1. Neurourology Panele Sakineh Hajebrahimi Associate Professor of Urology TUMS

2. 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

3. 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

4. Obstructive Uropathy due to Chronic Bladder Distension

5. Cystoscopic Findings

6. Dysfunctional voiding in a woman

7. What is the next option?

8. Appearance of Bladder neck after TUI- Bladder neck

9. Video Urodynamic results before and after TUI-Bladder neck

10. 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

11. CMG

12. Case#3 24 years old single woman with periodical acute urinary retention Normal sono Normal IVU Recurrent vaginitis( candidiasis)

14. 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,

15. Post-prostatectomy Low Detrusor Contractility

16. Poor bladder compliance and low contractility after prostatectomy

17. Case Study ► How should this patient be evaluated? ► What treatment options should be offered? 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

18. 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.

19. 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?

20. Case#6 A 25 years old man with history of falling and urinary retention

21. EMG DESD type1 DESD type2

22. EMG DESD type3 B-C reflex

23. 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