Download 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