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4th posting: Dr. Ind: thanks and ~~Pelvic repairFrom: Elizabeth (anonymous@obgyn.net)Thu, 29 Apr 1999 11:07:06 -0500 (CDT)
At Tue, 27 Apr 1999, Elizabeth wrote: > >At Thu, 22 Apr 1999, Elizabeth wrote: >> >>At Tue, 20 Apr 1999, Elizabeth wrote: >>> >>>At Fri, 16 Apr 1999, Thomas wrote: >>>&& I have a few more questions ;-). >>>> >>>>Wow! >>>> >>>&& Just curious, why the 'wow'? >>> >>>>There is little data on how many people require further surgery and alot depends on what type of prolapse you have and what type of repair is performed. >>>> >>>&& Could you elaborate a little here please? Do you mean by type of >>>prolapse the degree? It seems prolapse comes in groups of 3 at least >>>since the whole cavity is interrelated. >>> >>>>The only paper I can think of in the top of my head says that only 30% of women have no prolapse 10 years after a repair for a cystocele (bladder repair) however, the vast majority of those women with prolapse have no symptoms. >>>> >>>&& rough translation then would be that they had mild prolapse to begin >>>with? If a woman can keep a pessary in, does that perhaps suggest that >>>she's a better candidate for successful surgery? >>> >>>>It is possible to repair a uterine prolapse without removing the uterus performing a procedure called a Manchester or Fothergill repair. This operation tends to be reserved for women who wish to have further child and does involve amputation of the cervix. There is little data in the >>>>literature comparing it with a vaginal hysterectomy although most OBGYNs consider it less effective than a vaginal hysterectomy. >>> >>>&& Are there any studies out of the comparison of resuspension with and >>>without the uterus? And I've heard of a surgical procedure that includes >>>mesh and basically reforms the apex of the vaginal cavity >>>(hysterocolposacropexy with retaining the uterus). Have you heard much >>>about this? >>> >>>>A repeat operation is always more difficult. The initial success of >>>most operations in terms of symptoms in over 90 %. It is a few percent >>>less with a repeat procedure. However, most second operations for >>>prolapse normally involve supporting a different part of the vagina and >>>>therefore this makes no difference. >>> >>>&& In your opinion, do you think it makes a positive impact to have the >>>surgery at a younger age while there is still adequate amounts of >>>estrogen and collagen to aid in the healing process? >>>> >>>>I have just come out of theatre having participated in a laparoscopic sacrocolpoplexy. I think this is what you are referring to as a Mess procedure. This is a procedure for vault prolapse when women have had a >>>>hysterectomy and the top of there vagina is prolapsing. >>> >>>&& It seems there are a few procedures that combine the uterine >>>resuspension and the mesh approach. May I ask how old the patient who >>>had that surgery? >>> >>>>Hope this answers your questions >>> >>>&& Any ideas of why these repairs don't last that long and what would >>>you say is the average amount of time before the prolapse reoccurs. Is >>>it usually to a lesser degree? >>> >>>&&Have you done many resuspension or pelvic repair? I've heard that the >>>old anterior and posterior repairs aren't used quite as much and that >>>the Burch repair is used quite a bit when correcting a cystocele. >>> >>>&&Thank you for all your time - your information has been very helpful! >>> >>>-- >>>Elizabeth. >>>> >>>>-- >>>>Thomas Ind MB BS MD MRCOG >>>>London >>>>UK >>>> >>>>For every complex problem there is a simple solution...and it's wrong. (H L Mencken). >>>> >>>-- >>>Elizabeth >>> >>-- >>Elizabeth >> >-- >Elizabeth >
-- Elizabeth
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