Transcript TRIPLE_I_UROLOGY_LECTURE_PART1

THE 3 I’s of UROLOGY
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Presented by Dr. Mark P. Posner
Louisiana Occupational Health Conference
August 4, 2012
Baton Rouge, La.
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INCONTINENCE
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What is
urinary incontinence?
“The objective demonstration
of involuntary loss of urine
consequent to bladder and/or
sphincter dysfunction.”
Types of incontinence
• Stress Incontinence
– Leakage during physical activity that
increases intraabdominal pressure,
i.e. lifting, exercising, sneezing, and
coughing
• Urge Incontinence
– Leakage associated with an
overwhelming need to urinate Gotta
go, gotta go!
• Mixed Incontinence
What to expect at
an office visit
• History
– Pregnancy, Delivery
– Spinal or neurologic disease
– History of DM
• Physical Exam
– Neurologic exam
• Urinalysis
• Postvoid Residual
• Urodynamics, Cystoscopy
Treatment options
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Behavioral modification
Biofeedback
Medications
Injectables
Surgery
Behavioral
modification
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Decrease fluid intake
Void frequently
Avoid caffeine, alcohol
Avoid activity that increases
intraabdominal pressure
Pelvic floor rehabilitation
• a.k.a. biofeedback
• Means of teaching Kegel
exercises
• Objective way to
measuring pelvic floor
strength
• ? how much better than
verbal instruction
MEDICATIONS for
OAB(URGE
INCONTINENCE)
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Ditropan
Detrol
Toviaz
Vesicare
Enablex
Sanctura
Gelnique
Oxytrol
BoTox
Treatment Options for
SUI
• Nonsurgical treatments
• Pelvic floor muscle training
• Bladder training
• Prompted voiding
Surgical treatments
• Open retropubic
colposuspension (Burch
colposuspension)
• Suburethral sling procedure
SLING PROCEDURE
• Indicated for use in patients with SUI
due to urethral hypermobility and/or
intrinsic sphincter deficiency (ISD)19
• Synthetic mesh is placed under bladder
neck (proximal urethra) or mid-urethra
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IMPOTENCE or ERECTILE
DYSFUNCTION?
The inability to maintain
an erection firm enough
to have sexual
intercourse
How Common Is It?
• 1 in 10 men
• Over 30 million
American men
• 90% physical, 10%
psychological
Physical Causes of ED
• Diabetes
• Heart Disease
• Surgery (Prostate, Bladder,
Colon, Rectal)
• Medications
• Spinal injury
• Hormone imbalance
Treatment Options
• Oral Medications
(Viagra®, Levitra®,
Cialis®)
• Vacuum Erection
Devices
• Injection Therapy
• Urethral Suppositories
• Penile Implants
Oral Medications
Penile Implants
Ideal for men who have tried other
treatments without success
• On the market for over 30 years
• 25,000 penile implants per year
• Over 300,000 implants to date
• High patient and partner
satisfaction
The Satisfying Solution for You and Your Partner
Three – Piece Inflatable
Penile Implant
Advantages
Same advantages
as two – piece plus:
Acts and feels more like a
natural erection
Expands the girth of the
penis
More firm and full than
other implants
Feels softer and more
flaccid
The Satisfying Solution for You and Your Partner
Three – Piece Inflatable
Penile Implant
Disadvantages
Requires some manual
dexterity
Possibility of leakage
or malfunction
Possibility of
unintentional erections