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GYN: Contemporary Management of Pelvic RelaxationFrom: Garry E. Siegel, M.D. (garrys@mindspring.com)Mon Oct 25 20:39:35 1999
In this month's 10th anniversary issue of OB-GYN Management, one writer reflects on a decade of change in patient care with respect to pelvic reconstruction. His example is a 64 YO with a "bulge," SUI, and on exam she has a procidentia. He comments that the repair in 1989 would have been a TVH, BSO if accessible, McCall's culdoplasty, and A and P repair. In 1999, she would have a TVH, BSO (new technique with an endoloop that gets the ovaries), and then a "complete assessment of the pubocervical fascia would be made." Yada yada polybutester suture would be used, cystoscopy done, fix posterior and lateral fascial tears. This operation would restore normal anatomic landmarks that determine vaginal length and axis. "No longer are rapidly absorbable sutures used to fold the bladder wall in a futile attempt to use a distensible organ as its own support.. . Plication of the levator muscles is no longer an accepted practice." Somewhere else, he (or someone else) says that all of this isn't accessible by the lapscope. I'm feeling a bit out of the loop here. What think you? Garry
-- Garry E. Siegel, M.D., FACOG Private Practice Roswell, Ga.
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