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rzaskhan
Re: dilemma ! a pt. with a vaginal lump.& .....
Thanks !
chameed
Re: dilemma ! a pt. with a vaginal lump.& .....
quote:
rzaskhan wrote:
A 50 yr , postmenopausal woman came to the GYNAE OPD few days ago with complaints of a vaginal lump (4years)which she felt hampered her from sitting down, No other accompanied problem in her medical history.Surgically she had had a Manchester repair with an anterior & posterior repair. On examination there was a 2nd degree uterine descent. The past repair & subsiquent post menopausal vaginal shrinkage Had narrowed the vagina so much that the tightness of the interiotus had prevented the descent from being a procidentia. The cervix is fibrosed & almost flush with the vagina.
She refused a vaginal pessary in favour of surgery!
She has been offered A TAH & BSO. I would be grateful for anyones opinion. In particular What measures you would consider to prevent uretral/bladder injury especilly considering that her past injury risks damage to both these structures.The Patient is particularly annoyed since the last operation as it did not deliver what she wanted & wants to know of the potential risks involved this time !!!
Do a cystoscopy pre-op and place double J stents in both ureters, do the complete bowel prep and keep the bladder filled with formula during surgery and go ahead with TAH/BSO. Cheers!!!
rzaskhan
dilemma ! a pt. with a vaginal lump.& .....
A 50 yr , postmenopausal woman came to the GYNAE OPD few days ago with complaints of a vaginal lump (4years)which she felt hampered her from sitting down, No other accompanied problem in her medical history.Surgically she had had a Manchester repair with an anterior & posterior repair. On examination there was a 2nd degree uterine descent. The past repair & subsiquent post menopausal vaginal shrinkage Had narrowed the vagina so much that the tightness of the interiotus had prevented the descent from being a procidentia. The cervix is fibrosed & almost flush with the vagina.
She refused a vaginal pessary in favour of surgery!
She has been offered A TAH & BSO. I would be grateful for anyones opinion. In particular What measures you would consider to prevent uretral/bladder injury especilly considering that her past injury risks damage to both these structures.The Patient is particularly annoyed since the last operation as it did not deliver what she wanted & wants to know of the potential risks involved this time !!!
