Re: PVUS probs
From: Zachariah Newton (zbnewton@bellsouth.net)
Tue Sep 27 18:45:39 2005
Lynn-
A lot of overlap in the literature and failure to distinguish.
No, references are not currently available to me. I know that they exist.
Zach
--
>----- Original Message -----
From: "Lynn D. Montgomery, M.D." <apgar10@montanadsl.net>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
Sent: Tuesday, September 27, 2005 7:33 PM
Subject: Re: PVUS probs
> Zach,
> Believe me, I didn't do the repair. You wouldn't by chance have an old
> reference that addresses your statement regarding the fact that PVUS is
> not
> a choice for just SUI.
> 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
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf
> Of Zachariah Newton
> Sent: Tuesday, September 27, 2005 5:18 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: PVUS probs
>
> Sambo-
>
> Your post is representative of your established capacity to
> capture, visualize and target a plan of attack toward benign resolution.
>
> You send me reeling with your remarks on paravaginal defect repair. Dr.
> Cullen Richardson's doppelganger no doubt will slash your
> tires. Your concrete thinking denied your recognition that PVD
> repair is not primarily a procedure designed or claimed to be a
> surgical resolution of SUI. It is a primary operation for
> non-incontinent symptomatic women with paravaginal defect. It
> is complementary and synergistic with an additional procedure
> for SUI for women with PVD and SUI..
>
> I don't know if I can recover from your lapse.
>
> Zach
>
> Z. B. Newton, III, M.D.
> Gyn/retired
> Atlanta, GA
> --
>> ----- Original Message -----
> From: "Atkinson, Samuel M" <ATKINSONS@mail.ecu.edu>
> To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
> Sent: Tuesday, September 27, 2005 11:34 AM
> Subject: RE: PVUS probs
>
>> If you are comfortable with the operative cystoscope, see if
> you can cut
>> the suture. If not another alternative is to go above and remove any
>> permanent suture you find (a la retropubic lysis) . I would not do a
>> sling at this time. We see these same sx with slings, ASARC
> and TVT's.If
>> her sx persist, you are partially culpable. I would wait and
> see if her
>> incontinence recurs, then if so, do a TVT/O vs Monarch. Stay
> out of the
>> mined and torpedoed area. I too haven't done a paravaginal since Dr
>> Burch said it didn't work in 1962. That is why he developed
> the "BURCH"
>> which most of us haven't done since we learned the TVT/O technique.
>>
>> -----Original Message-----
>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Lynn
>> D. Montgomery, M.D.
>> Sent: Tuesday, September 27, 2005 8:25 AM
>> To: Multiple recipients of list OB-GYN-L
>> Subject: PVUS probs
>>
>> 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
>>
>
