PFD Week 2018-Thieves' Market

Video Transcription

Video Summary

The video featured discussions on various cases related to pelvic organ prolapse and other pelvic floor disorders. Some key highlights include:<br /><br />1. Case 1: The patient had a history of multiple surgeries and presented for treatment of prolapse. The differential diagnosis included mesh complications, recurrent urinary tract infections, and shortened vagina. The treatment plan involved a workup including CT urogram and cystoscopy and surgical removal of the mesh and repair of the prolapse.<br /><br />2. Case 2: The patient had a bulging mass in the left labia and urinary symptoms. The differential diagnosis included a canal of noc cyst, inguinal hernia, or hernia through the pelvic floor. The recommended approach was to perform a CT urogram to assess for kidney abnormalities and a cystoscopy to evaluate the urethra and bladder. Surgery would involve removing the mesh and repairing the prolapse. The risk of failure after the procedure was discussed, and the panel recommended considering the patient's symptoms and expectations for determining the treatment plan.<br /><br />3. Case 3: The patient had anterior dyspareunia and lower urinary tract symptoms. The diagnosis was an anterior urethral diverticulum. The panel recommended a vaginal approach if possible, but a suprameatal or robotic approach could also be considered. The risk of injury to the external urethral sphincter was highlighted.<br /><br />4. Case 4: The patient had uterine didelphys and presented with bothersome prolapse. The treatment plan involved robotic-assisted laparoscopic supracervical hysterectomies, sarcoplexy, and possible repair of anterior and posterior prolapse. The presence of a diverticulum was noted on imaging, but expectant management was chosen as the patient was asymptomatic.<br /><br />These cases highlight the complexity of pelvic organ prolapse and the need for individualized treatment plans based on the specific patient's symptoms and anatomical abnormalities.

Asset Subtitle

L L Barnes, MD, Katherine Hines, MD, Andre Plair, MD MS, & Tatiana Catanzarite, MD, MAS

Keywords

pelvic organ prolapse

mesh complications

CT urogram

cystoscopy

diverticulum

individualized treatment plans

labia

uterine didelphys