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What Does My Ultrasound Test Report Indicate?
Question: I had an anterior repair and hysterectomy 1st October last year.
Since the surgery I have felt the need to pass urine, I had an ultra sound 3 months ago which showed a residual urine of 150mls which was repeated two weeks ago which showed 50mls which I was told was normal.
I have also had a feeling of "something coming down" for the last few weeks. I saw the gynaecologist this week who said there was no problem with the surgery.
Today I have done some exercise and the feeling worsened. I have had a look at myself and on straining and can see bulging at the entrance to the vagina. Also as I touched this the need to pass urine increased.
I'm confused as to what this is, and only a few days ago I was told all was well. I feel these are the symptoms I had before and I have had this surgery. This has upset me this evening hence this email
Since the surgery I have felt the need to pass urine, I had an ultra sound 3 months ago which showed a residual urine of 150mls which was repeated two weeks ago which showed 50mls which I was told was normal.
I have also had a feeling of "something coming down" for the last few weeks. I saw the gynaecologist this week who said there was no problem with the surgery.
Today I have done some exercise and the feeling worsened. I have had a look at myself and on straining and can see bulging at the entrance to the vagina. Also as I touched this the need to pass urine increased.
I'm confused as to what this is, and only a few days ago I was told all was well. I feel these are the symptoms I had before and I have had this surgery. This has upset me this evening hence this email
Brief Answer:
Recurrent prolapse
Detailed Answer:
Your instincts regarding what is going on are almost perfect. Think about it: you have notice a bulge at the vaginal opening, that is worse with exertion and you are now having difficulty with complete emptying. This is recurrent anterior vaginal wall prolapse.
I think that your GYN is perhaps not recreating the prolapse at the time of the exam appropriately. In this case, a second opinion is warranted. In fact, this should be scheduled with a GYN that has some expertise or interest in GYN prolapse related problems.
Finally, at the time of your second opinion, ask about the option of a pessary. This is a flexible, plastic device that sits in the vagina comfortably and would reduce the prolapse and help with complete emptying. Repeat surgery for recurrent prolapse usually involve the use of mesh. This is a safe option but you should discuss any concerns about this at the time of your consult.
I hope that this helps
Dr. Raichle
Recurrent prolapse
Detailed Answer:
Your instincts regarding what is going on are almost perfect. Think about it: you have notice a bulge at the vaginal opening, that is worse with exertion and you are now having difficulty with complete emptying. This is recurrent anterior vaginal wall prolapse.
I think that your GYN is perhaps not recreating the prolapse at the time of the exam appropriately. In this case, a second opinion is warranted. In fact, this should be scheduled with a GYN that has some expertise or interest in GYN prolapse related problems.
Finally, at the time of your second opinion, ask about the option of a pessary. This is a flexible, plastic device that sits in the vagina comfortably and would reduce the prolapse and help with complete emptying. Repeat surgery for recurrent prolapse usually involve the use of mesh. This is a safe option but you should discuss any concerns about this at the time of your consult.
I hope that this helps
Dr. Raichle
Above answer was peer-reviewed by :
Dr. Prasad
The prolapse seems to be more posteriorly now. I can't understand how I had this surgery five months ago and was examined two days ago and was told all was well and the surgery was successful. He said the vault - (think I have got that right was high) He said the bowel was a little prolapsed but did not go as far as to say it was a rectocele. He is a consultant gynaecologist with many years experience.
I was told they do not use mesh and yes I have heard of a pessary but it is not something I would want to have.
I was told they do not use mesh and yes I have heard of a pessary but it is not something I would want to have.
Brief Answer:
Maybe it is a rectocele
Detailed Answer:
It is possible that you have good results with the anterior repair and the bulge you are noticing is related to the rectocele. It sounds to me like there was more of a "global" problem that was not completely addressed with the original surgery. This is why I think that you need a second opinion.
Let me know if this helps.
Maybe it is a rectocele
Detailed Answer:
It is possible that you have good results with the anterior repair and the bulge you are noticing is related to the rectocele. It sounds to me like there was more of a "global" problem that was not completely addressed with the original surgery. This is why I think that you need a second opinion.
Let me know if this helps.
Above answer was peer-reviewed by :
Dr. Prasad
So if it is a rectocele, how would that be treated? Surgery obviously would be one option but I don't feel I would want more surgery so closely. I know it is difficult for you to say but on what I've said does it sound more like a rectocele? Would that give me the need to pass urine? He was considering a urethral stricture at one point, but since the normal residual urine this was ruled out.
Would the ultrasound have shown if the bladder had prolapsed?
I really had faith in this surgeon and feel I would like to go back to him for an explanation. Perhaps this sounds silly if i have just seen him.
There is also the cost to consider.
Would the ultrasound have shown if the bladder had prolapsed?
I really had faith in this surgeon and feel I would like to go back to him for an explanation. Perhaps this sounds silly if i have just seen him.
There is also the cost to consider.
Brief Answer:
I still think that the cystocele is more likely
Detailed Answer:
Think about it this way. While the bladder seemed like the biggest problem originally, obviously you were at risk for relaxation of the pelvic floor anyway. We divide these support issues into anterior defects, posterior defects and vaginal apical defects. There is no problem with the apex from their exam. But now it sounds like you might have a component of recurrent bladder prolapse and also a rectocele that was not originally evident, but now a possibility.
