Transcript hajebrahimi
Neurourology Panele Sakineh Hajebrahimi Associate Professor of Urology TUMS Case#1 • A 45 years old housewife lady G:3 P:3 • Urgency, Failur to emptying, low flow urination , Nacturia and chronic pelvic pain, constepation • BMI<28 • No smoking • No history of neurological diseases • No pelvic floor surgery Case#1 • Vaginal exam: no hypermobility, no atrophy, cystocele grade:I and no recto or uterine prolaps • Recurrent UTI • Voiding Diary no polyuria • Ultrasound: bilateral hydronephrosis with PVR:245 • BUN:32, Cr:1.5 Obstructive Uropathy due to Chronic Bladder Distension Cystoscopic Findings Dysfunctional voiding in a woman • What is the next option? Appearance of Bladder neck after TUIBladder neck Video Urodynamic results before and after TUI-Bladder neck Case#2 65 year old Housewife Disabling symptoms of Urinary Urgency, Urge Incontinence and failed to empting, severe constipation Infections some times Multiple Cystoscopies URODYNAMICS ADVISED CMG Case#3 • 24 years old single woman with periodical acute urinary retention • Normal sono • Normal IVU • Recurrent vaginitis( candidiasis) Case-4 •A 60 years old man with a history of TUR-P, 2 weeks ago •Urinary retention after surgery and urethral cath for a week •Failure to empting, hesitency, low flow, Post-prostatectomy Low Detrusor Contractility Poor bladder compliance and low contractility after prostatectomy Case Study A 39-year old woman with history of MS from 2 years ago, and takes medications. She reports wetting her underwear small amounts and has urg to go. She denies nocturia, but some times feels an incomplete voiding ► How should this patient be evaluated? ► What treatment options should be offered? Case Study #4 A 71-year old male with symptoms of mild cognitive impairment (MMS exam) reports leaking variable amounts of urine on his underwear 4-5 times a day. He also reports nocturia, requiring 3 trips to the bathroom each night to void. His prostate exam shows minimal diffuse enlargement, but no nodules. His urinalysis is normal. The patient is started on an anticholinergic agent for OAB. The patient returns in follow up two weeks later and reports that the number of accidents has decreased but the severity of urinary loss remains the same. He is accompanied by his wife who reports that her husband has increased confusion, and sometimes forgets that he has eaten a meal. He has had recent problems with ambulation. Case Study #4 (cont) ► What is the strategy at this point? ► Refer patient for evaluation of dementia? ► Refer patient for urodynamic study? ► Start anti-cholinergic agent for OAB management? Case#6 A 25 years old man with history of falling and urinary retention EMG DESD type1 DESD type2 EMG B-C reflex DESD type3 • A 32 years old man with history of SCI at level of T10-12 • Paraplegic • Urinary and fecal incontinence • OAB DSD in UDS • Recurrent UTI • Antichlinergics and CIC • Still wet • Still fecal incontinence