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Transcripts: 528-4 and 528-5

Week: 528.4 Guest: Dr. Lamar Robinson, M.D., Women's Center, Houston, Texas Topic: Hysterectomy - Part One Host: Steve Girard Producer: Ed Graham

NEMA: Hysterectomy, the removal of the uterus and cervix, is typically a major abdominal or vaginal procedure. Dr. Lamar Robinson, of the Women's Center of Houston, Texas is with us to talk about when it can, and when it must be done....

ROBINSON: It's done in many many cases when you have a patient that has excessive, irregular or unacceptable amounts of menstrual flow that don't respond to more conservative procedures...bleeding patterns that are completely unacceptable and not managed by hormonal manipulation, previous dilatation curatage and hysteroscopic evaluation and treatments. Also, if a patient has severe pelvic pain that doesn't respond to usual and customary medication...and also, unfortunately, if there's a pre-cancerous condition involving the cervix, the endometrium, or the actual uterine musculature, that's a much less common indication, though.

NEMA: Is there an age range during which women face a hysterectomy....

ROBINSON: Most ladies tend to be in their late thirties to early forties...that seems to be the time that most ladies have problems. Generally, after 50 , they're menopausal, and its moot at that point.

NEMA: Tell me how you and the patient may deal with uterine fibroids...

ROBINSON: Well, the large majority of people with fibroids have no symptoms whatsoever. But, those that have symptoms often will have excessive bleeding and severe pelvic pain. Now, there's a medication that can be used known as lupron...an injection, what's known as a gnrh agonis. What this does is tell the pituitary to tell the ovary to not produce estrogen. And it will cause the fibroid to shrink...in many cases it will diminish bleeding and diminish pain, but it's only a temporary process. Once the medication is discontinued, unfortunately, the fibroid may get larger. Now, in a woman who wants to preserve her ability to have children in the future, a conservative procedure known as myomectomy can be done, and that means simply removing the fibroids only, and leaving the uterus intact. Now, myomectomies can be done abdominally, with a large incision, occasionally they can be done laperoscopically, with minimally invasive surgery, using a telescope through the navel and other small entry sites along the abdomen. This is a very common procedure now. And they can be removed hysteriscopically, and that's using a small telescope placed through the cervix looking inside of the uterus, seeing the inner workings, the endometrial cavity and lining. All of these things can be done, they are conservative procedures. Now, unfortunately, if the fibroids are very large, if they don't respond to suppressive medication and if the symptoms are severe...removal of the entire uterus and cervix with the fibroids is often the only thing that can be done.

NEMA: Dr. Lamar Robinson says there are ways women can deal with uterine problems that don't always end in hysterectomy...and the way to find them is to ask the opinion of doctors who offer and practice a variety of procedures. I'm SG.


Week: 528.5 Guest: Lamar Robinson, M.D. Topic: Alternatives to Hysterectomy - Part Two Host: Steve Girard Producer: Ed Graham

NEMA: When should a woman have a hysterectomy? When should she try other options to halt excessive, irregular bleeding and pain associated with endometriosis, or the presence of uterine fibroids? Here now is Dr. Lamar Robinson of the Women's Center of Houston, Texas...

ROBINSON: Well, the large majority of patients are concerned about quality of life issues...is their bleeding pattern disrupting their general activity? Its basically quality of life issues...unless we're looking at a pre-cancerous or cancerous condition. The large majority of people want this surgery at a point where they're just tired of feeling badly and tired of dealing with it.

NEMA: Let's talk about alternatives....

ROBINSON: When you have a patient who has excessive, irregular or unacceptable menstrual flow, and its due to some process involving the endometrium, if you think of the endometrium as a lawn, you can have very, very thick areas like crabgrass, you can have polyps, which can be like weeds...and sometimes these can be removed hysteriscopically, using a telescope, going through the cervix, carefully reflecting, or shaving away all of these irregularities, and then, going back with a roller bar instrument, and carefully, electrically sealing and coagulating that entire surface. Now, this procedure is known as an endometrial ablation. Now, patients unfortunately, with pain may not get a significant improvement with an endometrial ablation. Often, a laperoscopic procedure, a telescopic entry through the navel, looking down at the uterus and tubes can be done, and in many cases, using a laser, we can destroy implants of endometriosis which might be causing pain...we can divide scar tissue, we can also transect, or cut across what's known as the uterus-sacral nerves....and these are nerves that travel behind the cervix on the uterus...80% of the people who have this done report a significant decrease in pain. Now, unfortunately if those types of things don't work, then hysterectomy is often the only option.

NEMA: What about uterine prolapse.....

ROBINSON: This often happens after several vaginal deliveries. If a woman's family is complete, and she does not mind, certainly a vaginal hysterectomy is the most common procedure when you have prolapse. If you have a patient that wishes to conserve her fertility, then a uterine resuspension can be done...where you literally pull the uterus back up, and reattach it to the abdominal wall, and that's a pretty common procedure.

NEMA: Can medication sometimes help in reducing problems with endometriosis?

ROBINSON: The large majority are grnh agonists, drugs that tell the pituitary to tell the ovary to decrease the estrogen in the system and that will suppers the endometrial implants. All of these are very, very successful with minimal to moderate amounts of endometriosis. With really severe endometriosis, involving the entire pelvis, often this doesn't work well.

NEMA: How can a woman check out all her options?

ROBINSON: I'd highly recommend that you shop around...many practitioners will only offer you those therapies that they can provide, and there very well may be a good alternative for you that won't be offered if that physician doesn't perform that procedure...or just isn't motivated to try it.

NEMA: Dr. Lamar Robinson....I'm SG.

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