So I know that this is frustrating as I have had some of my own prior repairs fail over short periods of time - it is not common but it does happen. I also get it that this is not ideal AND gets expensive. You just need to decide based on a quality of life decision - is this interfering with my ability to lead a normal, happy life OR am I getting miserable. If you are miserable, then go back in and have them redo the exam. If a patient asked me "do you mind if I get another opinion" I would absolutely encourage this AND I will help them to find a suitable second opinion. If they are offended by the question, then maybe that is reason enough to get the second opinion.
I hope that this helps!
I still think that the cystocele is more likely
Detailed Answer:
Think about it this way. While the bladder seemed like the biggest problem originally, obviously you were at risk for relaxation of the pelvic floor anyway. We divide these support issues into anterior defects, posterior defects and vaginal apical defects. There is no problem with the apex from their exam. But now it sounds like you might have a component of recurrent bladder prolapse and also a rectocele that was not originally evident, but now a possibility.
So I know that this is frustrating as I have had some of my own prior repairs fail over short periods of time - it is not common but it does happen. I also get it that this is not ideal AND gets expensive. You just need to decide based on a quality of life decision - is this interfering with my ability to lead a normal, happy life OR am I getting miserable. If you are miserable, then go back in and have them redo the exam. If a patient asked me "do you mind if I get another opinion" I would absolutely encourage this AND I will help them to find a suitable second opinion. If they are offended by the question, then maybe that is reason enough to get the second opinion.
I hope that this helps!
Above answer was peer-reviewed by :
Dr. Prasad
So it could prolapse again that quickly? Surely it would happen over time, he did say I had a lot of internal stitches. I thought carefully about this surgery as I knew there was not a 100% success rate and was assured that mine had a good chance of success. Why when he examined me 2 days ago did he not say this had reoccurred (if it has). I'm upset as I have done everything I have been told and probably been sometimes over cautious.
I get your point about a second opinion but would still feel uncomfortable. If I do go back to the surgeon that did it, I feel he will think I'm "paranoid". I'm thinking of ringing his secretary tomorrow but not even sure what to say to her, especially as I saw him 2 days ago.
You didn't answer if a cystocele would show on an ultrasound?
I get your point about a second opinion but would still feel uncomfortable. If I do go back to the surgeon that did it, I feel he will think I'm "paranoid". I'm thinking of ringing his secretary tomorrow but not even sure what to say to her, especially as I saw him 2 days ago.
You didn't answer if a cystocele would show on an ultrasound?
Brief Answer:
see below
Detailed Answer:
Yes, it can prolapse again that quick.
No, ultrasound is only used to look at the uterus and ovaries - it would have NO place in the diagnosis of a cystocele.
Here is what I think - you have symptoms of recurrence and your current doctor, who did the surgery, thinks it looks fine. But you do not feel fine. This is all the more reason to NOT go back to that clinic and go get a second opinion in a different clinic. I know lots of surgeons who are 'nice guys' with great bedside manner, but terrible surgeons. You owe it to yourself to get a second opinion. This second opinion might very well be that you had a great repair. But you will not know until you get an unbiased opinion.
Dr. Tim
see below
Detailed Answer:
Yes, it can prolapse again that quick.
No, ultrasound is only used to look at the uterus and ovaries - it would have NO place in the diagnosis of a cystocele.
Here is what I think - you have symptoms of recurrence and your current doctor, who did the surgery, thinks it looks fine. But you do not feel fine. This is all the more reason to NOT go back to that clinic and go get a second opinion in a different clinic. I know lots of surgeons who are 'nice guys' with great bedside manner, but terrible surgeons. You owe it to yourself to get a second opinion. This second opinion might very well be that you had a great repair. But you will not know until you get an unbiased opinion.
Dr. Tim
Above answer was peer-reviewed by :
Dr. Prasad
Thanks, food for thought overnight.
I still can't understand why he said it was ok 2 days ago. He did get me to cough etc. Could it have reoccurred in those two days? Did I do too much exercise today? One of the questions I asked was re exercise and he said I could do anything. Is it something I have done/not done?
Yes he is "a nice guy". I just feel I should go back to him and say - I have looked in the mirror and this is not right. I hadn't done this before so I thought it could be my imagination. I told him I could feel "something coming down".
Yes I know you will say - get a second opinion but I feel I want more answers from him.
I still can't understand why he said it was ok 2 days ago. He did get me to cough etc. Could it have reoccurred in those two days? Did I do too much exercise today? One of the questions I asked was re exercise and he said I could do anything. Is it something I have done/not done?
Yes he is "a nice guy". I just feel I should go back to him and say - I have looked in the mirror and this is not right. I hadn't done this before so I thought it could be my imagination. I told him I could feel "something coming down".
Yes I know you will say - get a second opinion but I feel I want more answers from him.
Brief Answer:
That is a reasonable place to start
Detailed Answer:
Yes, go back to your doctor and explain exactly what you are able to see. Consider scheduling the visit later in the day when the symptoms might be a little worse. There is nothing wrong with asking for a better explanation as you are, after all, a paying customer for this procedure. Good luck and let me know if you need further help after the visit.
Dr. Tim
That is a reasonable place to start
Detailed Answer:
Yes, go back to your doctor and explain exactly what you are able to see. Consider scheduling the visit later in the day when the symptoms might be a little worse. There is nothing wrong with asking for a better explanation as you are, after all, a paying customer for this procedure. Good luck and let me know if you need further help after the visit.
Dr. Tim
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Above answer was peer-reviewed by :
Dr. Shanthi.E
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