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Gyn: Elongated cervixFrom: Garry E. Siegel, M.D. (garrys@mindspring.com)Sat Jul 29 10:15:09 2006
62 YO P2002, many years menopausal, has a very elongated cervix, i.e. 5+ cm., that is present at the introitus. On exam, she has a small uterus, and is hypoestrogenic, and really doesn't have an appreciable cystocele or rectocele, and I don't sense any vaginal vault descensus per se. She had two children vaginally, 6-ish pounds, and is a bit heavy, and has a narrow arch. She is a non-insulin requiring diabetic on 3 oral meds, and is now ready for a hysterectomy for this protrusion, which she has tolerated for years. She has no SUI or incontinence whatsover, no trouble with defecation, etc. My concerns: 1. I don't think this is such an easy vaginal hysterectomy. 2. Am I missing vault prolape? 3. Should I suspend the cuff anyway--Ashley kindly has taught me a pretty easy way to do a vaginal suspension to the uterosacrals at TVH. I'm kind of thinking about going to the OR and putting her up for a vaginal hyst, and seeing if her uterus is accesible vaginally by using a tenaculum as a test. Failing that, I could see if I thought starting laparoscopically (i.e. LAVH) would help, or simply do a TAH. If I can do this vaginally, ovaries would come out if accesible; if LAVH or TAH, then a BSO is added. Thoughts welcome. Garry
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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