Comments for Anatomy, Physiology and Urodynamics Hann-Chorng Kuo Department of Urology Buddhist Tzu Chi General Hospital.

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Presentation transcript:

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?