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

2. Differences in Male and Female Lower Urinary Tract Anatomy

3. Pelvic Floor Muscles in Women

4. 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

5. 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

6. 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

7. 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?