Re: Gyn: Elongated cervix
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Sat Jul 29 22:27:07 2006
How did you remove it?
Garry
At Sat, 29 Jul 2006, Joe wrote:
>
>Garry: Had a patient like this. No relaxation but a long cervix. I just
>excised it: didn't do hyst. I've followed her over the years: problem
>was solved. Just be sure you are not dealing with relaxation or
>prolapse. Joe C
>
>Garry E. Siegel, M.D. wrote:
>> 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
>>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
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