DISCUSSION ON THIS CASE The patient is a 55-year-old P4 postmenopausal woman with bothersome pelvic pressure and some voiding difficulty. She has tried a pessary but finds it too uncomfortable to wear regularly. While she was wearing the pessary she noted improvement in her voiding dysfunction and no urinary incontinence. She has no postmenopausal bleeding, is not on estrogen replacement therapy, and has a normal Pap smear. She desires surgical repair of her prolapse but for personal reasons absolutely does not desire a hysterectomy. She is sexually active. On pelvic examination, her POP-Q measurements are as follows: Aa +1, Ba +3, C +3, gh 4, pb 3, tvl 8, Ap 0, Bp 0, and D –4. On bimanual examination, there are no masses or enlarged ovaries and her uterus is symmetrically enlarged about 6-week size. Her levator muscles are weak and genital hiatus widened. A simple office cystometrogram with the prolapse reduced manually yielded the following information: first sensation 130ml, maximumbladder capacity 380ml, and no signs of uninhibited bladder contraction or urgency with filling; cough stress test at capacity standing with the prolapse reduced was negative for any urine loss. She voided 360 ml and had a catheterized post-void residual volume of 30 ml

Uterovaginal prolapse in a woman desiring uterus preservation. Case Presentation with Expert discussion

COSTANTINI, Elisabetta;LAZZERI, MASSIMO
2008

Abstract

DISCUSSION ON THIS CASE The patient is a 55-year-old P4 postmenopausal woman with bothersome pelvic pressure and some voiding difficulty. She has tried a pessary but finds it too uncomfortable to wear regularly. While she was wearing the pessary she noted improvement in her voiding dysfunction and no urinary incontinence. She has no postmenopausal bleeding, is not on estrogen replacement therapy, and has a normal Pap smear. She desires surgical repair of her prolapse but for personal reasons absolutely does not desire a hysterectomy. She is sexually active. On pelvic examination, her POP-Q measurements are as follows: Aa +1, Ba +3, C +3, gh 4, pb 3, tvl 8, Ap 0, Bp 0, and D –4. On bimanual examination, there are no masses or enlarged ovaries and her uterus is symmetrically enlarged about 6-week size. Her levator muscles are weak and genital hiatus widened. A simple office cystometrogram with the prolapse reduced manually yielded the following information: first sensation 130ml, maximumbladder capacity 380ml, and no signs of uninhibited bladder contraction or urgency with filling; cough stress test at capacity standing with the prolapse reduced was negative for any urine loss. She voided 360 ml and had a catheterized post-void residual volume of 30 ml
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11391/41389
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