Presentation on theme: "Neurourology Panele Sakineh Hajebrahimi Associate Professor of Urology TUMS."— Presentation transcript:
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
Poor bladder compliance and low contractility after prostatectomy
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
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