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 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 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 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 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?