Re: PVUS probs
From: Atkinson, Samuel M (ATKINSONS@mail.ecu.edu)
Thu Sep 29 11:22:14 2005
Didn't know you smoked pipes..
sAm
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
Zachariah Newton
Sent: Tuesday, September 27, 2005 7:18 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
>
