Medical History:
53 Y F, last degree prolapsed uterus presents with four ulcers, 2 on the surface of the uterus, one on the surface of cervix and another one (Can't recall the location). There is daily discharge. What is the appropriate treatment to eliminate the discharge until she undergoes vaginal hysterectomy? Local antibiotic therapy or what?
Medications she takes:
Bisoprolol 2.5 mg once daily for Atrial Fibrillation
Cetirizine 10 mg once daily for Allergic Rhinitis
Daflon 500 mg once daily for chronic venous insufficiency
Non-Alcoholic-Fatty liver disease (Not managed with medications)
Blood tests were done and no other abnormalities.
Hi, estriol local therapy and hysterosacropexy. The hysterectomy its not the causal therapy in case of uterus prolapse. The most common reason for prolapse is the apical defect. I recommend you our article: Laparoscopic hysterosacropexy in case of total uterus prolapse - case report. https://www.ncbi.nlm.nih.gov/pubmed/30391736
Best regards
Why hysterectomy isn't the causal therapy ? What about the ulcerated uterus and the discharge? What is the reason behind the discharge? And is antibiotic therapy recommended for the treatment of the discharge? Pawel Szymanowski
The reason of the ulcerated uterus and discharge is the prolapse caused by defect of sacrouterin ligaments. The treatment should be dedicated to the damaged ligaments not to the uterus. In my opinion there are no urogynecological indications for hysterectomy and for sure the hysterectomy doesn't treat the apical defect. The hysterectomy is likely the mostly unnecessary performed operation.
Replacing the uterus back inside is of prime importance.. Ulcer can be treated with packing.. The packing can be done with a variety of creams depending upon the clinical findings n availability of products.. She can later undergo surgical treatment.. That maybe in the form of hysterectomy or hysteropexy.. This should be discussed with the patient.A treatment option considered suitable for one may not be suitable for another so a thorough discussion with the patient is mandatory in these cases.
Application of estrogen gel on the ulcer or estrogen soaked vaginal packing till ulcer is healed and then proceed for vaginally hysterectomy.
If discharge is purulent, it is best to give antibiotics first. If a long time passes through the uterine prolapse, and the wounds are chronic, because of the risk of SCC, it is necessary to conduct a sampling before surgery. Using topical steroids for up 7 to 10 days before surgery will also help to heal wounds, as well as easier surgery if vaginal hysterectomy is performed. Of course, the main treatment of these wounds and prevention of their re-establishment is to prevention of the uterus prolaps.
If the patient refuses surgery, pessary can be used for this purpose. Of course, the patient should have periodic vaginal examinations. In the case of surgery, whether with or without hysterectomy, the important point is sacro-colpopexy, because the main problem is in uterine ligaments, not in the womb and by doing hysterectomy alone, only symptomatic treatment is actually done for the patient. This surgery can be done in the form of laparoscopic sacro-colpopexy with or without hysterectomy.
This patient need to sent pap smear and accordingly she may need punch biobsy for ulcerative edges to exclude premalignant and malignant condition
regard her compleant she can putted on medication that improve the healing of these ulcers ,by return her uterus back inside pelvice by pack and local antibiotic eg.flumazin and treatment that decrase frction of pack with ulcer and treatment improving healing of ulcer
In Finland they use hysterectomy for prolapse. This should not necessary be the choice:
- Badges
- Science topic
- Similar topics
- Medicine