Transcript Comments for Anatomy, Physiology and Urodynamics

Comments for Anatomy,
Physiology and Urodynamics
Hann-Chorng Kuo
Department of Urology
Buddhist Tzu Chi General Hospital
Differences in Male and Female
Lower Urinary Tract Anatomy
Pelvic Floor Muscles in Women
Similarities in LUTD
in Men & Women
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Detrusor overactivity (idiopathic,
obstructive, neurogenic)
Bladder neck dysfunction
Spastic urethral sphincter (Dysfunctional
voiding)
Poor relaxation of pelvic floor muscles
Urethral stricture & meatal stenosis
Treatment of Detrusor overactivity
refractory to anticholinergics
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Botulinum toxin A: reduces detrusor
contractility, lessens urgency incontinence,
impairs voiding efficiency
Intravesical resiniferatoxin: high dose (10
µM) inhibits detrusor overactivity &
reduces detrusor contractility; low dose (10
nM) inhibit overactivity without impairs
contractility
Interpretation of Urodynamics
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BOO is a graded condition, surgery is
indicated only when BOO resulting in
voiding dysfunction and severe LUTS
SUI contains detrusor overactivity occurred
on stress and genuine stress incontinence
Intrinsic sphincter insufficiency &
hypermobility may coexist in GSI, surgical
correction should base on pathophysiology
Consideration in Treatment of
Voiding Dysfunction
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Combination of pathophysiology?
Accurate diagnosis is the basis of treatment
Choice of investigation: as simple as
possible? or videourodynamics?
Surgery? or medical treatment? or
physiotherapy?
Adverse effect vs. therapeutic effect?