Re: Gyn: Elongated cervix
From: Joe (forcep@intercom.net)
Sun Jul 30 09:00:30 2006
Bard Parker.
Garry E. Siegel, M.D. wrote:
> 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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