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PVUS probsFrom: Lynn D. Montgomery, M.D. (apgar10@montanadsl.net)Tue Sep 27 07:23:19 2005
Had a 47 y.o. patient come and see me yesterday for an opinion. She had a paravaginal suspension performed 10 months ago for incontinence. She was an extremely fit, healthy athlete prior to the surgery. Following the surgery, she developed the following symptoms: -severe bladder pain -urinary frequency -parathesia and weakness of her left leg -profuse diarrhea -excessive sweating of her upper inner thigh and perineum -persistent post-void residuals She has been seen by three urologists, all of whom have documented a stitch visible in the bladder(ethibond), but all have shrugged their shoulders regarding any solution. Now I haven't been around PVUS's since residency when we were forced to operate with the PVUS king, Stanley Rogers. However, it seems to me that there are three components to this patient's problems; 1)the stitch in the bladder, 2)nerve entrapment from stitch placement, 3)the suspension is likely too tight. My guess is that at the very least, the stitch in the bladder should be addressed. The nerve entrapment issue would be complicated by scarring by this point and "take down" would not likely remedy this. My inclination is to take down the PVUS and perform a sling. I appreciate any thoughts on this complicated case. This poor woman is miserable. Lynn
-- Lynn D. Montgomery, M.D. Maternal-Fetal Medicine, OB/GYN Rocky Mountain Women's Health 2835 Fort Missoula Rd., Suite 304 Missoula, Montana, 59804 406-549-0978 fax 406-549-0987 e-mail: apgar10@montanadsl.net
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