before takedown. good luck, Michael At Thu, 27 Feb 2003, Mario Colombo, MD wrote: > >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 > -- Michael J. Wolpmann, MD, FACOG, FACS The Women's Centre at Bayside Gynecology Venice, Florida Next message: Garry E. Siegel, M.D.: "Re: Newly pregnant existing patients" Previous message: Karen: "Sorry, disregard last message ,I posted to wrong board!!!!!!"

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