Re: Granulation tissue

From: Steve & Eryl Raymond (eryl@intekom.co.za)
Wed Sep 22 15:26:32 2004


This is not going to get better until the ring has been out for about 4 to 6 weeks. She really should have adequate oestrogenisation of her vagina before it is put back. Twice weekly Premarin cream is insufficient 0- should be daily. In fact for a month a course of oral Premarin would be a better idea. I think you should do a cystocoele repair or a LeFort procedure and dispense with the ring altogether. Steve

Rafael Haciski wrote:

> Question for the listers:
>
> I have an elderly pt. with post hysterectomy (many years ago) vaginal
> prolapse, who until now was satisfied with ring pessary.
> Over the course of last year she has developed sporadic vaginal
> bleeding - granulation tissue by appearance and biopsy. Initially
> cauterized with silver nitrate, but today a much greater area is seen
> (on both sides of vaginal walls, an at top of vault).
>
> The question concerns both treating the granulation tissue and vaginal
> prolapse.
> .. it seems too great an area for silver nitrate cauterization (prob.
> ~6 square cm)
> .. my concern in this frail pt. in using cautery (or cryo) is
> collateral injury to adjacent organs (rectum, bowel) and indeed poor
> healing leading to fistula formation.
> .. due to atrophy, her introitus is getting too painful for pessary
> removal and cleaning (lacerates each time, and she is using Premarin
> cream on the introitus 2-3 times weekly)
> .. LeFort procedure may be acceptable to her - she is thinking about this
>
> Any thoughts?
>
> Rafael C. Haciski MD FACOG
> Bradenton FL
>





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