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Re: Lichen Planus and urinary incontinence From: Atkinson, Samuel M, Jr (ATKINSONS@ecu.edu) Mon Oct 29 13:46:18 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: GIN11153@aol.com: "How can a physician be so stupid??" Previous message: Myer Bornstein: "Re: ABOG- AGAIN!" Maybe in reply to: Allan: "Lichen Planus and urinary incontinence" If she has mixed incontinence, she will get "cured" only with surgery and anticholinergics. Why not try cholonergics first?..I personally do not beliee there is enough estrogen in Femstat. Would go with higher doses of estrogen cream--even oral if necessqry..no uterus..and the data on breast and cardiac is weak. Give estrogen and ASA /Plavix to protect cardiac risks. If she is on anticholinergics, still wet, a TVT/O or even the new mini approaches would be a simple way to dry her up. I agree, they all scar back up again without continuous therapy. sAm ________________________________ From: ob-gyn-l@obgyn.net on behalf of Dr. John Provatopoulos B.Sc. = -- ________________________________ M.D.C.M. F.R.S.C. Sent: Wed 10/24/2007 2:24 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Lichen Planus and urinary incontinence At Wed, 24 Oct 2007, Allan wrote: > >I am treating this 82 yo otherwise very healthy woman for Lichen Planus. >Her labial agglutination was so severe that her urethra was hidden >behind a flap of tissue created by her labia minora fusing in the mid >line. I could not even pass one finger through the small opening that >was left the first time I saw. I took down the labial adhesions to >expose her urethral meatus. Her vaginal epithelium was bright red. >Cervix not present because she had a hysterectomy at age 50. I have >been giving her Vagifem in the vagina and Clobetasol on the labia. She >has made significant improvement. She is not complaining of anything >now except for her vagina appearing bright red. Besides for the >atrophic vaginal epithelieum, I see no lesions. > >Here is the problem - she has mixed urinary incontinence and does not >want to do anything about it. I am afraid she may not be getting the >maximum benefit of the Clobetasol (I have given her cream and ointment) >because of the constant wetness at the introitus. I am thinking about >telling her that it is going to be as good as it can get. She is >asymptomatic now, so I think systemic therapy would be unnecessary. Any >suggestons? > >-- >Allan I think you are doing the best you can, very frustrating problem. I have taken down complete vaginal/Vulvar fusion on more than one occassion only to have it reccur with 6-12 months because patients don't bother with pressure dilation and estrogen cream. The only thing I may add is to do a biopsy of any area's that don't just look atrophic, VIN and VAIN are very difficult to diagnose IMHO. >Southeasten PA > -- Take care, John Next message: GIN11153@aol.com: "How can a physician be so stupid??" Previous message: Myer Bornstein: "Re: ABOG- AGAIN!" Maybe in reply to: Allan: "Lichen Planus and urinary incontinence"

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