teaching hospital surgery

[Sahararose]

Can you please tell me what the differences would be getting surgery at a university teaching hospital urogynocolgist and a team vs a private practice urogynocolgist?

[robinwRN]

Well just double check with the staff physician.  Ask her if she will do the entire surgery or if she has help, how much?  Also the cath is terrible, I bleed so don't feel bad.  Hopefully you will not need the sling.  I am doing great without it.  I wish money did not play a part in our health care but it does.  So sad.  It sounds like you have asked great questions.  

I really found Sherrie Palm's book The Silent Epidemic to be very valuable.  It gave me questions to ask and prepared me for after surgery.  I wish you the best

Robin

[Sahararose]

The hospital is two hours from where I live. I went for the urodynamic screening and the catheter insertion was so painful I had to decline the procedure which was embarrassing. I have had a catheter before, I have had major low back artificial disc surgery so I am no stranger to this, but for some reason I could not relax and it hurt too much. So I was warned about the chances of the need for a sling later, which is supposed to be an outpatient procedure. I have also read studies where this type of testing has not necessarily proven correct in the end any way and many question whether it is necessary.

[Sahararose]

I live in Oregon. The staff doc did the initial consult and exam and I really liked her and she assured me she was the one doing the operating. But, who knows once you are under anesthesia. This is probably an area I could research more, and you have personal experience so I take your word for it. Unfortunately its this or nothing since I am under a financial aid with the hospital and otherwise would have no way to pay for this anywhere else. I wonder what the bowel blockage you have is all about. If you find out more, please share, and I appreciate your honesty and any other advice you can give.

[robinwRN]

I can get up and out of bed without any difficulty.  Urination is no problem I did not have a sling placement as my MD did extensive testing prior to surgery and decided once the cycocele was repaired I would not need the sling and she was correct.  I developed a post op bowel blockage and have had constipation problems post surgery but other than that my pain is very minimal.  I walk 4 to 6 miles ever other day on my tread mill and do light house work.  I am still off work.  I am having a upper and lower GI scope because of my bowel issues.  My MD is wonderful.  What state do you live in?  Having worked in a teaching hospital, I know that you will be told the staff will do your surgery but having worked in the operating room it just does not always work that way.  If the staff doc is not seeing you in the office that he/she does not have the personal knowledge to do the complex procedure you need done.  You should find a private physician.  

[Sahararose]

Thanks for your reply which is interesting. I was under the impression that the teaching surgeon is the one doing the surgery, and the others are just observing. She has done 100s of these. When I asked if she would be the one performing the surgery, I was assured that this was so. Maybe I will ask again or a few more times to several people. I do agree that the personal attention is lacking, and the trainees are the ones usually at the appointments including the pre-op I went to, which I found very impersonal (not getting to talk to my surgeon). So far I have decided to wait until at least April. I was wondering if I request that the surgeon be present at the next pre-op if they would be willing/able to facilitate it. I wish there was  way to research the success rate of the surgeon. She claimed more than 90 percent were very happy, but said there are no data as to five to ten years out. What is your body like now that you are a couple months out from surgery? Is there still pain? Does it hurt to get up out of bed or to use the bathroom? Are the bulges gone and everything working normally?

[robinwRN]

The difference is massive.  I am a registered nurse, I worked for over 10 years in a teaching hospital.  Residents and fellows do need to learn but surgery for pelvic organ prolapse is very complicated with a very high risk of complications if not done correctly.  Instead of a doctor who has done hundreds of surgeries you would have someone learning do your surgery.  Yes a faculty physician is involved but usually the staff/faculty are teaching several residents/fellows at the same time and have way too many patients to be closely involved in all patients cases.  A private physician is able to be the ultimate provider.  

I had a grade 4 uterine, grade 3 rectocele, grade 3 cystocele and an entrocele repair in November 2012.  I too had an option of teaching university or private urogyn.  After much research I choose private physician.  I live in Indiana.  Hope this helps