Tips/Tricks Presentations: AUGS Abstracts: 2005 26th Annual Scientific Meeting of The American Urogynecologic Society
To describe the use of plastic wrapping with estrogen cream in the preoperative preparation of women with advanced prolapse and vaginal atrophy and/or ulcerations.
Women with advanced prolapse often have concomitant atrophy, which may be associated with vaginal erosions or ulcerations. Preoperative treatment with local estrogen is usually recommended for patients with atrophic changes, in order to improve the quality of the tissues, which may also improve prolapse surgery success rates. Traditional use of local hormone therapy, such as vaginal tablets or creams are often unsuccessful, due to the inability to retain the vaginal tablet, or from vaginal cream rubbing off on protective pads or undergarments. Vaginal pessaries may be used in this situation, though some women with advanced prolapse can not retain a pessary, and for others, the pessary itself may promote vaginal erosions, especially in the severely atrophic patient. In order to overcome these problems, we describe the innovative use of polyethylene plastic film (eg Saran Wrap), which creates a temporary barrier so that the vaginal epithelium may be kept moist with estrogen cream, permitting local absorption of the estrogen. Specific recommendations were made based on the patient's individual situation, although, in general, we asked patients to place liberal amounts of estrogen cream over the anterior and posterior portions of the prolapse and place a large enough piece of plastic film to cover the exteriorized vaginal tissues. Patients were asked to perform this task several days a week and to keep the plastic wrap and estrogen cream on for 4 to 8 hours at a time.
We have used this technique on patients with advanced uterine or vaginal vault prolapse who were either unable to retain a vaginal pessary due to poor perineal support, or who were found to have vaginal erosions caused by the use of a vaginal pessary. We have seen clinical improvement in all patients with regard to vaginal atrophy, and resolution of vaginal erosions in patients who presented with this finding.
The use of commercially-available flexible plastic film along with estrogen cream appears to provide an effective means by which vaginal atrophic changes may be treated preoperatively in cases of severe prolapse.